Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

 Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a Centrally Sponsored Scheme having central sector component under Ayushman Bharat Mission anchored in the Ministry of Health and Family Welfare (MoHFW). It is an umbrella of two major health initiatives, namely Health and wellness Centres and National  Health Protection Scheme


National Health Protection Mission (AB-PMJAY)

Benefits

AB-PMJAY provides a defined benefit cover of Rs. 5 lakh per family per year. This cover will take care of almost all secondary care and most of tertiary care procedures.

To ensure that nobody is left out (especially women, children and elderly) there will be no cap on family size and age in the scheme.

The benefit cover will also include pre and post-hospitalisation expenses. All pre-existing conditions will be covered from day one of the policy. A defined transport allowance per hospitalization will also be paid to the beneficiary.

Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.

The beneficiaries can avail benefits in both public and empanelled private facilities. All public hospitals in the States implementing AB-PMJAY, will be deemed empanelled for the Scheme. Hospitals belonging to Employee State Insurance Corporation (ESIC) may also be empanelled based on the bed occupancy ratio parameter. As for private hospitals, they will be empanelled online based on defined criteria.

To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis. The package rates will include all the costs associated with treatment. For beneficiaries, it will be a cashless, paper less transaction. Keeping in view the State specific requirements, States/ UTs will have the flexibility to modify these rates within a limited bandwidth.

Ayushman Bharat Yojana Eligibility Criteria for Rural and Urban People

As we know, over 10 crore families across the country will be provided basic health care under the PMJAY scheme. Among the 10 crore families, almost 8 crore families belong to the rural areas while the remaining are from the urban areas. If we break the statistics even further, the scheme will be beneficial to over 50 crore individuals.

Now, just like any other health plan, the PMJAY scheme too has certain pre-conditions. Depending on these pre-conditions, it decides who can avail the health coverage benefits. When it comes to rural areas, the eligibility criteria mainly depends on the individuals’ living conditions, income, and other deprivations. Whereas for the urban areas, it is based on each individual’s occupation

PMJAY Eligibility Criteria: Rural

According to the 71st round of the National Sample Survey Organisation, over 85.9% of people in rural areas do not have access to basic healthcare plans. Moreover, 24% of the rural population seeks healthcare facilities by borrowing money.

This is where the Pradhan Mantri Jan Arogya Yojana scheme comes in handy. It helps these people avoid getting into a debt trap and avail health facilities. This scheme is economically beneficial to underprivileged households. Also, the families enrolled under the Rashtriya Swasthya Bima Yojana (RSBY) will be covered under the PMJAY scheme

Which hospital will benefit?

All the government and hospitals in the country connected with Ayushman Bharat Yojana will get benefit of Ayushman Bharat Yojana. The connection of 8,000 hospitals has been completed in Ayushman Bharat Yojana and the Government aims to connect 20,000 hospitals. So that the poorest family living in any corner of the country can access health services near their home. In India, more than 1700 government and private hospitals will provide medical treatment under aging India.
Important Link :

Ayushman Bharat Yojana Scheme: Medical Packages and Hospitalisation Process  Idividuals, as well as families, can utilise the health coverage of ₹5 lakh provided under the Pradhan Mantri Arogya Scheme. This sum is enough to cover surgical treatments and medical expenses in almost 25 specialities that include:

Cardiology

Neurology

Oncology

Paediatrics

Orthopaedics