Launched By – Prime Minister Narendra Modi
Objective of this scheme:
- The objectives of the scheme are to reduce out of pocket hospitalisation expenses, fulfil unmet needs and improve access of identified families to quality inpatient care and surgeries.
- The scheme aims to provide annual health cover of Rs 5 lakh to 10.74 crore beneficiaries ‘families.
- Touted as the world’s biggest health insurance scheme which would benefit over 50 crore Indians
Aims of this Scheme
- Around 10.74 crore poor and vulnerable families whose name appears in the SECC-2011 data are elegibile.
- There is no cap on family size and age.
- Benefits will be portable across country.
- Around 85% of rural families and 60% of urban families have already been identified.
- 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 benefit cover will also include pre and post-hospitalisation expenses. All pre-existing conditions will be covered from day one of the policy.
Facts of this Scheme:
- 7 states have choosen to implement this AB-PMJAY (Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana) Scheme in Insurance Mode, 18 in Trust Mode, 9 in Mixed Mode and 2 states (Telangana & Odisha) have still not decided.
- A Baby girl was born in East Singbhum Sadar Hospital in Jamshedpur to 22 year old Poonam Mahto – the first beneficiary of the health programme after its official rollout.
- The NHA has also started a website mera.pmjay.gov.in and a helpline number 14555 where prospective beneficiaries can call and check whether they are eligible for the scheme.
- The scheme allows the beneficiary to take cashless benefits from any public or private empanelled hospitals across the country.
- For beneficiaries, it will be a cashless and paper less transaction.
- Indu Bhushan is the CEO of this Scheme.
- A defined transport allowance per hospitalisation will also be paid to the beneficiary.
- No enrolment is required for beneficiaries to avail benefits of NPS (National Health Protection) Scheme.
- Pre- and post-hospitalisation expenses will be covered, but within the total limit of Rs 5 lakh.
- Family members can be added after the government’s approval.
- About 7,826 hospitals have joined the PMJAY network so far, of which 47 per cent are private and the rest are public hospitals.
Which State Is The Best And The Worst?
- Mizoram’s per capita health expenditure is Rs 5,862, almost five times the Indian average, with the state spending 4.2 percent of its GDP on health in 2015. Arunachal Pradesh (Rs 5,177) and Sikkim (Rs 5,126) followed at the top.
- Bihar spent Rs 491 per capita on health, less than half the Indian average, spending 1.33 percent of its GDP on health. Just above Bihar were Madhya Pradesh (Rs 716) and Uttar Pradesh (Rs 733).
Who all can avail of the scheme?
- The beneficiaries are identified based on the deprivation categories on the basis of deprivation criteria in the SECC database. (D1, D2, D3, D4, D5, and D7).
- Families having only one room with Kucha walls and Kucharoof.
- Families having no adult member between age of 16 to 59.
- SC/ST Households.
- For urban areas, 11 defined occupational categories entitled under the scheme.
- In addition, the Rashtriya Swasthya Bima Yojna (RSBY) beneficiaries in states where it is active are also included.
What is the procedure?
- 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.
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