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PMJAY-Ayushman Bharat Scheme

The programme is being touted as the world’s largest health protection scheme.

The scheme has two pillars under it –

  1. Ayushman Bharat (AB) –  5 lakhs health sub-centres will be converted into health and wellness centres.
  2. National Health Protection Mission (NHPM) – Provides health cover of Rs. 5 lakhs per family, per annum, reaching out to 50 crore beneficiaries.
  • The benefits of the scheme are portable across the country for secondary and tertiary care hospitalisation.
  • Also, a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
  • Coverage – The scheme will aim to target over 10 crore f

Scheme:

  • PMJAY is government-sponsored health insurance scheme, that will provide free coverage of up to Rs 5 lakh per family per year in any government or impaneled private hospitals all over India.
  • It will cover beneficiaries families identified on the basis of the Socio-Economic Caste Survey (SECC) 2011 in 444 districts of 30 states/Union Territories.
  • National Health Agency (NHA) is the apex body for implementing this scheme. 
  • States will be required to form the State Health Agency (SHA) to implement the scheme and at the district level also structure for its implementation will be set up. 
  • Around 13000 hospitals both public and private in the country have been coordinated for implementation of the scheme.
  • PMJAY will be funded with 60% contribution from the Centre and remaining from the states.
  • NITI Aayog will be working as a partner for this scheme for operationalizing robust, modular and interoperable IT platform which will involve a paperless and cashless transaction.
  • PMJAY is entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SEC database.
  • There will be no cap on family size and age under this scheme. 
  • The benefit cover under it also includes pre and post-hospitalisation expenses.
  • It also takes into consideration all pre-existing medical conditions. 
  • It will provide reimbursement for bed charges and drugs and diagnostics two days before, during and 15 days after hospitalisation. Beneficiary will be also paid transport allowance for hospitalisation defined under it.
  • The payment for treatment will be done on package rate which will be defined by Government in advance basis. 
  • The package rates will include all costs associated with treatment. 
  • States and UTs have flexibility to modify these rates within limited bandwidth.
  • PMJAY allows national portability i.e. resident of any part of country is entitled for free hospitalization at empanelled hospital anywhere in the country. 
  • It will strengthen healthcare services in India by targeting poor and vulnerable population of the country.
  • The scheme allows beneficiary to take cashless benefits from any public or private empanelled hospitals across the country. 
  • ID documentation required for verifying beneficiary under this scheme may be Aadhaar card or election ID card or ration card. 
  • Aadhaar is not mandatory. 
  • Beneficiaries will QR codes having letters for verification through scanning.
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