AYUSHMAN BHARAT PM JAY IN ENGLISH

                                       

                      AYUSHMAN BHARAT PM JAY IN ENGLISH

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AYUSHMAN BHARAT PM JAY

Ayushman Bharat sheme was launched in 2018 and it adopts a continuum of care approach, comprising of two inter-related components, which are -

1.    Establishment of Health and Wellness Centres

2.    Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Pradhan Mantri Jan Arogya Yojana (PM-JAY)

•        The second component under Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojna or PM-JAY as it is popularly known. This scheme was launched on 23rd September, 2018 in Ranchi, Jharkhand by the Hon’ble Prime Minister of India, Shri Narendra Modi.

•        Ayushman Bharat PM-JAY is the largest health assurance scheme in the world which aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 12 crores poor and vulnerable families. 

•        It is estimated that approximately 55 crore beneficiaries will be benefitted form the bottom 40% of the Indian population by this scheme 

•        PM-JAY is fully funded by the Government and cost of implementation is shared between the Central and State Governments. Nodal Agency: National Health Authority (NHA) at the center and State Health Agencies (SHA) at the state level.

PM-JAY (key features)

1.    PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government.

2.    It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.

3.    Over 12 crore poor and vulnerable entitled families (approximately 55 crore beneficiaries) are eligible for these benefits.

4.    PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.

5.    PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.

6.    It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.

7.    There is no restriction on the family size, age or gender.

8.    All pre–existing conditions are covered from day one.

9.    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.

10.Services include approximately 1,929 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.

11.Public hospitals are reimbursed for the healthcare services at par with the private hospitals.

PM-JAY ( benefits)

•        PM-JAY provides cashless cover of up to INR 5,00,000 to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment.

•        Medical examination, treatment and consultation

•        Pre-hospitalization

•        Medicine and medical consumables

•        Non-intensive and intensive care services

•        Diagnostic and laboratory investigations

•        Medical implantation services (where necessary)

•        Accommodation benefits

•        Food services

•        Complications arising during treatment

•        Post-hospitalization follow-up care up to 15 days

PM-JAY ( beneficiary)

•        Beneficiary Eligibility is primarily based on the Socio-Economic Caste Census (SECC 2011) data. As of 2024–2026, a major expansion also includes all senior citizens aged 70+

Rural Criteria (Category-based)

•        Families living in one-room houses with "kucha" (non-durable) walls and roofs.

•        Families with no adult male member aged 16–59.

•        Female-headed households with no adult male member aged 16–59.

•        Families with at least one disabled member and no able-bodied adult member.

•        SC/ST households.

•        Landless households deriving a major part of their income from manual casual labor.

Urban Criteria (Occupation-based)

Eligibility in urban areas is defined by 11 occupational categories:

•        Domestic workers, Ragpickers, and Beggars.

•        Street vendors, Cobblers, and Hawkers.

•        Construction workers, Masons, Painters, and Plumbers.

•        Sweepers, Sanitation workers, and Gardeners.

•        Transport workers (Drivers, Conductors, Helpers).

•        Shop workers, Peons, and Delivery assistants.