FAQ RELATED TO AB PMJAY- KASP
1. Can I get a new Insurance card now?
Only RSBY/CHIS enrolled families with a valid card during 2018-19. Also, those who have received letter from Hon’ble PM based on Socio Economic Caste Census Data of 2011.
2. Can I add a new member from my Family in thatcard?
Yes, unlike in RSBY/CHIS, each family member needs to get registered under the new scheme and get a AB PMJAY-KASP id card to get the treatment. So, the member already enrolled along with the additional family member needs to visit any of the empaneled hospitals and get the AB PMJAY-KASP card. Documents like AADHAR card and Ration must be provided to get the id card.
3. How can I claim the Family assurance cover?
Rs. 5 lakh cover is for the entire family. Any family member of the enrolled family can present the card at the Hospital AB PMJAY-KASP counter and avail the cashless treatment benefits as per approved packages under the scheme
4. Is there any age limit in getting this scheme benefits?
No age limit nor restrictions like pre-existing medical conditions
5. Calls from Hospitals to approve the data in BIS
First level approvers are the DISHA call center staff assigned for AB PMJAY-KASP who will clear the approvals assigned in their logins in BIS.
6. How much amount can be claimed using the AB PMJAY-KASP card?
Refer Q. 3
7. Where can they go for adding a new member in the existing card?
Empanelled Hospitals under the scheme
8. Do I need to renew my existing card now?
No need to renew a valid AB PMJAY- KASP id card.
9. Can Karunya Benevolent beneficiaries can join in this Scheme?
As of now no new registrations other than the families mentioned in Q. 1.
10. Empanelled private hospitals are not providing treatment because of payment issues?
Issue has resolved. Govt. has released premium to Insurance Company and they are in turn to making payments to the hospitals.
11. Hospitals are not uploading the proper documents in the BIS for approvals?
If the documents are not valid, reject with precise comments on the rejection remarks box provided.
12. New empanelment of private hospitals?
Private Hospitals interested to join the scheme are joining the scheme which is an ongoing process. Hospitals can register on the portal of NHA www.hospitals.pmjay.gov.in.
13. Technical errors reported by the hospital to be addressed by whom?
Hospitals can raise query to District Project Co-ordinators of SHA. IT portal issues can be raised directly by the hospitals through support portal logins provided.
14. Counter in many of the hospitals are not yet functional and many complaints regarding the same isarising.
Directions have been given from SHA to operationalize the counters and many hospitals have already started functioning the counter. If any issues reported direct them to DPCs concerned.
15. When can I take a newcard?
New registration of families except answered in Q 1 has not started yet which will be informed to public through various media as and when decided by the Government.
16. Validity of the existing card?
No validity fixed.
17. Will this card cover the COVID treatment?
Yes. AB PMJAY-KASP has Covid-19 treatment packages under Infectious diseases specialty.
18. While checking 2018-2019 renewed RSBY card with URN number in website, the name of the beneficiaries not showing in somecases?
Some cards database may contain names like Dummy, Family of…etc. which are valid cards but issued during previous period due to some emergencies and issues in data correction. So, those cases need not be considered as an intentional fraud.
FAQ by TPA
1) Do Mental Illness Claims Covered or not?
Ans: Yes. Mental Illness separate speciality available in HBP.
2) Do Alcohol related claims Covered or not?
Ans: Yes. Alcohol related claim not included in exclusion criteria.
3) Will Suicide related Claims are covered or not?
Ans: No. DSH related claims are included in exclusion criteria.
4) The Investigation report such as A scan report, Blood Report are handwritten reports with sign. Is it acceptable or only system generated report to accept?
Ans: Can be accepted if signed by treating doctor / authorised personnel.
5) Do we need Patient on bed and Patient photo during discharge mandatory?
Ans: Patient photographs On Bed / During Treatment / Discharge not made mandatory in Kerala region.
6) In case of any doubt can we ask for Patient ID Proof or Health Card photo?
Ans: Yes. Patient photograph mandatory during admission. Can raise query if any discrepancies found.
7) Is ICP mandatory in general ward?
Ans: In general ward claims, ICPs are mandatory. Should verify whether drug chart and progress notes are documented in each day of claimed period.
8) Are ABG Reports mandatory?
Ans: ABG report is not mandatory if evidence for diagnosis is met, even if the patient is in ventilator. If the CPD deems it necessary to process claim, S/He can raise query for the same.
9) In case of Doubt, Can we ask for Patient on ICU Photo?
10) Is Patient On Dialysis Photo mandatory?
11) Is RFT Report mandatory, If Yes Till How many days one RFT Report is Valid?
Ans: RFT report not kept mandatory in Kerala region, since most of the patients are availing HD as a day care procedures. If deemed necessary by CPD, may raise query for the same.
12) Are Seal and Signature on HD Notes mandatory?
Ans: Yes. HD charting should be signed by authorised personnel.
13) Is Discharge summary mandatory in HD?
14) Is Surgery Scar Photo mandatory?
15) Are Post OP USG/HP Reports mandatory?
Ans: If evidence necessary to support Diagnosis, Yes; as considered by processing doctor.
16) Are Pre and Post OP X ray/CT/MRI mandatory?
17) Is Discharge summary mandatory CT / RT?
18) The Aadhar authentication and Biometric authentication are compulsory or not we need your guideline?
19) High end radiological cases are blocked single but as per standard guideline it has to be in conjunction with other package.
Ans: Should be blocked in conjunction with conservative management packages.
20) For Delivery related claim even after the package is available still we have to enter the amount of approval. Why? If there is any guideline please share.
Ans: All packages have the option to make changes in approved amount, if required by CPD. Unless necessary, package amount needs to be approved.