The Ayushman Bharat Yojana Scheme is introduced by the central government of India on 23rd September, 2018. It is a health insurance scheme that aims to provide health coverage to the poor and lower section people. Here know important details of the scheme.
Now a landmark have been achieved in this scheme. Till now one crore subscribers have joined this scheme. Know the complete details and the features of this Ayushman Bharat yojana scheme.
Ayushman Bharat reaches 1 crore Beneficiaries milestone:
- Over one crore treatments worth Rs 13,412 crore were provided under Ayushman Bharat Yojana health insurance scheme since its launch in September 2018, even as hospitalization was heavily impacted during April and May due to the nationwide lockdown amid Covid-19 outbreak.
- PM Modi had a telephonic conversation with the Pooja Thapa from Meghalaya, the 1 croreth beneficiary of the scheme.
What is Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY)
India takes a giant leap towards providing accessible and affordable healthcare to the common man with the launch of Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) by the Prime Minister, Shri Narendra Modi on 23rd September, 2018 at Ranchi, Jharkhand. Under the vision of Ayushman Bharat, Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) shall be implemented so that each and every citizen receives his due share of health care.
The Ayushman Bharat yojana programme was launched in 2018 to address health issues at all levels – primary, secondary and tertiary. It has two components:
- Health and Wellness Centres (HWCs).
- Pradhan Mantri Jan Arogya Yojana (PM-JAY), earlier known as the National Health Protection Scheme (NHPS).
Ayushman Bharat yojana scheme is the largest government-funded healthcare programme in the world with over 50 crore beneficiaries.
Health and Wellness Centers (HWCs)
In February 2018, the Government of India announced the creation of 1,50,000 Health and Wellness Centres (HWCs) by transforming the existing Sub Centres and Primary Health Centres. These centres are to deliver Comprehensive Primary Health Care (CPHC) bringing healthcare closer to the homes of people. They cover both, maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Ayushman Bharat Yojana scheme, 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 10.74 crores poor and vulnerable families (approximately 50 crore beneficiaries) that form the bottom 40% of the Indian population. The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.
- PM-JAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened.
- It subsumed the then existing Rashtriya Swasthya Bima Yojana (RSBY) which had been launched in 2008.
- The coverage mentioned under PM-JAY, therefore, also includes families that were covered in RSBY but are not present in the SECC 2011 database.
- PM-JAY is fully funded by the Government and cost of implementation is shared between the Central and State Governments.
Need for Ayushman Bharat
- The 71st round of the National Sample Survey Office (NSSO) revealed many grim numbers about the country’s healthcare system.
- About 86% of rural households and 82% of urban households do not have access to healthcare insurance.
- Over 17% of the country’s population spend a minimum of 1/10th of their household budgets on availing health services.
- Unexpected and serious healthcare problems often lead families to debt.
- Over 19% and over 24% of the urban and rural households respectively meet their healthcare financial needs through borrowings.
- To address these grave concerns, the government, in accordance with the National Health Policy 2017, launched the Ayushman Bharat yojana scheme along with its two sub-missions, PMJAY and HWCs.
Key Features of PM-JAY
- ayushman Bharat yojana scheme is the world’s largest health insurance/ assurance scheme fully financed by the government.
- 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.
- Over 10.74 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
- PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
- PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.
- It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
- There is no restriction on the family size, age or gender.
- All pre–existing conditions are covered from day one.
- 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.
- Services include approximately 1,393 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.
- Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
Benefit Cover Under PM-JAY
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 this Ayushman Bharat yojana health insurance 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
The benefits of INR 5,00,000 are on a family floater basis which means that it can be used by one or all members of the family. The RSBY had a family cap of five members. However, based on learnings from those schemes, PM-JAY has been designed in such a way that there is no cap on family size or age of members.
In addition, pre-existing diseases are covered from the very first day. This means that any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.
