Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY)

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY)

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY): The Ayushman Bharat Scheme (PMJAY) was devised by the National Health Protection Mission Council in an effort to make healthcare insurance more accessible for the economically vulnerable masses of India. The scheme was officially launched on 25th September of the same year, as per Prime Minister Hon’ble Shri. Narendra Modi’s instructions. There have been over 4.5 lakh beneficiaries of this scheme as of September 2019.

Features of Ayushman Bharat

Some of the features of the Ayushman Bharat Scheme are-

  • The scheme provides each family with a sum total of five lakh.
  • The scheme is aimed to provide basic affordable healthcare to families which belong to the poor and vulnerable population as per the Socio-Economic Caste Census of 2011.
  • The scheme has benefited around 50 crore families, making it the largest healthcare scheme in the world.
  • The scheme is designed to cover most diseases and procedures- all of which are included in a list released by the government covering 1354 different treatment packages and approximately 23 different types of diseases including heart ailments, knee and hip implants, etc.
  • The coverage includes 3 days of pre-hospitalisation and 15 days of post-hospitalisation care.
  • One of the main aims of the scheme is to promote cashless transactions for secondary and tertiary healthcare procedures. Thus, the scheme provides the beneficiaries with an e-card.
  • The e-card can be used to avail any of the listed services at an impanelled hospital, whether it is public or private.
  • Thus, instead of cash, the beneficiary can avail all healthcare with the help of the e-card.
  • No hospital is allowed to charge additional amounts for medical treatment.
  • The policy also covers pre-existing diseases from the first day of availing, along with pre and post hospitalization expenses.
  • Everyone, irrespective of age, gender or family size can apply and avail of the benefits of this scheme.
  • The Ayushman Bharat scheme will include the ongoing centrally sponsored healthcare schemes- The Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS) in an effort to generalize healthcare schemes.
  • It is not essential to have an Aadhar card to be eligible for this scheme. However, the beneficiaries must have the prescribed ID in order to receive free treatment at the hospital.

Beneficiaries Covered under Ayushman Bharat

The Government used the Socio-Economic Caste Census of 2011as the primary database to identify the beneficiaries of this scheme. The categories which will be included in the scheme are –

For Rural

The 71st National Sample Survey Organisation revealed that 85.9% of rural households had no access to any healthcare insurance. All households which belong to one of the six deprivation criteria, namely, D1, D2, D3, D4, D5 and D7 can avail of the scheme. The deprivation criteria are as follows:

  • D1- House has only one room with kucha walls and kucha roof.
  • D2- An absence of adult members in the age range of 16-59.
  • D3- A family with a female head and an absence of an adult male member between the ages of 16-59.
  • D4- There are no physically able adult members in the family and at least one physically challenged member.
  • D5- Family belongs to the SC/ST category.
  • D7- The main source of income in the household is obtained by manual casual labour. The family is landless.

The following families are also included in the scheme

  • Families without shelter
  • Livelihood depends on alms
  • The family works as manual scavengers
  • They belong to backward tribal communities
  • They part take in legally contracted labour

For Urban

The workers residing in urban areas who are included in this scheme are-

  • Ragpickers
  • Beggars and destitute
  • Domestic laborers
  • Street hawkers/vendors/ other types of service providers
  • Construction workers/plumbers/welders/security personnel/coolie
  • Sweepers/sanitary workers/gardeners
  • Artisans/tailors/workers based at home
  • Transport workers/ drivers/helpers/rickshaw pullers
  • Shopkeepers/assistants/waiters/delivery personnel
  • Electricians/mechanics/other handymen
  • Cloth washers

Other Features of Ayushman Bharat

  • The beneficiary does not need to fill any applications or register to avail the scheme. The concerned Department will send all identified beneficiaries their unique registration numbers.
  • The Ayushman Bharat National Health Protection Mission Agency will overlook the management of the scheme.
  • States/UTs can implement the scheme either through an insurance company or directly through the Trust or by an integrated model.
  • Private hospitals with more than 10 beds can apply to be included under the Ayushman Bharat scheme.
  • All empanelled hospitals will have a support system named ‘Ayushman Mitra’ to help patients and coordinate with the beneficiaries and the hospital as per the guidelines of the Empanelled Health Care Provider (EHCP). Ayushman Mitra will run help desks, check for eligibility and also enroll the beneficiary to the scheme.
  • All payments will be done as per the package rate pre-determined by the Government. Hospitals that are NABH or NQAS accredited can charge higher rates for the packages depending on the procedure to be performed.
  • The expenses of the scheme will be divided among the Central and the State in the ratio of 60:40 (for all states and union territories), 90:10 for the North-Eastern states and 100:1 for the states of Jammu and Kashmir, Himachal Pradesh and Uttarakhand.

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