Amid Ayushman Yojana row, High Court orders continuation of scheme

Srinagar, August 29

The Jammu and Kashmir High Court has intervened after all private hospitals in the union territory decided to refuse patients under the national health insurance programme, Ayushman Bharat Yojana, from September 1.

Private hospitals claimed that multiple crores of outstanding amount under this programme had not been paid by the insurance company to them resulting in huge financial implications for these hospitals.

The high court has now directed the insurance company to continue with the existing arrangement as per the terms and conditions of the contract agreement regarding Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana-SEHAT (AB-PMJAY-SEHAT) pending resolution of dispute with the UT government by the arbitrator.

The direction has been passed in a petition filed by the J&K government wherein it was submitted that the government launched the scheme to provide free of cost universal health coverage to its residents.

The scheme was introduced with the objective of reducing catastrophic health expenditure and improving access to quality health care of the domiciles of J&K.

The eligible beneficiary families under this scheme are to be provided with health coverage through a network of Empanelled Health Care Providers (EHCPs). As a result, the bidding process was commenced by the government, through State Health Agency (SHA) by issuing the tender document and the respondent company emerged as the successful bidder.

Consequently, a contract for a maximum period of three years came to be executed between the parties on March 10, 2022. The contract is to subsist till March 14, 2025, but the company served a notice that it was not interested in further renewal of the contract after the expiry of the policy period ending March 14, 2024.

After hearing counsels for the UT, Justice Rajesh Sekhri observed, “Functions of all insurance companies, public and private, are regulated under the Insurance Act and the regulations framed thereunder. Therefore, an insurance contract is subservient to the statutory provisions of the Insurance Act and must be interpreted and construed having regard to larger public policy and public interest, particularly, when it intends to provide service of health care to the citizens.”

While allowing the petition, the High Court temporarily directed the respondent company to continue with the existing arrangement as per the terms and conditions of the contract agreement pending the resolution of the dispute by the arbitrator.