AB-PMJAY SEHAT Scheme: Dispelling falsehoods through transparency, verified data

Srinagar: Reacting to recent social media dissemination of misleading information aiming to tarnish the reputation of AB-PMJAY SEHAT scheme in Jammu and Kashmir, State Health Agency (SHA) on Saturday said the claims were found baseless after thorough examination of irrefutable facts and figures
Contrary to misinformation alleging favoritism and a multi-crore scam, the agency said the contractual agreement with Bajaj Allianz incurred a substantial loss of Rs. 93.82 crore to the Insurance Company. The contract adhered to the stipulations in the Tender Document issued by the National Health Authority, outlining a maximum three-year term with the option of annual renewal upon mutual agreement.
Bajaj Allianz General Insurance Company formally communicated their decision not to renew the contract through an exit notice issued in September 2021. Despite extensive deliberations between the State Health Agency of J&K and the insurance company, no positive response was elicited.
The 4th Governing Council meeting of SHA J&K decided to instigate a fresh tendering process, utilizing the Model tender document from the National Health Authority. The transparent process involved the participation of five insurance companies, namely IFFCO TOKIO General Insurance Co. Ltd, Reliance General Insurance Company Ltd, Bajaj Allianz General Insurance Company Pvt. Ltd, United India Insurance Company, and National Insurance Company, during the pre-bid meeting.
In strict adherence to the guidelines of the General Financial Rules (GFR) 2017, the procurement process guaranteed transparency, competition, fairness, and the eradication of arbitrariness. The qualification criteria mirrored those specified by the National Health Authority, ensuring a just selection process.
The bidding document, explicit and comprehensive, was accessible on www.jktenders.gov.in, with all modifications and clarifications duly conveyed to bidders. A generous period of 22 days was allocated for bid preparation and submission.
Following the pre-bid meeting and the public unveiling of technical bids, meticulous scrutiny by the Central Tender Committee affirmed that three out of four bidders, including IFFCO Tokio General Insurance Company, Bajaj Allianz General Insurance Company, and National Insurance Company, met the specified requirements, qualifying for the subsequent stage.
Opening financial bids revealed IFFCO Tokio General Insurance Company Ltd. as the lowest (L1) bidder with a quoted rate of Rs 1840/- per family.
With the imminent expiration of the policy with Bajaj Allianz GIC on December 25, 2021, SHA J&K sought an interim arrangement to prevent service disruption. Bajaj Allianz GIC responded by offering to continue implementing the scheme at a quoted price of Rs 3,261.60 per beneficiary family unit on a Pro-Rata basis for the requested coverage period.
To prevent service interruption, SHA J&K entered into an agreement with Bajaj Allianz GIC to continue services on a Stop Loss basis until the selection of a new Insurance Company is finalized. The Insurance Company would not share the risk of loss of claims, and the entire claims outgo would be borne by the Government of J&K and the National Health Authority.
The financial details underscore that the Interim Arrangement, with 15% administrative charges, was the most cost-effective option, serving public interest during the transition period. Contrary to the misinformation circulating on social media, there were no changes or additions to the number of beneficiary families, which remained consistent throughout both the primary policy and the interim period.
Despite the necessity for retendering due to high premium rates quoted by the lowest bidder (L1), the interim arrangement with the existing insurance company continued seamlessly, benefiting over 69,000 individuals. This underscores the scheme’s commitment to public interest. Contrary to misinformation, the interim arrangement was thoroughly vetted by the Law department, Finance Department, and Learned Advocate General, contradicting claims that the government ignored advice from its own departments.