Pradhan Mantri Jan Arogya Yojana (PM-Jai)
Ayushman india
To achieve the objective of Universal Health Coverage (UH-C), the launch of “Ayushman Bharat”, a flagship scheme of the Government of India, was recommended by the National Health Policy 2017. This initiative is designed to meet the Sustainable Development Goals (SDGs) and its underlined commitment, with the aim of “leaving no one behind.”
“Ayushman Bharat” is an attempt to move away from regional and fragmented approaches to healthcare delivery towards a comprehensive and expected healthcare. The objective of the scheme is to address the health care system (Prevention, Promotion and Ambulatory Care) holistically at primary, secondary and tertiary levels. Ayushman Bharat is a big step towards uninterrupted health services. It consists of two inter-related components, which are as follows: –
1.Health & Wellness Center (HWC’s)
2.Pradhan Mantri Jan Arogya Yojana (PM-Jai)
Health and Welfare Center (HWCs)
In February 2018, the Government of India announced the conversion of existing sub-centers and primary health centers to 1,50,000 Health and Welfare Centers (HWCs). This initiative is an effort to bring comprehensive Primary Health Centers (CPHC) and health services to people’s homes. Free essential medicines, non-communicable diseases including diagnostic and maternal and child health services are also available in these centers.
These health and welfare centers were envisaged with the goal of expanding and universalizing primary health services to the entire population of its region. Health promotion and prevention are designed to encourage healthy practices and empower people and communities to be healthy and empowered so that they can be protected from complex diseases and the risk of exposure to them.
Pradhan Mantri Jan Arogya Yojana
The second component under Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojana which people (PM-Jai) know. The scheme was launched by Hon’ble Prime Minister of India Shri Narendra Modi on 23 September 2018 in Ranchi, Jharkhand.
Ayushman Bharat (PM-Jai) is the world’s largest health assurance scheme, with the objective of providing free treatment up to Rs 5 lakh per family per year for secondary and tertiary health services to more than 10.74 crore poor and underprivileged families (or about 50 crore Providing beneficiaries) who constitute 40% of the Indian population. These numbers and included families are based on the absence and occupational parameters of the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas. (PM-Jai) was earlier known as National Health Protection Scheme (NHPS). The erstwhile National Health Scheme (RSBY), which was launched in 2008, was merged into (PM-Jai). Therefore, under (PM-Jai), the families included in the RSBY are also included, But do not exist in the SECC 2011 database. (PM-Jai) is a fully government-funded scheme with the cost of implementation shared between the central and state governments.
(PM-JAY) Highlights
(PM-Jai) is the world’s largest health insurance / assurance scheme, fully government-funded.
The scheme provides funds up to Rs 5 lakh per family per year for secondary and tertiary health treatment in public and private listed hospitals in India.
More than 10.74 crore poor and deprived families (or about 50 crore beneficiaries) can avail benefits under this scheme.
(PM-JAY) The service provides health services free of cost to beneficiaries in institutes ie “hospitals”.
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(PM-Jai) Medical treatment helps in reducing excessive expenditure, which brings about 60 million Indians below the poverty line every year.
Under this scheme, clinical treatment, health treatment and medicines are available free of cost up to 3 days before and 15 days after hospitalization.
There is no limit on family size, age or gender under this scheme.
Under this scheme, various pre-existing medical conditions and serious diseases are covered from day one.
(PM-Jai) is a portable scheme that means beneficiaries can avail of it in any public or private listed hospital across the country.
The plan covers about 1,393 procedures and packages such as medicines, supplies, diagnostic services, doctors’ fees, room charges, OT and ICU charges etc. which are available free of charge.
Private hospitals are reimbursed for health services at par with public hospitals.
Benefits under PM-JAY
There have been a number of government-funded health insurance schemes in India under which funds from Rs 30,000 to Rs 3,00,000 per family were provided in various states which created inequality. (PM-Jai) provides Rs 5,00,000 per family per year for all secondary and tertiary health services listed to all beneficiaries. The following treatments are available free of cost under this scheme.
Medical examination, treatment and counseling
Expenses before hospitalization
Medicines and Medical Consumables
Non-Intensive and Intensive Health Services
Diagnostic and laboratory investigations
Medical Implant Services (where required)
Hospitalization costs
Hospital expenses
Complications arising during treatment
15 days of care after hospitalization
The entire family gets a benefit of Rs 5,00,000 under this scheme, as it can be used by one or all members of the family. There was a family limit of five members under the RSBY scheme. Learning from those plans, (PM-Jai) is structured such that no limit is placed on the size of the family or the age of the members. Apart from this, various pre-existing diseases are included in the scheme from day one. This means that a person suffering from any type of disease or health condition before being enrolled in (PM-Jai) for all those medical conditions, as well as all treatment under the PM-Jai scheme, before receiving Beneficiary from the day itself.
PM Modi’s Mega Healthcare Scheme Rejected By 5 States. Here’s Why
Under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), beneficiaries can now buy their eligibility cards for free. The government on Friday waived a fee of Rs 30 per card, which till now the beneficiaries had to pay to rural level operators under Common Service Centers (CSCs) across the country. However, for issuing duplicate cards or reprints, beneficiaries will be charged by CSC excluding tax of Rs 15.
The arrangement comes after the National Health Authority (NHA), the government agency responsible for the implementation and management of the scheme, signed a memorandum of understanding (MoU) with the CSC under the Ministry of Electronics and Information Technology on Friday. The purpose of this MoU is to create a new PVC beneficiary card called “Ayushman Card” under PM-JAY. Also, the process of service delivery has to be streamlined and facilitated under this scheme.
The government said that the Ayushman cards are available in any PM-JAY hospital, although they are issued free of cost and will be issued free of cost even further. NHA CEO Ram Sewak Sharma says, “With the introduction of special PVC Ayushman cards, beneficiaries will now be able to keep them at home easily after completely replacing paper-based cards.”
While the card is not a necessary requirement to avail health arrangements under the AB PAM-JAY scheme, it identifies and verifies the beneficiaries to ensure that patients continue to receive uninterrupted health services and prevent any misconduct and fraud. Is part of the mechanism.
Under the Memorandum of Understanding, it has been decided that the National Health Authority (NHA) will pay a fixed amount of Rs 20 to the Common Service Center (CSC) for issuing Ayushman cards for the first time only.
