Ayushman Bharat Yojana or Healthy India is a national initiative launched by Prime Minister Narendra Modi as the part of National Health Policy 2017, in order to achieve the vision of Universal Health Coverage (UHC). This initiative has been designed on the lines as to meet SDG and its underlining commitment, which is leave no one behind
AyushmanBharat is an attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service. Ayushman Bharat aims to undertake path breaking interventions to holistically address health (covering prevention, promotion and ambulatory care), at primary, secondary and tertiary level.
Establishment of Health and Wellness Centres
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
- Establishment of Health and Wellness Centres–The first component, pertains to creation of 1,50,000 Health and Wellness Centres which will bring health care closer to the homes of the people. These centres will provide Comprehensive Primary Health Care (CPHC), covering both maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.
- Pradhan Mantri Jan Arogya Yojana (PM-JAY) –PM-JAY is one significant step towards achievement of Universal Health Coverage (UHC) and Sustainable Development Goal – 3 (SDG3).It aims to provide health protection cover to poor and vulnerable families against financial risk arising out of catastrophic health episodes.
Pradhan Mantri Jan Arogya Yojana (PM-JAY) will provide financial protection (Swasthya Suraksha) to 10.74 crore poor, deprived rural families and identified occupational categories of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data (approx. 50 crore beneficiaries). It will have offer a benefit cover of Rs. 500,000 per family per year (on a family floater basis).
PM-JAY will cover medical and hospitalization expenses for almost all secondary care and most of tertiary care procedures. PM-JAY has defined 1,350 medical packages covering surgery, medical and day care treatments including medicines, diagnostics and transport.
To ensure that nobody is left out (especially girl child, women, children and elderly), there will be no cap on family size and age in the Mission. The scheme will be cashless & paperless at public hospitals and empaneled private hospitals. The beneficiaries will not be required to pay any charges for the hospitalization expenses. The benefit also includes pre and post-hospitalization expenses. The scheme is an entitlement based, the beneficiary is decided on the basis of family being figured in SECC database. When fully implemented, the PM-JAY will become the world’s largest government funded health protection mission.
Benefits of PM-JAY
Beneficiary Level –
- Government provides health insurance cover of up to Rs. 5,00,000 per family per year.
- More than 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries) covered across the country.
- All families listed in the SECC database as per defined criteria will be covered. No cap on family size and age of members.
- Priority to girl child, women and and senior citizens.
- Free treatment available at all public and empaneled private hospitals in times of need.
- Covers secondary and tertiary care hospitalization.
- 1,350 medical packages covering surgery, medical and day care treatments, cost of medicines and diagnostics.
- All pre-existing diseases covered. Hospitals cannot deny treatment.
- Cashless and paperless access to quality health care services.
- Hospitals will not be allowed to charge any additional money from beneficiaries for the treatment.
- Eligible beneificiares can avail services across India, offering benefit of national portability. Can reach out for information, assistance, complaints and grievances to a 24X7 helpline number – 14555
Health System
- Help India progressively achieve Universal Health Coverage (UHC) and Sustainable Development Goals (SDG).
- Ensure improved access and affordability, of quality secondary and tertiary care services through a combination of public hospitals and well measured strategic purchasing of services in health care deficit areas, from private care providers, especially the not-for profit providers.
- Significantly reduce out of pocket expenditure for hospitalization. Mitigate financial risk arising out of catastrophic health episodes and consequent impoverishment for poor and vulnerable families.
- 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.
- Strengthen public health care systems through infusion of insurance revenues.
- Enable creation of new health infrastructure in rural, remote and under-served areas.
- Increase health expenditure by Government as a percentage of GDP.
- Enhanced patient satisfaction.
- Improved health outcomes.
- Improvement in population-level productivity and efficiency
- Improved quality of life for the population
Details of PMJAY Scheme:
The primary aim of the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme is to provide health insurance coverage to approximately 50 crore citizens of India. Due to the requirement for better healthcare services to battle medical contingencies, the government of India introduced this health insurance scheme to secure the economically weaker sections of the country.
Moreover, the Ayushman Bharat Yojana offers an average coverage amount of ₹5 lakh to beneficiaries. This covers a majority of diagnostics, pre-hospitalisation costs, medicines, and medical treatment expenses. In addition to this, the cashless, as well as paperless services, work in favour of the nominees at any given point of time in their lives.
PMJAY scheme makes quality healthcare accessible to the poorest of poor families in India. Hence, the benefits offered by this health insurance plan are massive. Take a look at these features and benefits offered by the healthcare scheme to every family in need:
Eligibility Criteria for PMJAY Scheme:
Rural:
According to the 71st round of the National Sample Survey Organisation, over 85.9% of people in rural areas do not have access to basic healthcare plans. Moreover, 24% of the rural population seeks healthcare facilities by borrowing money.
This is where the Pradhan Mantri Jan Arogya Yojana scheme comes in handy. It helps these people avoid getting into a debt trap and avail health facilities. This scheme is economically beneficial to underprivileged households. Also, the families enrolled under the Rashtriya Swasthya Bima Yojana (RSBY) will be covered under the PMJAY scheme.
In the rural areas, this health facility is available to:
- People belonging to scheduled caste and scheduled tribe families
- Households with no male member between the age of 16 years and 59 years
- Beggars and those surviving on alms
- Families with no individual between the age of 16 years and 59 years
- Households with no healthy adult individual and at least one physically challenged member
- Landless families who make a living by working as casual manual labourers
- Primitive tribal communities
- Legally released bonded labourers
- People living in one-room makeshift houses with no proper walls or roof
- Manual scavenger families
Urban:
In the urban areas, the PMJAY scheme can be availed mainly by:
- Washerman/ Chowkidars
- Rag Pickers
- Mechanics, electricians, and repair workers
- Domestic help
- Sanitation workers, gardeners, and sweepers
- Home-based artisans and handicraft workers
- Tailors
- Cobblers, hawkers, and people providing services by working on streets or pavements
- Plumbers, masons, construction workers, porters, welders, painters, and security guards
- Transport workers such as drivers, conductors, helpers, cart, or rickshaw pullers
- Assistants, peons of a small organisation, delivery men, shopkeepers and waiters
Critical Ailments covered under PMJAY Scheme:
- Prostate cancer
- Coronary artery bypass grafting
- Double valve replacement
- Carotid angioplasty with stent
- Pulmonary valve replacement
- Skull base surgery
- Laryngopharyngectomy with gastric pull-up
- Anterior spine fixation
- Tissue expander for disfigurement following burns
- COVID-19 treatment and testing
How to register for PMJAY Scheme?
Step 1: Visit the PMJAY government website (https://www.pmjay.gov.in/) and click on ‘Am I Eligible’.
Step 2: Enter your contact information and click on ‘Generate OTP’.
Step 3: Select your state and search by name/HHD number/ration card number/mobile number.
Step 4: Based on the results, you can verify whether your family is covered under the PMJAY scheme.
Moreover, to know about Ayushman Bharat Yojana eligibility, you can contact any Empanelled Health Care Provider (EHCP) or Ayushman Bharat Yojana call centre at 14555 or 1800-111-565.