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).
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| 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.
For more details Visit -
https://www.pmjay.gov.in/
