Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Introduction

• Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, is an important health service scheme of Government of India.
• It is also known by the following names:-
  • " Pradhan Mantri Jan Arogya Yojana (PM-JAY)."
  • "Ayushman Bharat Yojana."
  • "PM-JAY Scheme."
• It was launched by the Prime Minister of India on 23rd September 2018 in Ranchi, Jharkhand.
• Primarily, the Ayushman Bharat Yojana has two components :-
  • Health and Wellness Centres (HWCs).
  • Pradhan Mantri Jan Arogya Yojana (PM-JAY).
• Under the Health and Wellness Centres component, the Government of India announced the creation of 1,50,000 Health and Wellness Centres (HWCs) by updating existing sub centres and primary health centres.
• These centres are meant to provide comprehensive primary health care (CPHC) facilities to the people of country.
• They cover both maternal and child health services and non-communicable diseases, including essential medicines and diagnostic services free of charge.
• The Second component under the Ayushman Bharat Yojana is the Pradhan Mantri Jan Arogya Yojana or PM-JAY.
• It is the world's largest health insurance scheme which aims to provide a health cover of Rs. 5 Lakh per family per year.
• More than 10.74 crore poor and vulnerable families (about 60 crore beneficiaries) will get the benefit of this scheme.
• The families included are based on the deprivation and occupational criteria of Socio-Economic Caste Census (SECC 2011) from rural and urban areas.
• Pradhan Mantri Jan Arogya Yojana (PM-JAY) was earlier known as National Health Protection Scheme (NHPS).
• Pradhan Mantri Jan Arogya Yojana (PM-JAY) is fully funded by the Government and the cost of implementation is shared between the Central and State Governments.

Benefits of the scheme

• Under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana provides cashless cover of Rs. 5,00,000/- per year to each eligible family.
• The cover under the scheme includes all expenses incurred on the following components of treatment :-
  • Medical Examination.
  • Treatment and Consultation.
  • Pre-hospitalization.
  • Medicine and Medical Consumables.
  • Non-intensive and intensive care services.
  • Diagnostic and laboratory investigations.
  • Medical Implantation services.
  • Accommodation Benefits.
  • Food Services.
  • Complication arising during treatment.
  • Post-hospitalization follow-up care up to 15 days.
• The benefit of Rs. 5,00,000/- can be used by one or all of the family.
• There is no limit on the size of the family or the age of the family members.
• Pre-existing diseases are also covered under this scheme.
• Any eligible person suffering from any medical condition before being covered by Pradhan Mantri Jan Arogya Yojana will now be able to get treatment for all type of medical conditions from the day beneficiary get enrolled.

Eligible Beneficiaries

• Under Ayushman Bharat Yojana, the following beneficiary are automatically included
  • Households without shelter
  • People living on alms or destitute
  • Families of manual scavenger
  • Primitive tribal groups
  • Legally released bonded labour
• Whereas, there are detailed criteria for rural and urban areas people, whose details are shared in the table given below:

Features of the Scheme

• The Government of India has committed to ensuring universal access to good quality healthcare services for its population, without facing financial hardship.
• In Ayushman Bharat Yojana, cashless and paperless medical treatment will be provided to all beneficiary at selected empanelled public and private hospitals.
• Under the scheme, the beneficiary will get the medical cover of Rs. 5 Lakh per family per year.
• It also aims to reduce the financial burden on poor and vulnerable groups arising out of catastrophic hospital episodes.
• Around 10 crores families or about 60 crore Indian are going to receive benefit of the scheme.
• Medical facilities will be available across public and private empanelled hospitals in India.
• There is no restriction on family size, age or gender.
• This scheme covers 3 days of pre-hospitalisation and 15 days of post hospitalization expenses incurred on treatment.
• For any grievance, a 24*7 helpline number (14555) is available for people.
• Under this scheme, the beneficiary can take benefit anywhere in the country.

Status of the Scheme

How to Avail Benefit

• To avail of the benefit of the schemes, the beneficiary must possess an Ayushman Card.
• A beneficiary may apply for the Ayushman Card through any nearby CSC Centre.
• Empanelled public and private hospitals have a dedicated Ayushman Yojana Counter to facilitate beneficiaries.
• Beneficiary have to register and submit a related document at this counter, to start the procedure.
• In emergency cases, hospitals staff will admit the patient first without immediate registration, which can be completed later.
• Once the beneficiary is admitted under the Ayushman yojana, all expenses up to Rs 5 lakh will be borne by the government.
• To get the benefits of the scheme, it is mandatory for the beneficiary to furnish their ayushman card.

Employees' State Insurance Corporation Joins Ayushman Bharat Yojana.

• Employees' State Insurance (ESIC) has entered into a partnership with National Health Authority (NHA).
• This convergence between Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (ABPM-JAY) and Employees' State Insurance Corporation (ESIC) will enable Employees' State Insurance Corporation (ESIC) beneficiaries to access services at Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana empanelled Hospitals and vice versa.
• In the initial phase, it was launched as a pilot project in Ahmednagar, Maharashtra and Bidar, Karnataka, Where Employees State Insurance beneficiaries got access to medical care services of Pradhan Mantri Jan Arogya Yojana (PM-JAY) empanelled Hospitals.
• After successful completion of pilot project, the Employees State Insurance Scheme has been extended to 113 designated districts in 4 states by merging with Pradhan Mantri Jan Arogya Yojana.
• Those States are :-
  • Chhattisgarh.
  • Karnataka.
  • Madhya Pradesh.
  • Maharashtra.
• The major benefits to the Employees'' State Insurance Corporation (ESIC) beneficiaries are :-
  • Employees' State Insurance Corporation (ESIC) beneficiaries will get access to healthcare provided under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
  • Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) beneficiaries will also able to avail the services in Employees'' State Insurance Corporation (ESIC) empanelled Hospitals.
  • Beneficiaries of Employees' State Insurance Corporation (ESIC) can use their ESIC card to access free treatment at Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) empanelled Hospitals.
  • Similarly, beneficiaries of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) can use their AB PM-JAY card to access free treatment at Employees' State Insurance Corporation empanelled hospitals.

Important Links

• Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana Website.
• Ayushman Bharat-Health and Wellness Centre.
• Eligibility Check.
• Find Empanelled Hospital.
• National Health Portal.
• Employees' State Insurance Corporation.
• National Health Authority.
• Ministry of Health and Family Welfare.
• Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY) APP.

Contact details

• Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana Toll Free Number :-
  • 14555.
  • 14588.
  • 1800111565.
• Postal Address : 9th Floor, Tower-l,
  Jeevan Bharati Building, Connaught Place,
  New Delhi - 110001