Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)
Ayushman Bharat, a flagship scheme of Government of India was launched on 23rd Sept. 2018 by our Prime Minister Narendra Modi under the aegis of Ministry of Health and Family Welfare. The main aim of the scheme is t to provide healthcare facilities to over 10 crore families covering urban and rural poor. PMJAY-Ayushman Bharat is the biggest government-sponsored healthcare scheme in the world. this centrally sponsored schemes -this PM-JAY scheme is formed by subsuming the multiple schemes Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).
Purpose of this Scheme:
The eradication of major communicable diseases remains unfinished, the population is also bearing the high burden of non-communicable diseases (NCDs) and injuries. This leads to an overall rise in the demand for health care over a prolonged period of time. But, there is no adequate and affordable healthcare for 1.3 billion population.even in the private sector health care centres, there is no adequate facilities and they are unregulated. and these private hospitals are mostly situated in large metros or urban neighbourhoods leaving a great deficit of health services for the underprivileged population of India. and public sector hospitals have to work under challenging circumstancing arising from the lack of sufficient funds, a shortage of trained health workers and the erratic and often deficient supply of drugs and equipment which adversely impacts their functioning.
Over the last two decades, the Government of India not spending much towards Health care.
once observe this pattern
(Source: National Health Accounts, 2015).
Out-of -pocket expenditure means, The expenses that the patient or the family pays directly to the health care provider, without a third-party (insurer, or State) is known as 'Out of Pocket Expenditure' (OOP). These expenses could be medical as well as non-medical expenditure. Thus, it has been deduced that increasing health care needs, coupled with high out-of-pocket expenditure, is a leading cause of poverty in India. Not only does it keep people poor, but it also pushes nearly 6 crore Indians back into poverty each year.
To address these challenges, the Government of India took a two-pronged approach under the umbrella of Ayushman Bharat. The first component of this strategy was disease prevention and health promotion to curb the increasing epidemic of non-communicable diseases. This was to be ensured through upgradation of the existing network of Sub-centres and Primary Health Centres to Health and Wellness Centres (HWC). Nearly 150,000 HWCs are to be set up in the country over the next few years which will work towards reducing the overall disease burden and hospitalisation needs of the population.
The second component was the launch of the Pradhan Mantri-Jan Arogya Yojana (PM-JAY) which aims to create a system of demand-led health care reforms that meet the immediate hospitalisation needs of the eligible beneficiary family in a cashless manner thus insulating the family from catastrophic financial shock
Coverage under PM-JAY
The inclusion of households is based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas, respectively. This number also includes families that were covered in the RSBY but were not present in the SECC 2011 database.
SECC-2011 is a study of socio economic status of rural and urban households and allows ranking of households based on predefined parameters. this was conducted for the 2011 Census of India. Ministry of Rural Development commenced the Socio-Economic Caste Census-2011 on 29th June, 2011 through a comprehensive door to door enumeration across the country. The data of the exercise is now available for policy, research and for implementing various development programmes.
this secc datat was released in 2015. govt is thinking to use this data to identify the beneficiaries for governments schemes. In line with the approach of the Government to use the SECC database for social welfare schemes, PM-JAY also identifies targeted beneficiary families through this data. Based on this data household ranked and categorised them on the basis of socio economic status using automatic exclusion criteria, automatic inlusion criteria and deprivation criteria.
Deprivation Data
| D1. | Households with one or less room, kuccha walls and kuccha roof | 2.38 Crore (13.28%) |
| D2. | No adult member in household between age 18 and 59 | 65.33 Lakh (3.64%) |
| D3. | Female headed household with no adult male member between 16 and 59 | 69.43 Lakh (3.86%) |
| D4. | Households with differently able member with no other able bodied adult member | 7.20 Lakh (0.40%) |
| D5. | SC/ST Households | 3.87 Crore (21.56%) |
| D6. | Households with no literate adult above age 25 years | 4.22 Crore (23.52%) |
| D7. | Landless households deriving a major part of their income from manual labour | 5.40 Crore (30.04%) |
Rural households which are included (not excluded) are then ranked based on their status of seven deprivation criteria (D1 to D7). Urban households are categorised based on occupation categories.
Rural Beneficiaries
Out of the total seven deprivation criteria for rural areas, PM-JAY covered all such families who fall into at least one of the following six deprivation criteria (D1 to D5 and D7) and automatic inclusion(Destitute/ living on alms, manual scavenger households, primitive tribal group, legally released bonded labour) criteria:
- D1- Only one room with kucha walls and kucha roof
- D2- No adult member between ages 16 to 59
- D3- Households with no adult male member between ages 16 to 59
- D4- Disabled member and no able-bodied adult member
- D5- SC/ST households
- D7- Landless households deriving a major part of their income from manual casual labour.
For urban areas, the following 11 occupational categories of workers are eligible for the scheme:
- Ragpicker
- Beggar
- Domestic worker
- Street vendor/ Cobbler/hawker / other service provider working on streets
- Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and other head-load worker
- Sweeper/ Sanitation worker/ Mali
- Home-based worker/ Artisan/ Handicrafts worker/ Tailor
- Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller
- Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter
- Electrician/ Mechanic/ Assembler/ Repair worker
- Washer-man/ Chowkidar.
Main features of PM-JAY:
- It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
- PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
- It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
- There is no restriction on the family size, age or gender.
- All pre-existing diseases are covered from the very first day. This means that any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.
- Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
- Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician's fees, room charges, surgeon charges, OT and ICU charges etc.
- Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
Benefit Cover Under PM-JAY
PM-JAY provides cashless cover of up to INR5,00,000 to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment.
- Medical examination, treatment and consultation
- Pre-hospitalization
- Medicine and medical consumables
- Non-intensive and intensive care services
- Diagnostic and laboratory investigations
- Medical implantation services (where necessary)
- Accommodation benefits
- Food services
- Complications arising during treatment
- Post-hospitalization follow-up care up to 15 days
The benefits of INR 5,00,000 are on a family floater basis which means that it can be used by one or all members of the family.
How to apply for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana
Ayushman Bharat Registration: How to Apply for Ayushman Bharat Yojana (Application Process)
There is no special Ayushman Bharat registration procedure pertaining to PMJAY. This is because PMJAY applies to all beneficiaries as identified by the SECC 2011 and those who are already part of the RSBY scheme. However, here’s how you can check if you are eligible to be a beneficiary of PMJAY.
- Visit https://www.pmjay.gov.in/ and click on ‘Am I Eligible’
- Enter your mobile number and the CAPTCHA code and click on ‘Generate OTP’
- Then select your state and search by name/ HHD number/ ration card number/ mobile number
- Based on the search results you can verify if your family is covered under PMJAY
Alternatively, to know if you are eligible for PMJAY you can approach any Empanelled Health Care Provider (EHCP) or dial the Ayushman Bharat Yojana call centre number: 14555 or 1800-111-565
Ayushman Bharat Yojana: PMJAY Patient Card Generation
Once you are eligible for the PMJAY benefits, you can work towards getting an e-card. Before this card is issued, your identity is verified at a PMJAY kiosk with the help of a document like your Aadhaar card or ration card. Family identification proofs that can be produced include a government certified list of members, PM letter and an RSBY card. Once the verification is completed, the e-card is printed along with the unique AB-PMJAY ID. You can use this as proof at any point in the future.
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