Jammu & Kashmir: Chief Secretary Atal Dulloo Reviews PMJAY-SEHAT Progress, Rs 666 Crore Pre-Authorizations Approved

JAMMU, March 1: Chief Secretary Atal Dulloo on Saturday chaired the 11th Governing Council Meeting of the State Health Agency (SHA) to review the progress and performance under the PMJAY-SEHAT scheme during the current policy period, which commenced on April 17, 2025.The meeting was attended by Commissioner Secretary, Health and Medical Education; Secretary IT; Secretary RDD; Secretary L&E; DG Codes; CEO, State Health Agency; Principal, GMC Jammu and other senior officials.During the meeting, the Chief Secretary stressed the need to put in place a robust mechanism to detect and eliminate fake or fraudulent claims. He emphasized that safeguarding the integrity of the scheme is essential to ensure that benefits reach genuine beneficiaries. He also underscored the importance of instituting an effective third-party monitoring system to enhance oversight, transparency and accountability in the processing and disbursement of claims.CEO, SHA, Ananth Dwivedi informed the Council that the scheme has recorded substantial utilization across both public and private healthcare institutions, improving access to cashless treatment for beneficiaries across Jammu and Kashmir.As per official data presented during the meeting, from April 17, 2025 to February 25, 2026, a total of 3,52,563 pre-authorizations were approved under the current policy term. Of these, 2,43,967 approvals were granted to public hospitals and 1,08,596 to private hospitals.The total value of pre-authorizations approved during this period stands at Rs 666.34 crore, including Rs 444.75 crore for public institutions and Rs 221.59 crore for private hospitals.The Council was informed that 3,23,468 claims have been submitted so far — 2,21,642 from public hospitals and 1,01,826 from private hospitals — amounting to Rs 604.46 crore. Public sector claims account for Rs 395.36 crore, while private sector claims amount to Rs 209.10 crore.In terms of settlement, 1,16,667 claims have been paid to date, including 85,570 in the public sector and 31,097 in the private sector. The total disbursement stands at Rs 183.09 crore, of which Rs 123.86 crore has been released to public hospitals and Rs 59.23 crore to private healthcare providers.The meeting was further informed that 28,631 claims were rejected after due scrutiny, involving a total amount of Rs 55.58 crore. Of these, 27,110 claims pertained to public institutions and 1,521 to private hospitals.Officials highlighted that the pre-authorization amount of Rs 666.34 crore was achieved over 315 days. On a pro-rata basis, the projected outgo for the full 365-day policy period is estimated at approximately Rs 772 crore.The Governing Council emphasized timely claim processing, strengthened monitoring mechanisms and enhanced coordination between public and private healthcare institutions to ensure seamless delivery of benefits to eligible beneficiaries. The performance during the current policy period reflects the State Health Agency’s continued efforts to provide financial risk protection and expand quality healthcare access across Jammu and Kashmir.