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Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)

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Overview
Ayushman Bharat, a flagship initiative of the Government of India, was launched following the recommendations of the National Health Policy 2017. The scheme is aimed at achieving the vision of Universal Health Coverage (UHC) by addressing healthcare holistically. This initiative also aligns with the Sustainable Development Goals (SDGs) with a core commitment of “leaving no one behind.”

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Ayushman Bharat represents a paradigm shift in healthcare service delivery. Unlike the earlier sector-specific and fragmented approach, this program emphasizes comprehensive, need-based healthcare services. It encompasses primary, secondary, and tertiary healthcare levels, focusing on prevention, promotion, and curative care. The program is built around a continuum of care approach and has two key components:

  1. Health and Wellness Centres (HWCs)
  2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Launched on September 23, 2018, in Ranchi, Jharkhand, by the Honorable Prime Minister of India, Shri Narendra Modi, AB PM-JAY is a revolutionary health assurance scheme globally.

Key Features of AB PM-JAY

World’s Largest Health Assurance Scheme
AB PM-JAY is the world’s largest government-funded health assurance scheme. It provides health coverage of ₹5,00,000 per family annually for secondary and tertiary care hospitalization. This scheme targets over 10.74 crore economically weaker families, covering nearly 50 crore individuals, which constitutes the bottom 40% of India’s population.

Eligibility Criteria
The inclusion of households under the scheme is based on the deprivation and occupational data from the Socio-Economic Caste Census (SECC) 2011. The cost of implementing the program is entirely funded by the Government, with shared responsibilities between the Central and State Governments.

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Benefits of AB PM-JAY

AB PM-JAY offers cashless and paperless coverage up to ₹5,00,000 annually for every eligible family. This coverage includes expenses related to:

  • Medical consultations and examinations
  • Hospitalization (pre and post)
  • Medicines and consumables
  • Diagnostic and laboratory investigations
  • Non-intensive and intensive care services
  • Medical implants (if required)
  • Accommodation and food for patients
  • Follow-up care (up to 15 days post-treatment)

Family Floater Benefit

The scheme offers a family floater benefit, meaning the ₹5,00,000 coverage can be utilized by any member of the family or collectively by multiple members. There is no age limit or cap on family size, ensuring that even large families are fully covered.

Coverage of Pre-existing Conditions
One of the standout features of AB PM-JAY is the inclusion of pre-existing medical conditions from the first day of enrollment. Individuals suffering from any ailment prior to joining the scheme are eligible for treatment without any waiting period.

Eligibility for AB PM-JAY

For Rural Families

PM-JAY covers households that fall under at least one of the six deprivation criteria mentioned in the SECC 2011 database or meet automatic inclusion criteria. These include:

  1. Families living in a single-room house with kucha walls and roof.
  2. Households with no adult members aged between 16 and 59 years.
  3. Families with no adult male members aged between 16 and 59 years.
  4. Families with a disabled member and no able-bodied adult.
  5. Scheduled Caste/Scheduled Tribe (SC/ST) households.
  6. Landless families relying primarily on casual manual labor for livelihood.

Automatic inclusion categories are:

  • Families living in destitution or dependent on alms.
  • Households of manual scavengers.
  • Primitive tribal groups.
  • Legally released bonded laborers.

For Urban Families

For urban areas, AB PM-JAY includes households belonging to specific occupational groups such as:

  1. Ragpickers and beggars.
  2. Domestic workers.
  3. Street vendors, cobblers, and hawkers.
  4. Construction workers, plumbers, and masons.
  5. Sweepers, sanitation workers, and gardeners.
  6. Drivers, conductors, and cart pullers.
  7. Artisans, tailors, and handicrafts workers.
  8. Electricians and mechanics.
  9. Shop workers, delivery assistants, and waiters.
  10. Washermen and security guards.

Exclusions from the Scheme

Certain individuals and households are excluded from the scheme:

  1. Owners of motorized vehicles such as two-wheelers, three-wheelers, four-wheelers, or fishing boats.
  2. Owners of mechanized farming equipment.
  3. Households with Kisan Credit Cards with a credit limit above ₹50,000.
  4. Individuals working in government jobs or government-managed enterprises.
  5. Households with a monthly income above ₹10,000.
  6. Owners of refrigerators and landline phones.
  7. Owners of houses built with solid materials or over five acres of agricultural land.

Enrollment Process

Beneficiaries of PM-JAY can register for an e-card to access the benefits. The offline application process involves the following steps:

Step-by-Step Process

  1. Verification of Beneficiary Details
    • The Arogya Mitra identifies potential beneficiaries by searching the PM-JAY database using information like name, ration card number, or mobile number.
  2. Database Search
    • The beneficiary’s details are cross-referenced with the SECC 2011 database and other records such as RSBY and State Health Scheme databases.
  3. Individual Identification
    • Eligible beneficiaries must provide documents like Aadhaar or a government ID, along with family proof such as a ration card, to confirm identity.
  4. Family Identification
    • The Arogya Mitra validates the family information using the ration card and other supporting documents, which are then submitted for approval.
  5. Approval or Rejection
    • The State Health Agency (SHA) or insurance provider reviews the submitted details and either approves or rejects the application.
  6. Issuance of E-card
    • Once approved, the beneficiary receives an e-card, which they can use to access healthcare services under AB PM-JAY.

Documents Required for Registration

  1. Proof of Age and Identity (Aadhaar Card or PAN Card).
  2. Address Proof.
  3. Contact Information (Mobile number, Email ID).
  4. Caste Certificate (if applicable).
  5. Income Certificate.
  6. Proof of Family Structure (Joint or Nuclear).
  7. Ration Card.

Impact of AB PM-JAY

Since its launch, Ayushman Bharat has significantly contributed to improving healthcare access for economically disadvantaged families. By reducing the financial burden of medical expenses, the scheme has played a pivotal role in reducing poverty caused by out-of-pocket healthcare costs. It has also strengthened India’s healthcare infrastructure by encouraging the participation of public and private hospitals.

With a focus on inclusivity and affordability, AB PM-JAY has set a benchmark for universal healthcare schemes globally, transforming the lives of millions and reaffirming the government’s commitment to “Health for All.”

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