Government Schemes – 1ST JULY

WHY IS AYUSHMANN BHARAT – PRADHAN MANTRI JAN AROGYA YOJANA (AB-PMJAY) IMPORTANT?

The National Health Policy 2017 advised the launch of Ayushman Bharat, the government of India’s flagship programme, in order to realize the goal of Universal Health Coverage (UHC). The Sustainable Development Goals (SDGs) and their main commitment to “leave no one behind” have been addressed by this project.

This is an effort to shift from a sectoral and segmented approach to the delivery of health services to a thorough need-based strategy. This programme aims to implement ground-breaking interventions to comprehensively address the healthcare system at the primary, secondary, and tertiary levels (including prevention, promotion, and ambulatory care).

Under one of the two components of Ayushman Bharat comes Pradhan Mantri Jan Arogya Yojana or PM-JAY. The largest health assurance programme in the world, Ayushman Bharat PM-JAY, aims to cover secondary and tertiary care hospitalization for over 10.74 crores vulnerable and poor families (roughly 50 crore beneficiaries), who make up the bottom 40% of the Indian population, with a health benefit of Rs. 5 lakhs per family per year.

The cost of implementing PM-JAY is split between the Central and State Governments, with all funding coming from the government.

FEATURES OF PM-JAY

1. The largest health insurance/assurance programme in the world, PM-JAY, is entirely funded by the government.

2. For secondary and tertiary care hospitalization in both public and private empaneled hospitals in India, it offers a cover of Rs. 5 lakhs per family per year.

3. These benefits are available to around 10.74 crore poor and vulnerable families, or roughly 50 crore beneficiaries.

4. At the point of service, which is the hospital, PM-JAY offers the beneficiary cashless access to healthcare services.

5. Nearly 6 crore Indians fall into poverty each year, and PM-JAY wants to assist reduce the catastrophic medical costs that cause this.

6. Up to 3 days of pre-hospitalization and 15 days of post-hospitalization costs, including medical tests and medications, are covered.

7. There are no limitations on the number of children, age, or gender.

8. Every pre-existing condition is covered right away.

9. The scheme’s benefits are transferable throughout the nation; a user may visit any public or private hospital in India that has been certified to receive cashless care.

10. Approximately 1,393 procedures are included in the services, which comprise all treatment-related expenses such as medications, equipment, diagnostic services, physician fees, accommodation and meal, surgical fees, OT and ICU fees, etc.

11. Healthcare services provided by public hospitals are paid for on par with those provided by private hospitals.

INSURANCE COVERAGE UNDER PM-JAY

Benefit coverage under various government-funded health insurance schemes in India has always been limited at an annual amount ranging from INR30,000 to INR3,00,000 per family across several States, which has led to a disjointed system.

Each qualified household is provided cashless coverage of up to INR 5,00,000 year by PM-JAY for the listed secondary and tertiary care problems. The following costs related to the treatment are all covered by the scheme’s insurance.

1. examination, treatment, and consultation in medicine

2. Pre-hospitalization

3. Drugs and medical supplies

4. Services for both non-intensive and intensive care

5. investigations that are diagnostic and laboratory

6. Services for medical implantation (where necessary)

7. accommodations advantages

8. Food services

9. problems that develop during treatment
10. Follow-up care after hospitalization for up to 15 days

The benefits of INR 5,00,000 are family floater benefits, therefore any one or all family members may use them. However, based on the lessons learned from those programmes, PM-JAY was created with no restrictions on family size or member ages.

Additionally, pre-existing conditions are covered right away. This means that starting the day they participate in the programme, any eligible person who has ever had a medical condition that was not previously covered by PM-JAY will be able to receive treatment for all of those conditions as well.