AYUSHMAN BHARAT- PRADHAN MANTRI JAN AROGYA YOJANA
AB-PMJAY


1.      Overview of the Mission

 

o   Ayushman Bharat: India’s commitment to Universal Health Coverage. Ayushman Bharat is a fundamental restructuring of the manner in which beneficiary’s access healthcare services at the primary, secondary and tertiary care levels. It represents a transition from segmented, sectoral and fragmented program implementation models towards a comprehensive, holistic, need-based healthcare system.

 

o   Ayushman Bharat encapsulates a progression towards promotive, preventive, curative, palliative and rehabilitative aspects of Universal Healthcare through access of Health and Wellness Centers (HWCs) at the primary level and provisioning of financial protection for accessing curative care at the secondary and tertiary levels through engagement with both public and private sector. 

 

2.      Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (PMJAY):

 

o   71st Round of National Sample Survey Organization (NSSO) has found 85.9% of rural households and 82% of urban households have no access to healthcare insurance/assurance.

 

o   More than 17% of Indian population spend at least 10% of household budgets for health services. Catastrophic healthcare related expenditure pushes families into debt, with more than 24% households in rural India and 18% population in urban area have met their healthcare expenses through some sort of borrowings. 

 

o   Approximately 10.74 crore identified families (approximately 50 crore beneficiaries) are entitled to get the scheme benefits in the Country.

 

o   There is no cap on family size and age as well as restriction on pre-existing conditions.

 

o   PMJAY will help reduce out of pocket hospitalisation expenses, fulfil unmet needs and improve access of identified families to quality inpatient care and day care surgeries

o   PMJAY will provide a coverage up to Rs.5,00,000 per family per year, for secondary and tertiary care hospitalization through a network of Empanelled Health Care Providers (EHCP).

 

o   The EHCP network will provide completely cashless and paperless access to services for the beneficiaries at the both public and private hospitals. The services will include 1350 procedures covering pre and post hospitalization, diagnostics, medicines etc.

 

o   PMJAY beneficiaries will be able to move across borders and access services across the country through the provider network seamlessly.

 

o   The scheme is entitlement based. No formal enrolment process is required.

 

o   PMJAY will target poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) 2011 data, both rural and urban. Additionally, all such enrolled families under Rashtriya Swasthaya Bima Yojana (RSBY) that do not feature in the targeted groups as per SECC data will be included as well. 

 

o   The categories in rural and urban that will be covered under PMJAY are given as follows:

 

    For Rural:

·         Total deprived Households targeted for PMRSSM who belong to one of the six deprivation criteria amongst D1, D2, D3, D4, D5 and D7:

·         Only one room with kucha walls and kucha roof (D1)

·         No adult member between age 16 to 59 (D2)

·         Female headed households with no adult male member between age 16 to 59 (D3)

·         Disabled member and no able-bodied adult member (D4)

·         SC/ST households (D5)

·         Landless households deriving major part of their income from manual casual labour (D7)

Automatically included:

·         Households without shelter

·         Destitute/ living on alms

·         Manual scavenger families

·         Primitive tribal groups

·         Legally released bonded labour

 

    For Urban:

·         Occupational Categories of Workers

·         Rag picker

·         Beggar

·         Domestic worker

·         Street vendor/ Cobbler/hawker / Other service provider working on streets

·         Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/

·         Coolie and another head-load worker

·         Sweeper/ Sanitation worker / Mali

·         Home-based worker/ Artisan/ Handicrafts worker / Tailor

·         Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller

·         Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter

·         Electrician/ Mechanic/ Assembler/ Repair worker

·         Washer-man/ Chowkidar

 

o   As per the SECC 2011, the following beneficiaries are automatically excluded: 

·         Households having motorized 2/3/4 wheeler/fishing boat

·         Households having mechanized 3/4 wheeler agricultural equipment

·         Households having Kisan Credit Card with credit limit above Rs. 50,000/- 

·         Household member is a government employee

·         Households with non-agricultural enterprises registered with government 

·         Any member of household earning more than Rs. 10,000/- per month

·         Households paying income tax

·         Households paying professional tax

·         House with three or more rooms with pucca walls and roof

·         Owns a refrigerator 

·         Owns a landline phone

·         Owns more than 2.5 acres of irrigated land with 1 irrigation equipment

·         Owns 5 acres or more of irrigated land for two or more crop season

·         Owning at least 7.5 acres of land or more with at least one irrigation equipment

 

3.      Gujarat:

 

·         In Gujarat a total 44.85 lakh (Rural- 28.28 lakh and Urban- 16.56 lakh) households are been covered

·         More than 1900 hospital have been registered under AB-PMJAY and are still increasing day by day.

·         At the State level toll free no. is 1800-233-1022 and at the national level 14555/1800111565.