Ayushman Bharat Yojana Guidelines for Portability of Services

By | September 23, 2018
(Last Updated On: September 24, 2018)

Ayushman Bharat Yojana Guidelines for Portability of Services

Guidelines for Pradhan Mantri Rashtriya Swasthya Suraksha Mission (PMRSSM)

PMRSSM offers portability of health care services across the country through public and
empanelled private hospitals.

1.1. What is Portability

This means that a beneficiary will be able to get treatment outside the home State also in
any empanelled hospital in a cashless manner. Any empanelled hospital will not be allowed
to deny services to any PMRSSM beneficiary.

1.2. How Portability will be Enabled

To enable portability under the scheme, each of the State participating in PMRSSM will sign
MoU with Central Government and each other which will allow any hospital empanelled
under PMRSSM to provide services to beneficiaries from across the country. This will also
enable participating insurance companies/ trusts to make payment to hospitals empanelled
beyond the boundaries of State where they are providing services.
PMRSSM offers portability of health care services across the country through public and
empanelled private hospitals. Portability of benefits would be implemented as per the
below:

A. Package list and package rates as applicable in the State where the treatment
takes place will be applicable.
B. The payment of claim to the hospital will be made by Trust/Insurance Company
implementing PMRSSM in the home State where the beneficiary belongs to.
C. The timelines for processing of claim and payment to the hospital would be the
same as other claims, i.e. within 30 days of receiving the claim.
D. In case, there is an alliance between PMRSSM and any State Scheme or PMRSSM
has been expanded, the above process for portability may be followed for all
beneficiaries.
E. Case of dispute, if any, with respect to treatment sought or taken in another
State, will be taken up the Grievance Committee of the Destination State where
the treatment took place.

 

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