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“Transforming Healthcare:- The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana Initiative”

Antra Mishra

Description:
To achieve the vision of Universal Health Coverage (UHC), Ayushman Bharat, a flagship scheme of the Government of India, was launched as per the recommendation of the National Health Policy 2017. The initiative is designed to meet the Sustainable Development Goals (SDGs) and its underlined commitment to “leave no one behind”.

Ayushman Bharat has implemented a comprehensive approach to healthcare, which comprises of two interconnected elements:

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

On 23 September 2018, the Honorable Prime Minister of India, Shri Narendra Modi, launched Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) in Ranchi, Jharkhand. This initiative is the largest health assurance scheme in the world, with the objective of providing health coverage of Rs 5,00,000 per family per year for secondary and tertiary care hospitalization. It aims to benefit over 10.74 crore poor and vulnerable families, which is approximately 50 crore beneficiaries. The eligible households are determined based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas. The funding for PM-JAY is fully provided by the government, and the implementation costs are shared between the central and state governments.

Benefits

Benefits

AB PM-JAY offers a cashless coverage of up to ₹ 5,00,000 per annum to every eligible family for specified secondary and tertiary care conditions. The plan encompasses all costs associated with the following aspects of treatment:

The advantage of ₹ 5,00,000 is provided on a family floater basis, allowing all members of the family to utilize it. AB PM-JAY does not impose any restrictions on family size or the age of its members. Moreover, pre-existing diseases are included in the coverage right from the beginning. Any eligible individual who had a medical condition prior to joining PM-JAY will now have the opportunity to receive treatment for all such conditions under the scheme starting from the day of enrollment.

Eligibility

Rural residents:

Urban dwellers:

Disfellowship

  1. Those who own a two, three or four-wheeler or a motorized fishing boat.
  2. Those who have mechanized agricultural equipment.
  3. Those who have Kisan Card with credit limit of ₹50000.
  4. Those who are employed by the government.
  5. People who work in non-agricultural enterprises managed by the government.
  6. Those whose monthly income is more than ₹ 10000.
  7. Those who have refrigerators and landlines.
  8. Those who have good, stable houses.
  9. Those who have 5 acres or more of agricultural land.

Application Process

offline

Arogya Mitra utilizes various details such as beneficiary name, location, ration card number, mobile number, or RSBY URN to search for the available list of beneficiaries. Subsequently, the beneficiary is searched in BIS, where the individual is identified and valid ID documents are scanned and uploaded. In order to obtain the PMJAY e-card for themselves and their family, the prospective beneficiary must personally visit the hospital or Community Service Center (CSC) for identification purposes. They are then required to follow the provided steps accordingly.

Step 1: To become eligible for AB-PMJAY benefits, interested individuals must provide their PM Letter/RSBY URN/RC Number/Mobile Number. The Arogya Mitra, who is the operator, will then conduct a search of the list of potential beneficiaries. This search is done by inputting various details such as the beneficiary’s name, location, ration card number, mobile number, or even RSBY URN.

Step 2: The operator conducts a search in the SECC, RSBY, State Health Scheme, and Additional Data Collection Drive databases to find potential beneficiaries in the BIS Application.

Step 3: The process of individual identification is conducted upon finding the name in the list. This necessitates the submission of documents such as Aadhaar or any government-issued identification, as well as a ration card or an alternative family ID for verification purposes, utilizing the information accessible in the system. Subsequently, the scanned documents are uploaded.

Step 4: Arogya Mitra proceeds with the identification of the family by utilizing the ration card, and subsequently uploads the scanned documents. Following this, the individual and family records are submitted by Arogya Mitra to the Trust/Insurance Company for approval.

Step 5: The health insurance company or trust has the authority to suggest either approval or denial for the beneficiaries who have submitted their claims. The cases that are recommended for denial will undergo further verification by the State Health Agency (SHA) to determine whether they should be approved or rejected.

Step 6: Issuance of e-Card – Upon approval by the SHA/Insurance Company/Trust, an e-Card will be issued to the beneficiary.

Required Documents

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