Ayushman Bharat Scheme, a flagship programme of the Government of India to protect the Indian citizens by providing them with an umbrella of health cover or health insurance. The AYUSH Bharat Scheme was launched in 2018 by the Hon’ble Prime Minister Narendra Modi. To achieve the vision of Universal Health Coverage (UHC), this scheme was recommended by the National Health Policy 2017. This initiative has been designed to meet the Sustainable Development Goals (SDGs) of the country with the motto to “leave no one behind.”
Ayushman Bharat is an integrated approach to achieve comprehensive need-based healthcare services leaving behind sectoral and segmented delivery of health services.
This scheme aims to undertake path-breaking interventions to holistically address the healthcare system which includes covering prevention, promotion and ambulatory care at the primary, secondary and tertiary levels. The Ayushman Bharat Scheme consists of two inter-related components, which are as under:
- Health and Wellness Centres (HWCs)
- Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Table of Contents
Health and Wellness Centres (HWCs)
The Government of India announced the creation of 1.5 Lakh Health and Wellness Centres to transform the available Primary Health Centers and sub-centres. The creation of these centres will bring health care facilities closer to the homes of people and it will also provide comprehensive primary health care to the people. There will be a cover of both Child and Maternal Health Services and non-communicable diseases including free essential drugs and diagnostic services.
These Health and Wellness centres are aimed to provide an expanded range of services to the large population in their area by addressing the primary health care needs. Such centres are also designed to promote health awareness, prevention and keep people healthy by encouraging them to choose healthy behaviours to reduce the risk of developing chronic diseases.
List of services provided by HWCs
- Care in Pregnancy and Child Birth
- Childhood and adolescent health care services
- Neonatal and infant health care services
- Prevention, Screening, Control, and Management of non-communicable diseases
- Emergency Medical Services
- Elderly and Palliative Healthcare Facilities
- Screening and basic management of mental health ailments
- Basic oral healthcare
- Family planning, contraceptive services, and other reproductive healthcare services.
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
The Ayushman Bharat Scheme is also known as PMJAY (Pradhan Mantri Jan Arogya Yojna). Basically, it is the second component under the Ayushman Bharat Yojna. The Hon’ble Prime Minister Shri Narendra Modi launched this scheme on 23rd September 2018 in Ranchi, Jharkhand. The PM-JAY which is popularly known as Ayushman Bharat is the world’s largest health guarantee scheme. Under this scheme, the Government of India has assured Rs. 5 lakh health cover per family in a year for secondary and tertiary care hospitalization. It is expected that more than 10 Crores poor families (50 Crore beneficiaries) will be benefitted from this scheme. In a country like India, where 80 to 90% population don’t have access to health care insurances, announcing the PM-JAY Scheme is a much-needed step. This scheme is fully funded by the Central Government where the cost of the implementation is shared between the State and Central Government.
प्रधान मंत्री आयुष्मान भारत योजना
Key Features of the Ayushman Bharat Scheme (PM-JAY)
- PM-JAY (Pradhan Mantri Jan Arogya Yojna) is the largest health insurance/ assurance scheme in the world which is fully funded by the Central Government.
- The scheme provides a health cover of Rs.5 lakhs per family annually for secondary and tertiary care hospitalization in all public and private empanelled hospitals of the Country.
- More than 10 Crore poor and vulnerable entitled families (around 50 crore beneficiaries) are covered under this scheme.
- PM-JAY provides cashless access to healthcare services for the beneficiaries at the hospitals.
- Ayushman Bharat Yojna (PM-JAY) envisions to help reduce the huge expenditure on medical treatment which forces around 6 crore Indians into poverty every year.
- In this scheme, 3 days of pre-hospitalization and 15 days post-hospitalization expenses like diagnostics and medicines are covered.
- No restrictions on family size, gender, and age.
- All pre-existing conditions are covered from day one.
- Beneficiaries can avail the cashless health care access throughout the country in empanelled public or private hospitals as benefits of the schemes are portable.
- Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, diagnostic services, supplies, physician’s fees, surgeon charges, room charges, OT and ICU charges etc.
- Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
Benefits under Ayushman Bharat Scheme (PM-JAY)
- Under Ayushman Bharat Scheme or PM-JAY, an eligible family can get a health cover of Rs.5 lakh per year.
- PM-JAY provides cashless access to health care facilities which is a big relief to the underprivileged.
- There are other Government-funded health insurance schemes available in India which are structured on an upper ceiling limit ranging from Rs.30000 to Rs.300000 per family in different states which created a fragmented system. But, PM-JAY provides Rs.5 Lakh cashless health cover to each eligible family for listed secondary and tertiary care conditions.
- The benefits of Rs.5 Lakh granted under this scheme are a family floater basis. It means the said amount can be used by one member or all members of the family.
- In Ayushman Bharat Scheme (PMJAY), there is no cap on the family size or age of the family member.
- Under this scheme, pre-existing diseases are covered from the very first day of the policy. It means any eligible person suffering from any disease before being covered by PM-JAY will now be able to avail the treatment for all those medical conditions as well under this scheme from day one of enrollment.
- An Indian citizen who is enrolled under PM-JAY can avail the cashless health care facilities throughout the country in an empanelled public or private hospital as benefits under this scheme are portable.
- The health cover under this scheme includes all expenses incurred on the following components of the treatment:
- Medical examination, treatment and consultation
- Medicine and medical consumables
- Pre-hospitalization
- Medical implantation services (where necessary)
- Diagnostic and laboratory investigations
- Non-intensive and intensive care services
- Complications arising during treatment
- Post-hospitalization follow-up care up to 15 days
- Food services
- Accommodation benefits
PMJAY Eligibility Criteria
- Pradhan Mantri Jan Arogya Yojna (PM-JAY) is an entitlement based Government scheme. As per the Socio-Economic Caste Census (SECC) database, the deprivation criteria have been considered to select eligible families.
- There are various categories in urban and rural India are given below:
- Families with only 1 room with kutcha roof and walls.
- Families with no adult member between 16 and 59 age group.
- Households headed by females with no male adult members between the ages of 16 and 59.
- Families with disabled members and no adult able-bodied member.
- SC/ST households.
- Landless households depend on a major chunk of their income from manual casual labour.
- Family living in a rural area with anyone of the following:
- Destitutes
- Households with no shelter
- Living on alms
- Manual scavenging
- Primitive tribal groups
- Legally released bonded labourer
- For urban areas, there are 11 occupational categories defined which are eligible under this scheme:
- Domestic worker/Ragpicker/Beggar
- Street vendor/Cobble/hawker/Other service provider working on the streets
- Plumber/Construction worker/Mason/Labourer
- Welder/Painter/Security guard
- Coolie and other head-load workers
- sanitation worker/Sweeper
- Home-based worker/Mali
- Artisan/ Tailor/handicrafts worker
- Driver/Conductor/ helper to driver and conductor/Transport worker/Cart puller/rikshaw puller
- Attendant/waiter/Shop worker/ Peon in small establishment/assistant/ Helper/delivery assistant
- Mechanic/Electrician/ Assembler/repair worker/Washerman/ Chowkidar
- As per the data of SECC 2011, certain beneficiaries are excluded. The households with a motorized vehicle, fishing boat, that pay income tax/professional tax, having a refrigerator, landline phone, an earning member who earns more than Rs.10000 per month, owns land above a certain limit, government servants, etc. are excluded under this scheme.
Ayushman Bharat Scheme: Need of the Time
- As per the 71st round of the National Sample Survey Office (NSSO), the findings of the country’s healthcare systems are as below:
- About 82% of urban households and 86% of rural households do not have access to healthcare insurance.
- Over 17% of India’s population, spend a minimum of 1/10th of their household budget for availing healthcare facilities.
- Over 24% of the Rural and 19% of urban households meet their healthcare expenses through borrowings.
- Serious healthcare problems and unexpected illnesses lead the family to debt.
- Keeping in mind these grave concerns, The Government of India in accordance with National Health Policy 2017, announced Ayushman Bharat Programme along its two sub-component i.e. PMJAY and HWCs.
PMJAY Eligibility: Check Here
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