Mainfeatures of PMJAY:
- Insurance: NHPS will cover over 10 crore poor and vulnerable families providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization through a network of Empanelled Health Care Providers (EHCP).
- Premium costs for the scheme are expected to be shared between the Centre and each State in a 60-40 ratio, with States expected to voluntarily opt into the scheme.
- Target: PMJAY primarily targets the poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data for both rural and urban areas.
- Entitlement: PMJAY will be an entitlement based scheme where it will be decided on the basis of deprivation criteria in the SECC database.
- Inclusions: PMJAY will cover medical and hospitalisation expenses for almost all secondary care and most of tertiary care procedures.
- The scheme is creating a cadre of certified frontline health service professionals called PradhanMantriAarogyaMitras (PMAMs) who will be primary point of facilitation for the beneficiaries to avail treatment at the hospital.
- Access: The EHCP network will provide cashless and paperless access to services for the beneficiaries at the both public and private hospitals.
- States role:The scheme is principle based rather than rule based, allowing States enough flexibility in terms of packages, procedures, scheme design, entitlements as well as other guidelines.
- States can implement the scheme through an insurance company or directly through the Trust/Society/Implementation Support Agency or a mixed approach.
- Council: There will be a council at the centre to monitor the scheme at national level.