Context

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana was launched to provide health cover up to Rs. 5 lakh per family per annum for secondary and tertiary care hospitalisation to around 10.74 crore poor and vulnerable families based on the deprivation and occupational criteria as per the Socio-Economic Caste Census.

About

• The scheme provides for paperless and cashless access to services for the beneficiary at the point of service i.e. empanelled public and private hospitals across India.
• To facilitate this, an online transaction management system has been adopted by States/UTs.
• Claims of the hospitals are also settled through online portal in a time-bound manner.

Salient Features of Ayushman Bharat -PradhanMantri Jan ArogyaYojana

• It is a centrally sponsored scheme. It is entirely funded by Government and the funding is shared between Centre and State governments as per prevailing guidelines of Ministry of Finance.
• PMJAY provides health cover up to Rs. 5 lakh per family per year for secondary and tertiary hospitalization to around 10.74 crore poor and vulnerable families (approx. 50 crore beneficiaries).
• PMJAY is an entitlement based scheme. This scheme covers poor and vulnerable families based on deprivation and occupational criteria as per SECC database.
• PMJAY provides cashless and paperless access to services for the beneficiary at the point of service in any (both public and private) empanelled hospitals across India. In other words, a beneficiary from one State can avail benefits from an empanelled Hospital anywhere in the Country.
• Under PMAJY, the States are free to choose the modalities for implementation. They can implement the scheme through insurance company or directly through the Trust/ Society or mixed model.
• There is no restriction on family size, ensuring all members of designated families specifically girl child and senior citizens get coverage.
• A well-defined Complaint and Public Grievance Redressal Mechanism, has been put in place through which complaints/ grievances are registered, acknowledged, escalated for relevant action, resolved and monitored.
• PMJAY has created a robust IT system for implementation and role of real time transaction data.
• At National level, National Health Authority (NHA) has been set up as an attached office to Ministry of Health and Family Welfare to manage the implementation of the scheme.

What is the hospitalisation process?

• The beneficiaries will not be required to pay any charges and premium for the hospitalisation expenses.
• The benefit also include pre- and post-hospitalisation expenses.
• Each empanelled hospital will have an 'Ayushman Mitra' to assist patients and will coordinate with beneficiaries and the hospital. They will run a help desk, check documents to verify the eligibility, and enrolment to the scheme.
• Benefits of the scheme are portable across the country.

Benefits of PM-JAY

• Priority to girl child, women and senior citizens.
• Covers secondary and tertiary care hospitalization.
• All pre-existing diseases covered. Hospitals cannot deny treatment.
• Hospitals will not be allowed to charge any additional money from beneficiaries for the treatment.
• Help India progressively achieve Universal Health Coverage (UHC) and Sustainable Development Goals (SDG).
• Acting as a steward, align the growth of private sector with public health goals.
• Enhanced used to of evidence based health care and cost control for improved health outcomes.
• Enable creation of new health infrastructure in rural, remote and under-served areas.
• Increase health expenditure by Government as a percentage of GDP.
• Improved quality of life for the population.