J&K High Court Orders Insurance Company To Maintain Health Coverage Amid Dispute

The Jammu and Kashmir High Court has intervened after private hospitals in the union territory announced they would refuse admissions under the Ayushman Bharat Yojana starting September 1. The decision followed claims from these hospitals that IFFCO TOKIO General Insurance Company had failed to settle outstanding payments, causing significant financial strain.

The High Court directed IFFCO TOKIO to uphold its contractual obligations under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana-SEHAT (AB-PMJAY-SEHAT) scheme until an arbitrator resolves the dispute between the insurance company and the J&K government.

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This intervention came in response to a petition from the Government of J&K. The government launched the AB-PMJAY-SEHAT scheme to offer free universal health coverage to residents, including serving and retired employees and their families. The scheme mirrors the benefits of the central Ayushman Bharat scheme, providing Rs 5 lakh annual health insurance coverage per family through a network of empanelled health care providers.

The contract for the scheme, executed on March 10, 2022, was set to last until March 14, 2025. However, IFFCO TOKIO notified the government in November 2023 of its intent not to renew the contract after March 14, 2024. Despite requests from the Chief Executive Officer of the State Health Agency (SHA) to reconsider, the company maintained its decision.

Dispute To Arbitration

The SHA invoked Clause 41.3 of the contract to refer the dispute to arbitration and sought the nomination of an arbitrator. The J&K government argued that the insurance company could not unilaterally exit the contract and leave beneficiaries without coverage.

Justice Rajesh Sekhri, upon reviewing the case, emphasized that insurance contracts must align with statutory regulations and public policy, particularly when serving public health interests. The judge acknowledged the urgency of the matter, noting that damages from a breach could not be easily remedied in the future.

In granting the petition, the High Court temporarily instructed IFFCO TOKIO to continue with the existing coverage arrangement under the contract terms while the arbitration process proceeds. The decision aims to ensure uninterrupted health coverage for beneficiaries amidst the ongoing dispute.