Pradhan Mantri Jan Arogya Yojana: PM launches world’s largest healthcare scheme
Prime Minister Narendra Modi launched ambitious Pradhan Mantri Jan Arogya Yojana (PMJAY), under Ayushman Bharat umbrella at Ranchi, Jharkhand. The scheme aims to provide annual health insurance cover of Rs 5 lakh to 10.74 crore beneficiary families i.e. over 50 crore beneficiaries across India. It is touted as world’s largest healthcare scheme that will serve beneficiary population that equals 27-28 European countries and almost equal to population of Canada, Mexico and US put together. The scheme will become operational from September 25, 2018 i.e. on birth anniversary of Deendayal Upadhyay.
Pradhan Mantri Jan Arogya Yojana (PMJAY)
PMJAY is government-sponsored health insurance scheme, that will provide free coverage of up to Rs 5 lakh per family per year in any government or empanelled private hospitals all over India. It will cover beneficiaries families identified on the basis of Socio Economic Caste Survey (SECC) 2011 in 444 districts of 30 states/Union Territories.
Note: Telangana, Odisha, Kerala, Punjab and Delhi (UT) are the states which have still not signed MoUs for joining this schemes.
National Health Agency (NHA) is the apex body for implementing this scheme. States will be required to form State Health Agency (SHA) to implement scheme and at the district level also structure for its implementation will be set up. Around 13000 hospitals both public and private in the country have been coordinated for implementation of the scheme.
PMJAY will be funded with 60% contribution from Centre and remaining from the states. NITI Aayog will be working as partner for this scheme for operationalizing robust, modular and interoperable IT platform which will involve a paperless and cashless transaction.
Key Features of PMJAY
PMJAY is entitlement based scheme with entitlement decided on basis of deprivation criteria in the SECC database. There will be no cap on family size and age under this scheme. The benefit cover under it also includes pre and post-hospitalisation expenses.
It also takes into consideration all pre-existing medical conditions. It will provide reimbursement for bed charges and drugs and diagnostics two days before, during and 15 days after hospitalisation. Beneficiary will be also paid transport allowance for hospitalisation defined under it.
The payment for treatment will be done on package rate which will be defined by Government in advance basis. The package rates will include all costs associated with treatment. States and UTs have flexibility to modify these rates within limited bandwidth.
PMJAY allows national portability i.e. resident of any part of country is entitled for free hospitalization at empaneled hospital anywhere in the country. It will strengthen healthcare services in India by targeting poor and vulnerable population of the country.
The scheme allows beneficiary to take cashless benefits from any public or private empanelled hospitals across the country. ID documentation required for verifying beneficiary under this scheme may be Aadhaar card or election ID card or ration card. Aadhaar is not mandatory. Beneficiaries will QR codes having letters for verification through scanning.