Ayushman Bharat Yojana:
- Ayushman Bharat Yojana:
- Ayushman Bharat Yojana Eligibility Criteria for Rural and Urban People
- Who are Not Entitled to Health Coverage Under PMJAY Scheme?
- List of Critical Ailments Covered Under PMJAY Scheme
- How to Register for PMJAY Scheme?
- Documents Required to Apply for the Ayushman Bharat Yojana Scheme
- How to Download the Ayushman Bharat Yojana Card Online
- Ayushman Bharat Yojana Scheme: Medical Packages and Hospitalisation Process
Ayushman Bharat Yojana or “Healthy India” is a national initiative launched by Prime Minister Narendra Modi as the part of National Health Policy 2017, in order to achieve the vision of Universal Health Coverage (UHC). This initiative has been designed on the lines as to meet SDG and its underlining commitment, which is “leave no one behind”.Mission Karmayogi
AyushmanBharat is an attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service. Ayushman Bharat aims to undertake path breaking interventions to holistically address health (covering prevention, promotion and ambulatory care), at primary, secondary and tertiary level.
Ayushman Bharat (AB) is an attempt to move from a selective approach to health care to deliver comprehensive range of services spanning preventive, promotive, curative, rehabilitative and palliative care. It has two components which are complementary to each other. Under its first component, 1,50,000 Health & Wellness Centres (HWCs) will be created to deliver Comprehensive Primary Health Care, that is universal and free to users, with a focus on wellness and the delivery of an expanded range of services closer to the community. The second component is the Pradhan Mantri Jan Arogya Yojana (PM-JAY) which provides health insurance cover of Rs. 5 lakhs per year to over 10 crore poor and vulnerable families for seeking secondary and tertiary care.
HWC are envisaged to deliver expanded range services that go beyond Maternal and child health care services to include care for non -communicable diseases, palliative and rehabilitative care, Oral, Eye and ENT care, mental health and first level care for emergencies and trauma , including free essential drugs and diagnostic services
Ayushman Bharat adopts a continuum of care approach, comprising of two inter-related components, which are –
Establishment of Health and Wellness Centres
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
- Establishment of Health and Wellness Centres–The first component, pertains to creation of 1,50,000 Health and Wellness Centres which will bring health care closer to the homes of the people. These centres will provide Comprehensive Primary Health Care (CPHC), covering both maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.
- Pradhan Mantri Jan Arogya Yojana (PM-JAY) –PM-JAY is one significant step towards achievement of Universal Health Coverage (UHC) and Sustainable Development Goal – 3 (SDG3).It aims to provide health protection cover to poor and vulnerable families against financial risk arising out of catastrophic health episodes.
Pradhan Mantri Jan Arogya Yojana (PM-JAY) will provide financial protection (Swasthya Suraksha) to 10.74 crore poor, deprived rural families and identified occupational categories of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data (approx. 50 crore beneficiaries). It will have offer a benefit cover of Rs. 500,000 per family per year (on a family floater basis).
PM-JAY will cover medical and hospitalization expenses for almost all secondary care and most of tertiary care procedures. PM-JAY has defined 1,350 medical packages covering surgery, medical and day care treatments including medicines, diagnostics and transport.
To ensure that nobody is left out (especially girl child, women, children and elderly), there will be no cap on family size and age in the Mission. The scheme will be cashless & paperless at public hospitals and empaneled private hospitals. The beneficiaries will not be required to pay any charges for the hospitalization expenses. The benefit also includes pre and post-hospitalization expenses. The scheme is an entitlement based, the beneficiary is decided on the basis of family being figured in SECC database. When fully implemented, the PM-JAY will become the world’s largest government funded health protection mission.
Benefits of PM-JAY
Beneficiary Level –
- Government provides health insurance cover of up to Rs. 5,00,000 per family per year.
- More than 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries) covered across the country.
- All families listed in the SECC database as per defined criteria will be covered. No cap on family size and age of members.
- Priority to girl child, women and and senior citizens.
- Free treatment available at all public and empaneled private hospitals in times of need.
- Covers secondary and tertiary care hospitalization.
- 1,350 medical packages covering surgery, medical and day care treatments, cost of medicines and diagnostics.
- All pre-existing diseases covered. Hospitals cannot deny treatment.
- Cashless and paperless access to quality health care services.
- Hospitals will not be allowed to charge any additional money from beneficiaries for the treatment.
- Eligible beneificiares can avail services across India, offering benefit of national portability. Can reach out for information, assistance, complaints and grievances to a 24X7 helpline number – 14555
- Help India progressively achieve Universal Health Coverage (UHC) and Sustainable Development Goals (SDG).
- Ensure improved access and affordability, of quality secondary and tertiary care services through a combination of public hospitals and well measured strategic purchasing of services in health care deficit areas, from private care providers, especially the not-for profit providers.
- Significantly reduce out of pocket expenditure for hospitalization. Mitigate financial risk arising out of catastrophic health episodes and consequent impoverishment for poor and vulnerable families.
- Acting as a steward, align the growth of private sector with public health goals.
- Enhanced used to of evidence-based health care and cost control for improved health outcomes.
- Strengthen public health care systems through infusion of insurance revenues.
- Enable creation of new health infrastructure in rural, remote and under-served areas.
- Increase health expenditure by Government as a percentage of GDP.
- Enhanced patient satisfaction.
- Improved health outcomes.
- Improvement in population-level productivity and efficiency
- Improved quality of life for the population
What is PMJAY Scheme in Detail?
