The State Administrative Council (SAC) headed by Jammu and Kashmir Governor Satya Pal Malik on Monday approved a health insurance scheme for the government employees and pensioners based on ‘Trust Model’.
The SAC, which met here under the chairmanship of the governor, decided that ‘Trust Model’ may be implemented for the employees health insurance across the state for its added advantages, an official spokesman said.
Under this model, he said, a trust will be set up by the state government which may design appropriate insurance product and offer it to designated beneficiaries — state government employees and pensioners.
On October 27 last year, the governor had ordered foreclosure of the contract with Reliance General Insurance for implementing the group mediclaim health insurance for state employees and asked the Anti-Corruption Bureau (ACB) to probe the matter after it sparked a row.
After the scrapping of the previous Medical Claim Policy, the state government constituted a committee of officers headed by principal secretary, Health and Medical Education, to examine the possibility of operating the health insurance scheme through third party administrator (TPA) by dispensing with the insurer and intermediary.
In an interview to a New Delhi-based TV channel, Malik said, “It will take couple of days (for the official cancellation order).”
“I studied it myself. The issue is that the government had not issued any tenders. A private company had asked for tenders on behalf of another company. Those bids were not displayed anywhere on our (government’s) website. The tenders were changed to suit a particular company,” Malik said in the interview.
“It was full of frauds. I discussed the issue with the chief secretary and made it clear that such things can’t happen in my presence. So we decided to cancel it”.
The committee, which was mandated to determine the contours of such scheme and a selection procedure after discussing and analysing health insurance models of various states, submitted its report along with three models, the spokesman said.
“The SAC considered the options or models suggested by the ‘committee of officers’ vis-a-vis advantages-disadvantages of each model. After considering feasibility of various models and their merits, the SAC approved the trust model,” he said.
The spokesman said the administration of the scheme, including collection of premia, enrollment of the insured, settlement of claims, will be with the said trust.
“This measure would address the issue on long-term basis and do away with issues of renewal and other issues which crop up every now and then,” he said, adding that this would also ensure close monitoring.
The spokesman said the SAC directed the Health and Medical Education Department to take necessary measures in this regard.