They will work together to standardise hospital rates and also reduce fraud
Insurance Regulatory and Development Authority of India (IRDAI) and National Health Agency (NHA) will set up a joint working group for better implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
The working group will do a comparative study of packages and define standards for quality healthcare. It will also look into the management of the network hospitals, defining hospital infrastructure and facility audits to understand the capacity of hospitals and specialists availability.
The 11-member group will have representatives from both IRDAI and NHA. Dinesh Arora, Deputy CEO of NHA will chair the working group.
AB-PMJAY is a scheme for availing secondary and tertiary care, cashless treatment at empanelled private and public hospitals across the country to families listed in SECC (Socio-Economic Caste Census) 2011. Eligible families get Rs 5 lakh per year.
The working group will also develop a roadmap to get one common list of verified hospitals for the entire industry. It will get 12 months for this purpose.
Over and above this, the group will also be involved in fraud and abuse control and help in detecting malpractices.
NHA is the apex agency that looks after the implementation of PMJAY. Several insurance companies and third-party administrators regulated by IRDAI are involved in the implementation of the scheme.
