PMJAY (Ayushman Bharat or AB-NHPM)
Pradhan Mantri Jan Arogya Yojana-PMJAY (Ayushman Bharat or AB-NHPM)
- Ayushman Bharat, the government-sponsored health insurance scheme, will provide free coverage of up to Rs 5 lakh per family per year in any government or even empanelled private hospitals all over India.
- Launched with an aim to help the poor and the economically deprived, the scheme will be available for 10.74 crore beneficiary families and about 50 crore Indian citizens.
- This scheme will strengthen the healthcare services in India. Around 13000 hospitals in the country have been coordinated for the implementation of the scheme.
- The Ayushman Bharat programme will be funded with 60 percent contribution from the Centre and the remaining from the states.
- The scheme aims to target poor and vulnerable population of the country, based on the Socio Economic and Caste Census 2011 (SECC) database. There will be no cap on family size and age in the scheme.
The benefit cover will also include pre and post-hospitalisation expenses. All pre-existing conditions will be covered from day one of the policy.
- A defined transport allowance per hospitalisation will also be paid to the beneficiary.
- The scheme allows the beneficiary to take cashless benefits from any public or private empanelled hospitals across the country.
- The payment for treatment will be done on package rate which will be defined by the Government in advance basis. The package rates will include all the costs associated with treatment. The States and UTs will have the flexibility to modify these rates within a limited bandwidth.
- For beneficiaries, it will be a cashless and paper less transaction.
- The scheme will work in partnership with NITI Aayog to operationalise a robust, modular and interoperable IT platform which will involve a paperless and cashless transaction.
- The National Health Agency (NHA), the apex body implementing the scheme, has launched a website (mera.pmjay.gov.in).
Who all can avail of the scheme and how?
The Ayushman Bharat is an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database.
Here are the different categories of families in rural areas that can be covered under the scheme:
- The beneficiaries are identified based on the deprivation categories (D1, D2, D3, D4, D5, and D7). These are:
- Families having only one room with kucha walls and kucharoof
- Families having no adult member between age 16 to 59
- Female headed households with no adult male member between age 16 to 59
- Disabled member and no able bodied adult member in the family
- SC/ST households.
- Landless households deriving major part of their income from manual casual labour.
- The scheme will automatically include families in rural areas having any one of thefollowing- households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups or legally released bonded labour.
- For urban areas, 11 defined occupational categories are entitled under the scheme.
- In addition, the Rashtriya Swasthya Bima Yojna (RSBY) beneficiaries have also been included.
- There is no cap on family size and age in the scheme.
One would only need to establish one’s identity to avail benefits under the scheme and it could be through Aadhaar card or election ID card or ration card. Having an Aadhaar card is not mandatory.
All the beneficiaries will be given letters having QR codes which will be scanned. A demographic authentication will be conducted for identification to verify his or her eligibility to avail the benefits of the scheme.
In case of hospitalisation, members of the beneficiary families do not need to pay anything under the scheme, provided if one goes to a government or an empanelled private hospital.
- The beneficiaries can avail of the benefits in both public and empanelled private facilities. All public hospitals in the States implementing the scheme will be considered empanelled for the Scheme.
- Hospitals belonging to Employee State Insurance Corporation (ESIC) will also be empanelled based on the bed occupancy ratio parameter.
- Each empanelled hospital will have an ‘Ayushman Mitra help desk’ where a prospective beneficiary can check documents to verify the eligibility and enrolment to the scheme.
Check your Name
Apart from this, people can check on the website at http://mera.pmjay.gov.in whether their name is in the list or not.