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

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

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana also referred as Ayushman Bharat National Health Protection Scheme of the Government of India which aims to provide free access to healthcare facilities for 50 crore people in the country.

PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government of India providing a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization.

Need for Ayushman Bharat Yojana

• In this world of Digitalization in India about 86% of rural households and 82% of urban households do not have access to healthcare insurance.
• Over 18% of the country’s population spend a minimum of 1/10th of their household budgets on availing medicines and other health care services.
• Unexpected and critical healthcare problems often lead families to debt. Over 18% and over 23% of the urban and rural households respectively meet their healthcare financial needs through borrowings from money lenders. Even sometimes they have to pledge their precious gold to pawnbrokers.

To address these solemn concerns, the central government of India, under the National Health Policy 2017, launched the Ayushman Bharat programme

Details of Pradhan Mantri Jan Arogya Yojana

• The scheme offers eligible families a cashless and paperless insurance cover of Rs. 5 lakh per annum per family.
• This amount is intended to cover all secondary (When anyone needs additional care without hospitalization) and most tertiary care (those needing specialist treatment requiring hospitalization) expenditures incurred.
• There is no cap on family size and age under the scheme, to ensure that nobody is left behind but the sum assured is fixed i.e. 5 lakh rupees.
• It covers 3 days of pre-hospitalization and 15 days of post-hospitalization, including diagnostic care and expenses on medicines.
• All previous medical conditions are covered under the scheme.
• One can avail all these facilities at both public and private hospitals (it must be empaneled with this scheme).

Pradhan Mantri Jan Arogya Yojana Eligibility Criteria

The eligible families are fixed based on the deprivation criterion in the Socio-Economic Caste Census (SECC) database.

The detailed categories in both Rural and Urban areas are given below:

1. Families with only 1 room with kutcha roof and walls.
2. Female headed households with no adult male member between ages 16 to 59.
3. Households with no adult members between the ages of 16 and 59.
4. SC/ST households.
5. Landless households that depend on major part of their income from manual casual labor.
6. Families in rural areas having any one of the following: households without shelter, manual scavenger families, primitive tribal groups, destitute, living on alms, legally released bonded labor.
7. For urban areas, 11 defined occupational categories are entitled under the scheme.

• Beggar/Rag picker/Domestic worker
• Painter/Welder/Security guard
• Construction worker/Plumber/Mason/Laborer
• Street vendor/hawker/cobbler/Other service provider working on the streets
• Electrician/Mechanic/assembler/repair worker/Washer man/Chowkidar
• Shop worker/assistant/Peon in small establishment/Helper/delivery assistant/Attendant/waiter
• Transport worker/driver/conductor/helper to driver and conductor/Cart puller/rickshaw puller
• Artisan/handicrafts worker/Tailor
• Mali/home-based worker
• Sweeper/sanitation worker
• Coolie and other head-load worker

8. According to the data in the SECC 2011, certain beneficiaries are excluded. They include households with a motorized vehicle 2/3/4 wheeler, having fishing boat, who pay income tax/professional tax, with a refrigerator, landline phone, have a earning member who earns more than Rs.10000 per month, who owns land above a certain limit, government servants, etc.

Scheme Benefits

• Hospitalization expenses – including registration, nursing, and boarding charges in a general ward – are all covered by the insurance policy.
• The scheme also takes care of surgical equipment, consultation fees, and procedure charges, as well as cost of implants, medicines, diagnostic tests, and food for patients during their hospital stay.
• It will reduce medical expenditure for many families.
• Eligible families can avail quality medical services without getting into any trouble or debt.
• The insurance cover provided by this scheme includes many of the aspects that are generally excluded from standard medi-claims provided by other insurance companies (for example, pre-existing conditions, internal congenital diseases, and mental health conditions).
• This scheme has the potential to initiate wide reforms in India’s healthcare system.
• One of the report claims that after one year of the scheme’s beginning, beneficiary families are said to have saved over Rs.13000 crores by utilizing Ayshman Bharat Scheme.
• Economically weaker sections of society can have access to quality healthcare services without financial hardships.
• The scheme has also resulted in the creation of more jobs. In 2018, it generated more than 50000 jobs. This number is expected to increase as the government is planning to build 1.5 lakh Health and Wellness Centers (HWCs) by 2022.

Implementation Strategy

As this Schemes has to be implemented at the national level, to manage this nationwide program a National Health Agency has been set up. States/ UTs are advised to implement the scheme by a dedicated entity called State Health Agency (SHA).

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