Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PMJAY)
Overview
of Ayushman Bharat : India’s commitment to Universal Health Coverage
Ayushman Bharat is
National Health Protection Scheme, which will cover over 10 crore poor & vulnerable
families (approximately 50 crore beneficiaries) providing coverage up to 5 lakh
rupees per family per year for secondary and tertiary care hospitalization
Rationale behind Ayushman
Bharat- Pradhan Mantri Jan Arogya Yojana (PMJAY)
· National Sample Survey Organization (NSSO) has found 85.9% of
rural households and 82% of urban households have no access to healthcare
insurance/assurance.
· More than 17% of Indian population spends 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.
Targeted beneficiaries and benefits
· PMJAY will target
poor, deprived rural families and identified occupational category
of urban workers’ families identified as per 2011 census. Additionally, all
such enrolled families under Rashtriya Swasthaya Bima Yojana (RSBY) that do not
feature above will be included as well.
· Approximately 10.74
crore identified families (approximately 50 crore beneficiaries) will be
entitled to get the benefits.
· The scheme is entitlement based. No formal
enrolment process is required.
· There is no cap on
family size and age as well as restriction on preexisting conditions.
· PMJAY will help
reduce out of pocket hospitalisation expenses, fulfill unmet needs and improve
access of identified families to quality inpatient care and day care surgeries
· 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).
·
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.
· PMJAY beneficiaries
will be able to move across borders and access services across the country
through the provider network seamlessly.
· The categories in
rural and urban that will be covered under PMJAY are given as follows:
For Rural:
o
Total deprived Households who belong to one of
the six categories. deprivation criteria amongst D1, D2, D3, D4, D5 and D7:
o
Only one room with kucha walls and kucha roof
(D1)
o
No adult member between age 16 to 59 (D2)
o
Female headed households with no adult male
member between age 16 to 59 (D3)
o
Disabled member and no able-bodied adult member
(D4)
o
SC/ST households (D5)
o
Landless households deriving major part of their
income from manual casual labour (D7)
o
Automatically included:
Ø Households
without shelter / Destitute/ living on alms / Manual scavenger families / Primitive
tribal groups / Legally released bonded labour
For Rural:
Total deprived Households who belong to one of
the six categories. 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
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
The official website
of Ayushman Bharat yojana is www.abnhpm.gov.in one may visit the site to view and download
the beneficiary eligibility and empanelled hospitals list as and when it gets
updated.
To check whether you are eligible, please visit link:
In nutshell, Ayushman Bharat can prove to be a magic wand if implemented properly and will save lakhs of Indian from clutches of poverty as they get free Medical Treatments.
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