The second component under Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojana or PMJAY as it is popularly known. This scheme was launched on September 23, 2018 in Ranchi, Jharkhand by Prime Minister Narendra Modi. Ayushman Bharat, a flagship scheme of Government of India, was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC). This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlying commitment, which is to “leave no one behind”.
Pradhan Mantri Jan Arogya Yojana, a component under Ayushman Bharat scheme
Ayushman Bharat is an attempt to move from a segmented approach of health service delivery to a comprehensive need-based health care service. This scheme aims to undertake path breaking interventions to holistically address the healthcare system (covering prevention, promotion and ambulatory care) at the primary, secondary and tertiary level. Ayushman Bharat adopts a continuum of care approach, comprising of two interrelated components, which are:
- Health and Wellness Centres (HWCs)
- Pradhan Mantri Jan Arogya Yojana (PMJAY)
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana
Ayushman Bharat PMJAY is the largest health assurance scheme in the world which aims at providing a health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalization to over 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries) that form the bottom 40% of the Indian population.
The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.
PMJAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened. It subsumed the then existing Rashtriya Swasthya Bima Yojana (RSBY) which had been launched in 2008. The coverage mentioned under PM-JAY, therefore, also includes families that were covered in RSBY but are not present in the SECC 2011 database. PM-JAY is fully funded by the Government and cost of implementation is shared between the Central and State Governments.
- PMJAY is the world’s largest health insurance/assurance scheme fully financed by the government.
- It provides a cover of Rs 5 lakh 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.
- PMJAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
- PMJAY 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-hospitalisation and 15 days post-hospitalisation 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.
Eligibility of the scheme:
The inclusion of beneficiaries in the scheme is not through Registration. Instead, it is on the basis of information collated by the Socio Economic Caste Census 2011 (SECC 2011) and covers 9 crore families in rural areas and 2 crore families in urban areas.
While the yardstick for including beneficiaries in the rural areas differs from picking those in the urban areas, the general eligibility parameters followed in the SECC 2011 includes literacy rates, median household income, occupation type, type of housing and sanitation.
The beneficiaries in the rural areas are identified on the seven deprivations contained in the SECC database whereas in the urban areas, 11 occupational criteria are used to verify entitlement.
The SECC 2011 list of beneficiaries excludes government employees, people who own 5 acres or more of agricultural land, those who possess two, three or four wheelers or a mechanised fishing boat, those having Kisan cards with a Rs 50,000 credit limit, anyone who earns more than Rs 10,000 a month and anyone having a refrigerator and landline connections.