The State Administrative Council (SAC), which met here under the chairmanship of Governor Satya Pal Malik on Friday, approved a health insurance scheme based on ‘Trust model’ for government employees and pensioners of J&K.
After the scrapping of previous medical claim policy, the state administration on December 19 last year 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 by dispensing with the insurer and intermediary.
The committee was mandated to determine the contours of such scheme and a selection procedure. The committee after discussing and analysing health insurance models of various states submitted its report along with three models.
The SAC considered the options suggested by the committee of officers’ vis-à-vis advantages-disadvantages of each model.
After considering the feasibility of various models and their merits, the SAC decided that a ‘Trust model’ may be implemented for the employees’ health insurance across the state for its added advantages.
Under this model, a Trust will be set up by the state government. The Trust may design appropriate insurance product and offer it to designated beneficiaries — state government employees and pensioners.
The administration of the scheme, including collection of premium, enrolment of the insured and settlement of claims, will be with the said Trust. This measure will address the issue on a long-term basis and do away with renewal and other matters, which crop up every now and then. This will also ensure close monitoring.
The SAC directed the health and medical education department to take necessary measures in this regard.
In October last year, the Governor had cancelled the contract of the health scheme, saying it was ‘full of fraud’ and its implementation was erroneous. He had even said the tenders (for the scheme) were opened ‘secretly on a holiday to suit a particular company.’
Based on ‘Trust model’
- Under this model, a Trust will be set up by the state
- The Trust may design appropriate insurance product and offer it to designated beneficiaries — state government employees and pensioners
- The administration of the scheme, including collection of premium, enrolment of the insured and settlement of claims, will be with the said Trust
- It will address the issue on a long-term basis and do away with renewal and other matters
