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Govt to screen common beneficiaries under ESIC, PMJAY to reduce costs

Tabassum Barnagarwala
The PMJAY covers social and economic caste census (SECC) population and provides medical insurance cover of Rs 5 lakh for over 1,000 medical procedures. (File photo)

Realising that it is paying insurance premium for a single beneficiary multiple times, the Maharashtra government is in the process of identifying all government-funded health insurance schemes and corresponding beneficiaries that are getting replicated.

State officials said at least 40 lakh beneficiaries, whose monthly income is up to Rs 21,000 fall under Employee State Insurance Corporation (ESIC) in Maharashtra. Employees pay a part of their salary along with employers for medical, cash, disability benefits under ESIC. This year, the labour ministry reduced the contribution for employers to 3.25 per cent and for employees to 0.75 per cent of salary.

The National Health Authority wrote to Maharashtra and Bihar government last week to hold pilot project of identifying the number of ESIC employees who are also beneficiaries of Ayushman Bharat’s Pradhan Mantri Jan Arogya Yojana (PMJAY). The PMJAY covers social and economic caste census (SECC) population and provides medical insurance cover of Rs 5 lakh for over 1,000 medical procedures.

“If a beneficiary of ESIC is also under PMJAY, then government is paying insurance premium for same patient twice. By screening we will identify the duplication and stop paying premium for that patient under PMJAY,” said Dr Sudhakar Shinde, CEO of state insurance scheme in Maharashtra.

The government has recently rolled out tender for insurance companies for the PMJAY scheme in Maharashtra. An estimate of Rs 1,000 will be paid as insurance premium for each beneficiary family. Government officials estimate even if over 50 per cent ESIC beneficiaries replicate under PMJAY, removing payment of their premium under the latter can save up to Rs 200 crore in government’s kitty.

Maharashtra will do a pilot screening of ESIC and PMJAY beneficiaries in Ahmednagar before expanding the scope to entire state.

The ESIC patients will be permitted to get treatment under PMJAY empanelled hospitals. Maharashtra currently has 492 empanelled hospitals.