The primary aim of the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme is to provide health insurance coverage to approximately 50 crore citizens of India. Due to the requirement for better healthcare services to battle medical contingencies, the government of India introduced this health insurance scheme to secure the economically weaker sections of the country.
Moreover, the Ayushman Bharat Yojana offers an average coverage amount of ₹5 lakh to beneficiaries. This covers a majority of diagnostics, pre-hospitalisation costs, medicines, and medical treatment expenses. In addition to this, the cashless, as well as paperless services, work in favour of the nominees at any given point of time in their lives.
PMJAY scheme makes quality healthcare accessible to the poorest of poor families in India. Hence, the benefits offered by this health insurance plan are massive. Take a look at these features and benefits offered by the healthcare scheme to every family in need:
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. Like any other health plan, the Ayushman Bharat Yojana, 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 depend on the individuals’ living conditions, income, and other deprivations. Whereas for the urban areas, it is based on each individual’s occupation.
PMJAY Eligibility Critiera: 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.
In the rural areas, this health facility is available to:
- People belonging to scheduled caste and scheduled tribe families
- Households with no male member between the age of 16 years and 59 years
- Beggars and those surviving on alms
- Families with no individual between the age of 16 years and 59 years
- Households with no healthy adult individual and at least one physically challenged member
- Landless families who make a living by working as casual manual labourers
- Primitive tribal communities
- Legally released bonded labourers
- People living in one-room makeshift houses with no proper walls or roof
- Manual scavenger families
- Pre-hospitalisation expenses
- Post-hospitalisation expenses for up to 15 days
- Medical examination, consultation and treatment
- Intensive and non-intensive care services
- Medical consumables and medicines
- Diagnostic and laboratory investigations
- Any complications arising during treatment
- Medical implantation facility, only if required
- Food services
- Accommodation benefit
- Testing and treatment of COVID-19
Exclusions under this scheme:
- Drug rehabilitation programme
- Cosmetic related procedures
- Fertility related procedures
- Organ transplant
- Individual diagnostics (for evaluation purposes)
List of Critical Ailments Covered Under PMJAY Scheme
PMJAY scheme provides funding of ₹5 lakh per family annually. The benefit can be utilised for daycare procedures and even for pre-existing illnesses. Some of the critical illnesses covered in the plan are as follows:
- Prostate cancer
- Coronary artery bypass grafting
- Double valve replacement
- Carotid angioplasty with stent
- Pulmonary valve replacement
- Skull base surgery
- Laryngopharyngectomy with gastric pull-up
- Anterior spine fixation
- Tissue expander for disfigurement following burns
- COVID-19 treatment and testing
How to Register for PMJAY Scheme?
There is no specific process to register for the Ayushman Bharat Yojana. It applies to all beneficiaries as identified by the SECC 2011 and those who are already a part of the RSBY plan. In case you want to check whether you are eligible to be a beneficiary of the PMJAY scheme, follow the steps below:
Step 1: Visit the PMJAY government website (https://www.pmjay.gov.in/) and click on ‘Am I Eligible’.
Step 2: Enter your contact information and click on ‘Generate OTP’.
Step 3: Select your state and search by name/HHD number/ration card number/mobile number.
Step 4: Based on the results, you can verify whether your family is covered under the PMJAY scheme.
Moreover, to know about Ayushman Bharat Yojana eligibility, you can contact any Empanelled Health Care Provider (EHCP) or Ayushman Bharat Yojana call centre at 14555 or 1800-111-565.
Documents Required to Apply for the Ayushman Bharat Yojana Scheme
- A certified document confirming your age and identification
- Existing contact details of the buyer
- Income certificate
- Caste certificate
- A document stating the current family status
How to Download the Ayushman Bharat Yojana Card Online
The PMJAY beneficiaries can avail cashless health care services at any of the empanelled hospitals by simply using the Ayushman card. The beneficiaries are issued an Ayushman card at the time of registration. This e-card card contains all your necessary information and is mandatory to provide it when availing the treatments under the scheme.
CTo get the Ayushman card, follow the below steps:
Step 1: Visit the official PMJAY website.
Step 2: Login with your registered contact number.
Step 3: Enter the captcha code and generate the OTP (One-Time-Password).
Step 4: Opt for the HHD code.
Step 5: Provide the correct HHD code to the Common Service Centre (CSC) of PMJAY.
Step 6: They will check and verify the details provided.
Step 7: The PMJAY CSC representative (also known as Ayushman Mitra) will complete the remaining process.
Step 8: You will have to pay ₹30 to get the Ayushman card.
Ayushman Bharat Yojana Scheme: Medical Packages and Hospitalisation Process
Individuals, 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:
However, you cannot reimburse medical and surgical expenses simultaneously. In the case of multiple surgeries, the surgery with the highest cost is paid in the first instance; then a 50% waiver is offered for the second surgery and a 25% discount on the third.
Additionally, unlike other health insurance plans , PMJAY has no waiting period for pre-existing illnesses. This service comes under a larger umbrella scheme of Ayushman Bharat Yojana. So, in case you or any of your loved ones need immediate medical assistance, you do not have to worry about the expenses incurred. However, make sure that the individual seeking treatment is admitted to a network government or private hospital.
Moreover, this scheme also provides cashless treatment and hospitalisation, primarily because of the 60:40 cost-sharing agreement between the Centre and States. Once you are recognised under the plan, you and your family members will be issued the Ayushman card by professionals identified as Ayushman Mitras. The PMJAY or Ayushman card is an e-card that allows you to avail the benefits of Pradhan Mantri Jan Arogya Yojana at any of the network hospitals.
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