Process health workers’ insurance claims on priority, Nirmala Sitharaman tells States

PMGKP scheme for healthcare workers has been extended for a year after the emergence of the second COVID-19 wave

Insurance companies have processed just 419 claims pertaining to frontline healthcare workers who lost their lives in the COVID-19 pandemic, Finance and Corporate Affairs Minister Nirmala Sitharaman said on Saturday, urging insurers to expedite settlement of pending claims under different schemes.

The government had launched a Pradhan Mantri Garib Kalyan Package (PMGKP) Insurance Scheme for health workers with a life insurance amount of ₹50 lakh. So far, ₹209.5 crore has been disbursed to nominees of the deceased health care workers, the minister noted in a meeting with chiefs of insurance companies.

Directing States to take up COVID claims of health workers on a priority basis, Ms Sitharaman said a new simplified system has been put in place to address ‘delays arising out of States sending documents’ that must be put to ‘maximum’ use. As per the new mechanism, ‘a simple certificate’ from the District Magistrate (DM), endorsed by the nodal State health authority will be sufficient to process claims.

Citing an example from Ladakh of a health worker’s insurance claim being settled within four hours of receiving the DM’s certificate, the Finance Minister called for a similar approach to be maintained in future as well. The PMGKP scheme for healthcare workers has been extended for a year after the emergence of the second COVID-19 wave in April.

“The Finance Minister emphasised that insurance company officials should continue being sympathetic while providing services to nominees of deceased policy holders, especially during pandemic period… These claim amounts provide much-needed financial relief to nominees who have lost near and dear ones, and the government’s steps will enhance the ease and speediness of this process,” the ministry said in a statement after the meeting.

Ms Sitharaman also sought to accelerate the disbursement of pending claims under the Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY) and the Pradhan Mantri Suraksha Bima Yojana (PMSBY) during the pandemic. She asked insurance firms to streamline processes and documentation requirements under the schemes so that claims are disbursed faster.

The PMJJBY and the PMSBY, launched in 2015, provide life and accidental insurance covers, respectively, of ₹2 lakh each, at an annual premium of ₹330 and ₹12, respectively.

Under the PMJJBY, a total of 4.65 lakh claims have been paid of value ₹9,307 crore, of which 1.2 lakh claims amounting to ₹2,403 crore were settled since the beginning of the pandemic last year. The PMSBY scheme has settled 82,660 claims worth ₹1,629 crore by May 31 this year.

Insurers have been asked to process claims under these two schemes within seven days instead of 30 days and digitise the claim settlement process between banks and insurance companies. Public sector firms have been tasked with launching an app for transmitting claims by the end of this month.

“Attending doctor’s certificate & certificate issued by DM/authorized officer, in lieu of death certificate to be considered (and) rationalized forms for simplified claims process are being issued shortly,” the statement said.

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