Good Ideas: Everything you want to know about

Under the ambit of Ayushman Bharat, a Pradhan Mantri Jan Arogya Yojana (PM-JAY) to reduce the financial burden on poor and vulnerable groups arising out of catastrophic hospital episodes and ensure their access to quality health services was conceived. PM-JAY seeks to accelerate India’s progress towards achievement of Universal Health Coverage (UHC) and Sustainable Development Goal - 3 (SDG3).

Credit - Amar Ujala

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).

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

AB-NHPM: In Alliance with the States

-The Scheme architecture and formulation has undergone a truly federal process, with stakeholder inputs taken from all States and UTs through national conclaves, sectoral working groups, intensive eld exercises and piloting of key modules.

-The Scheme is principle based rather than rule based, allowing States enough exibility in terms of packages, procedures, scheme design, entitlements as well as other guidelines while ensuring that key benets of portability and fraud detection are ensured at a national level.

-States will have the option to use an existing Trust/Society or set up a new Trust/Society to implement the Scheme as State Health Agency and will be free to choose the modalities for implementation. They can implement the Scheme through an insurance company or directly through the Trust/Society/Implementation Support Agency or a mixed approach.

Some Questions:

Q - What benefits are available under PM-JAY?

Ans - PM-JAY provides an insurance cover upto Rs 5 lakh per family, per year for secondary and tertiary hospitalization. All pre-existing conditions are covered from day 1 of implementation of PM-JAY in respective States/UTs.

Q - What health services are available under PM-JAY?

Ans - The health services covered under the programme include hospitalization expenses, day care surgeries, follow-up care, pre and post hospitalization expense benefits and new born child/children services. The comprehensive list of services is available on the website.

Q - Who is eligible to avail benefits under PM-JAY?

Ans - PM-JAY covers more than 10 crore poor and vulnerable families across the country, identified as deprived rural families and occupational categories of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data. A list of eligible families has been shared with the respective state government as well as ANMs/BMO/BDOs of relevant area. Only families whose name is on the list are entitled for the benefits of PM-JAY. Additionally, any family that has an active RSBY card as of 28 February 2018 is covered. There is no capping on family size and age of members, which will ensure that all family members specifically girl child and senior citizens will get coverage.

Q- Where can beneficiaries avail of services under PM-JAY?

Ans - Services under the scheme can be availed at all public hospitals and empaneled private health care facilities. Empanelment of the hospitals under PM-JAY will be conducted through an online portal by the state government. Information about empaneled hospitals will be made available at through different means such as government website, mobile app. Beneficiaries can also call the helpline number at 14555. Regular updates will also be provided through ASHAs, ANM and other specific touch points This information will be activated shortly.

Q - Will beneficiaries have to pay anything to get covered under this scheme?

Ans - No. All eligible beneficiaries can avail free services for secondary and tertiary hospital care for identified packages under PM-JAY at public hospitals and empaneled private hospitals. Beneficiaries will have cashless and paperless access to health services under PM-JAY.

Q - What is the enrolment process? Is there any time period for enrolment?

Ans - PM-JAY is an entitlement based mission. There is no enrolment process. Families who are identified by the government on the basis of deprivation and occupational criteria using the SECC database both in rural and urban areas are entitled for PM-JAY.