Wednesday, October 12

PM's Largest Health Assurance Scheme

PM's Largest Health Assurance Scheme

Today we are going to discuss about Ayushman Bharat scheme ,yes here we need to know more about  Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, which provides health insurance cover of Rs. 500,000 to more than 500 million poor and vulnerable persons, was launched on 23rd september 2018.

In less than 20 months, the scheme has achieved a landmark of 1 crore above hospitalizations. The vision of pm-jay for the next five years is achieving SDG 3.8: ensuring financial protection against catastrophic health expenditure and access to affordable and quality healthcare for all  and the the mission of pm-jay for the next five years is creating the world s best health assurance programme on an efficient and technologically robust ecosystem.

Ayushman Bharat pm-jay is the largest health assurance scheme in the world which aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crores poor and vulnerable families (approximately 50 crore beneficiaries) that form the bottom 40% of the Indian population. This scheme aims to undertake path breaking interventions to holistically address the healthcare system (covering prevention, promotion and ambulatory care) at the primary, secondary and tertiary level.

Ayushman Bharat is an attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service. Ayushman Bharat adopts a continuum of care approach, comprising of two inter-related components. The coverage mentioned under pm-jay, therefore, also includes families that were covered in RSBY but are not present in the SECC 2011 database. Pm-jay is fully funded by the government and cost of implementation is shared between the central and state governments.

The households included are based on the deprivation and occupational criteria of socio-economic caste census 2011 (SECC 2011) for rural and urban areas respectively. Pm-jay was earlier known as the National Health Protection Scheme (NHPS) before being rechristened. It subsumed the then existing Rashtriya Swasthya BimaYojana (RSBY) which had been launched in 2008.

Key features of  PM - JAY pm-jay

  • Pm-jay is the world’s largest health insurance/ assurance scheme fully financed by the government.
  • It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
  • Over 10.74 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
  • Pm-jay provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
  • Pm-jay envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.
  • It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
  • There is no restriction on the family size, age or gender.
  • All pre–existing conditions are covered from day one.
  • Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
  • Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
  • Public hospitals are reimbursed for the healthcare services at par with the private hospitals.

Benefit cover under PMJAY
Benefit cover under various government-funded health insurance schemes in india have always been structured on an upper ceiling limit ranging from an annual cover of inr30,000 to inr3,00,000 per family across various states which created a fragmented system.

PM - JAY provides cashless cover of up to inr5,00,000 to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment.

  • Medical examination, treatment and consultation
  • Pre-hospitalization
  • Medicine and medical consumables
  • Non-intensive and intensive care services
  • Diagnostic and laboratory investigations
  • Medical implantation services (where necessary)
  • Accommodation benefits
  • Food services
  • Complications arising during treatment
  • Post-hospitalization follow-up care up to 15 days

The benefits of INR 5,00,000 are on a family floater basis which means that it can be used by one or all members of the family. The RSBY had a family cap of five members. However, based on learnings from those schemes, pm-jay has been designed in such a way that there is no cap on family size or age of members. 

In addition, pre-existing diseases are covered from the very first day. This means that any eligible person suffering from any medical condition before being covered by pm-jay will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled. if you want to check your name in this list please got to official PMJAY portal which available link from below.

User ID – 9846082785
Password- 9846082785