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La Gazette de L' État de Poudouchéry

The Gazette of Puducherry

PART - II

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EXTRAORDINAIRE

EXTRAORDINARY

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Publiée par

Published by

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Authority

Registered with the Registrar

of Newspapers for India under

No. 10410

Registered No.

PY/44/2021-23

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No.

2 Poudouchéry

Mercredi

13

Janvier

2021

No.

Puducherry

Wednesday

13th

January

2021

(23 Pausa 1942)

GOVERNMENT OF PUDUCHERRY

CHIEF SECRETARIAT (HEALTH)

(G.O. Ms. No. 03, Puducherry, dated 13th January 2021)

NOTIFICATION

The Lieutenant-Governor is pleased to notify “AB-PMJAY-

Convergence Scheme” for providing Health Care benefits to eligible

AB-PMJAY Scheme Beneficiaries and non-AB-PMJAY Beneficiaries

among all BPL (AAY & PHH) Ration Card Holders in the Union territory

of Puducherry.

12

LA GAZETTE DE L'ETAT

[PART–II

GUIDELINES

(1) The Scheme of providing medical assistance to poor, run by the

Pondicherry Medical Relief Society (PMRS) stands merged with the Central

Government run Scheme of AB-PMJAY from the date of issue of this

Notification.

(2) The AB-PMJAY-Convergence Scheme shall be implemented by

the State Health Agency on the same lines as AB-PMJAY Scheme in Trust

Mode for the present. All the Staff under PMRS shall be brought under

the control of State Health Agency on the existing terms and conditions

under the AB-PMJAY-Convergence Scheme.

(3) All eligible AB-PMJAY Scheme Beneficiaries and non-AB-PMJAY

Beneficiaries among all BPL (AAY & PHH) Ration Card Holders in the

Union territory of Puducherry are covered under the Scheme. The

Premium/Claim Payment for the AB-PMJAY Scheme Beneficiaries shall be

borne by National Health Authority and Union Territory Government in

the ratio 60:40. The Beneficiaries who are not covered under AB-PMJAY

Scheme shall be funded by the Union Territory Government (Non-SECC

BPL Families)

(4) The benefit coverage of this converged Scheme will be

` 5,00,000 per family per year covering all eligible AB-PMJAY Scheme

Beneficiaries and non-AB-PMJAY Beneficiaries among all BPL (AAY &

PHH) Ration Card Holders in the Union territory of Puducherry.

(5) No restriction on family size, ensuring all members of designated

families get coverage.

(6) The Scheme is on entitlement basis, providing cashless,

portability and paperless access to services for the Beneficiary at the point

of service in any (both public and private) empanelled hospitals of

AB-PMJAY.

(7) A well-defined Complaint and Public Grievance Redressal

Mechanism actively utilizing electronic, mobile platform, internet as well

as social media, will be put in place by the State Health Agency through

which complaints/grievances will be registered, acknowledged, escalated

for relevant action, resolved and monitored.

(8) Pre-Authorization is mandatory for all secondary and tertiary

care packages.

(9) The Scheme coverage shall be as per HBP 2.0.

13

PART–II]

LA GAZETTE DE L'ETAT

(10) Coverage will be made available throughout India through

Third Party Administrator (TPA)/Implementing Support Agency (ISA)/

lnsurance Company.

(11) The Guidelines issued by the Ministry of Health and Family

Welfare and National Health Authority shall be applicable to this Scheme

from time to time,

(12) Maintenance of Account:-

(i) The existing Escrow Account for Grant-in-Aid and Admin

Account of State Health Agency for AB-PMJAY only shall be utilized for

the Operation of the “AB-PMJAY-Convergence Scheme”.

(ii) Funds shall be disbursed to the health care provider/treating

hospital by DBT after it is duly sanctioned and authorized both by

Director of Health and Family Welfare Services, Puducherry and Senior

Accounts Officer/Junior Accounts Officer, Directorate of Health and

Family Welfare Services.

(iii) No cash payment to the individuals shall be made as per the

CVC Guidelines.

(iv) Cash Book shall be maintained as per the Double Entry

System and simultaneously entered electronically also and be closed daily

and monthly for auditing. A monthly account showing the allotment and

expenditure incurred shall be prepared, and submitted to the Director for

scrutiny. Annual accounts shall be drawn and audited by a Chartered

Accountant and furnish an Utilization Certificate to the Government.

(13) Annual Budget should be prepared by State Health Agency to

seek required funds for payment of remuneration to the employees and

for making payment to the empanelled hospitals.

(By order of the Lieutenant-Governor)

A. PUNITHAMARY,

Under Secretary to Government (Health).

online publication at “https://styandptg.py.gov.in”

Published by The Director, Government Press

Printed at: Government Central Press, Puducherry.

Posted at: Puducherry HPO on every Tuesday