State health scheme profits not enough for insurance firm

The state government’s six-month-old health insurance scheme for low-income families has now paid for more than 20,000 surgeries.

But while the number of people availing the Rajiv Gandhi Jeevandayi Yojana (RGJY) has increased, sources in the health department said the insurance company associated with the scheme is upset about meagre profits.

The state government has paid Rs93 crore out of the year’s premium of Rs184 crore to the National Insurance Company, but the cost of the 20,145 surgeries performed since July is approximately Rs59.02 crore. Till date, the company has reimbursed around Rs34.36 crore to the hospitals enrolled in the scheme.

Expecting a rise in the number of surgeries being performed under the scheme, government officials over the last few weeks have held various meetings with the insurance company on the issue. “The company has entered into an agreement with the government for a year, after which it can back out. If they do, we will have to call for fresh bids,” said an official from the state health department.

However, with the scheme doing well in eight state districts, the state government plans to expand it across Maharashtra. “As far as profits for the insurance company are concerned, the aim of the scheme is to benefit a large number of people, which it is doing” said K Venkatesan, chief operating officer, RGJY, adding that the project is a prestigious one for the insurance company.

At present, the scheme covers 49 lakh families. The government pays a premium of Rs374 per family to the insurance company and together, they provide cashless mediclaims for families with an income of less than Rs1 lakh per annum. The scheme covers 972 medical procedures including life-saving ones such as bypass surgery, angioplasty, kidney transplant and emergency procedures, along with medicines and other consumables.


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