Ayushman Bharat Scheme (PMJAY) | Benefits | Features | Implementation Strategy | Number Of Beneficlaries

What is Ayushman Bharat Yojana Scheme (PMJAY)?

Considered as one of the biggest healthcare schemes in the world, Ayushman Bharat Yojana aims to cover more than 50 crore Indian citizens. It is designed especially for the economically weaker sections of the country. The PMJAY was launched in September 2018 providing health insurance of a maximum sum insured amount of Rs.5 lakh.

The government health insurance scheme covers most of the medical treatment costs, medicines, diagnostics and pre-hospitalisation expenses. Additionally, the scheme offers cashless hospitalisation services through the Ayushman Bharat Yojana e-card which you can use to get healthcare services at any of the empanelled hospitals across the country. Beneficiaries of the scheme can avail hospitalisation for necessary treatment by showing their PMJAY e-card.


What is Covered Under Ayushman Bharat Yojana Scheme?

With the intention to provide accessible healthcare to the poor and needy, the Ayushman Bharat Yojana Scheme offers coverage of up to Rs.5 lakh per family per year for secondary and tertiary hospitalisation care.


BENEFITS UNDER THE SCHEME:

• Ayushman Bharat- Pradhan Mantri Jan ArogyaYojana (PMJAY) will provide a cover of up to Rs. 5 lakhs per family per year, for secondary and tertiary care hospitalization.
• Over 10.74 crore vulnerable entitled families (approximately 50 crore beneficiaries) will be eligible for these benefits.
• PMJAY will provide cashless and paperless access to services for the beneficiary at the point of service.
• PMJAY will help reduce catastrophic expenditure for hospitalizations, which impoverishes people and will help mitigate the financial risk arising out of catastrophic health episodes.
• Entitled families will be able to use the quality health services they need without facing financial hardships.
• When fully implemented, PMJAY will become the world’s largest fully government-financed health protection scheme. It is a visionary step towards advancing the agenda of Universal Health Coverage (UHC).

Key Features of PM-JAY

• PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government.
• 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.
• Over 10.74 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
• PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
• PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.
• 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 conditions are covered from day one.
• 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.

IMPLEMENTATION STRATEGY

• At the national level to manage, an Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA) would be put in place. States/ UTs would be advised to implement the scheme by a dedicated entity called State Health Agency (SHA). They can either use an existing Trust/ Society/ Not for Profit Company/ State Nodal Agency (SNA) or set up a new entity to implement the scheme.
• States/ UTs can decide to implement the scheme through an insurance company or directly through the Trust/ Society or use an integrated model.

EXPENDITURE INVOLVED

The expenditure incurred in premium payment will be shared between Central and State Governments in specified ratio as per Ministry of Finance guidelines in vogue. The total expenditure will depend on actual market determined premium paid in States/ UTs where Ayushman Bharat - National Health Protection Mission will be implemented through insurance companies. In States/ UTs where the scheme will be implemented in Trust/ Society mode, the central share of funds will be provided based on actual expenditure or premium ceiling (whichever is lower) in the pre-determined ratio.