What exactly is the Pradhan Mantri Jan Arogya Yojana?
The Pradhan Mantri Jan Arogya Yojana (PMJAY), often known as the Ayushman Bharat program, is a health insurance program for low-income and backward-class households. The PMJAY plan is India's largest Universal Health Coverage (UHC) scheme, providing health insurance coverage of Rs.5 lakhs to about 50 crore participants, or 10.74 crore impoverished households.
Eligibility of PMJAY
Beneficiaries for the plan are chosen based on occupational and deprivation criteria from the 2011 Socio-Economic Caste Census (SECC) conducted in rural and urban regions. As a result, the PMJAY plan can only cover qualifying families and individuals. So, the PMJAY qualifying conditions are as follows:
- Families enrolled in the Rashtriya Swasthya Bima Yojana (RSBY) program, which launched in 2008.
- Individuals who fall under the SC/ST category would be covered under PMJAY even if they are not in the SECC database
- Poor homes with no male members between the ages of 16 and 59.
- Beggars who rely on alms
- Poor households with no members between the ages of 16 and 59. Households with at least one physically challenged member but no healthy adult
- Families that do not own property and rely on informal labour to make ends meet
- Bonded labourers who have been legally released
- Families of manual scavengers
- Traditional tribal communities
- Individuals who live in one-room makeshift dwellings with no permanent walls or ceiling
In the urban areas, coverage under the PMJAY scheme can be availed by following-
Rag pickers, Washermen, Chowkidars, Domestic help, gardeners, sanitation workers, etc.
There are no restrictions on the scheme's entry age, number of members covered, or exit age for eligible beneficiaries.
Individuals who own any type of vehicle, have mechanized farming equipment, are employed by the government, have a Kisan card with an Rs.50,000 limit, earn Rs.10,000 or more per month, work in government-managed non-agricultural enterprises, own refrigerators, and landlines, 5 acres of agricultural land, or live in decently built houses are not eligible for the PMJAY scheme.
Ayushman Bharat, a flagship plan of the Government of India, is an attempt to transition from a sectoral approach to health service delivery to a need-based health care service. This project intends to implement initiatives to address the healthcare system holistically (prevention, promotion, and ambulatory care) at the primary, secondary, and tertiary levels. Ayushman Bharat uses a continuum of care strategy that includes two interconnected components.
1 Health and Wellness Centres (HWCs)- The Government of India announced in February 2018 the development of 1,50,000 Health and Wellness Centres (HWCs) by revamping existing Sub Centres and Primary Health Centres. These centres will provide Comprehensive Primary Health Care (CPHC), bringing healthcare closer to people's homes. They include free vital medications and diagnostic services, as well as maternity and child health care and non-communicable diseases.
The goal of health and wellness centres is to provide a wider range of services to meet the primary healthcare requirements of the local population as a whole, increasing accessibility, universality, and equity near the community. The goal of health promotion and prevention is to keep people healthy by motivating and enabling people to make healthy decisions and alter their lifestyles in order to lower their chance of contracting chronic illnesses and morbidities.
2 Pradhan Mantri Jan Arogya Yojana (PM-JAY)- PM-JAY is the largest health assurance scheme in the world, providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crore poor and vulnerable families. It is fully funded by the Government and the cost of implementation is shared between the Central and State Governments.
How to register for PMJAY?
The government has automatically registered identified beneficiaries in the PMJAY plan. A health card has been provided to designated families, and by showing the card at the time of hospitalisation, they can get cashless treatments. You can determine your eligibility for the plan by visiting a Common Service Centre (CSC), phoning the helpline number 14555 or 1800 111 565, or visiting the official PMJAY website.
Following documents, you need to submit for applying for PMJAY-
- Certified document with your identification and age
- Income certificate
- Caste certificate
- Document to show your current family status
- Contact details
How do you file a claim under PMJAY?
The PMJAY claim procedure is quite simple.
You must locate an impaneled hospital that provides PMJAY treatments.
When you are admitted to the hospital, present your PMJAY health card as identification.
You would not have to pay for your own medical expenditures since the system would cover them.
The PMJAY plan is a welfare program that attempts to give quality medical care to the needy and poor in times of medical emergency.
Benefits Covered Under PM-JAY
Benefits coverage under different government-funded health insurance plans in India has traditionally been organised on an upper ceiling limit varying from INR30,000 to INR3,000,000 per family across several States, resulting in a fragmented system. PM-JAY offers cashless coverage of up to INR5,00,000 per year to each qualified household for designated secondary and tertiary care conditions. The scheme's coverage includes all fees incurred on the following therapy components.
- Medical examination, treatment, and advice
- Medicine and medical supplies
- Services for non-intensive and intensive care
- Laboratory and diagnostic testing
- Services for medical implantation (where necessary)
- Accommodation advantages
- Catering services
- Complications that occur during treatment
- Follow-up treatment after hospitalisation for up to 15 days
The AB-PMJAY provides a once-in-a-lifetime chance to enhance the health of hundreds of millions of Indians while also eliminating a key cause of poverty. However, significant hurdles must be solved in order for these advantages to be realised by the Indian people for the plan to make a lasting contribution to India's development towards UHC. To do this, the scheme's success will be dependent on addressing the Indian system's existing and interconnected structural shortcomings, including public and private sector governance, stewardship, quality control, and health system organisation. This will need extensive change, intervention, and leadership at all levels of the system.
References: NHA Website
Author - Kunjal Jain