Ayushman Bharat Pradhan Mantri- Jan Arogya Yojana (AB PM-JAY), one of the key components of Ayushman Bharat (AB), a flagship scheme of Government of India (GoI), which emerged from the National Health Policy 2017, has completed 6 years of successful implementation.
- It was launched on 23rd September, 2018 by Prime Minister (PM) Narendra Modi in Ranchi, Jharkhand.
- AB PM-JAY has been instrumental in India’s commitment to achieving Universal Health Coverage (UHC).
- The scheme is being implemented by National Health Authority (NHA) under the Ministry of Health and Family Welfare (MoHFW).
Background:
i.Earlier, the scheme named National Health Protection Scheme (NHPS) was rechristened to PM-JAY.
ii.The scheme subsumed the then existing Rashtriya Swasthya Bima Yojana (RSBY), which was launched in 2008.
Key Features of AB PM-JAY:
i.Free Health Insurance Coverage up to Rs 5 lakh: AB PM-JAY is the largest health assurance scheme in the world which offers a cashless health cover of Rs 5 lakh per family annually for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
- The households under the scheme are classified based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011).
ii.Funding: The scheme is fully-funded by the GoI and cost of implementation is shared between the Central and State Governments.
iii.Key Target: Initially, the scheme aims to cover 10.74 crore poor and vulnerable families under AB PM-JAY, comprising the bottom 40% of India’s population.
- In January 2022, the GoI revised the beneficiary base under AB PM-JAY from 10.74 crore to 12 crore families (i.e. around 55 crore beneficiaries across India) considering India’s decadal population growth of 11.7% over 2011 population.
iv.No restriction on Family Size, Age: The scheme covers all members of eligible families irrespective of their family size, age, or gender, which ensures inclusivity for all.
Key Benefits of scheme:
i.The scheme covers up to 3 days of pre-hospitalization and 15 days of post-hospitalization expenses which include expenses of diagnostics and medications.
ii.PM-JAY covers significant medical costs, thus, helps in preventing more than 6 crore Indians from falling into poverty yearly due to healthcare expenses.
iii.The scheme ensures nationwide portability as beneficiaries can access cashless treatment at any empanelled public or private hospitals across India.
iv.The scheme offers comprehensive coverage across 1,949 medical procedures which spans in 27 medical specialties such as: General medicine, Surgery, Oncology, and Cardiology, among others.
v.The GoI reimburses the public hospitals for healthcare services provided under AB PM-JAY at par with private hospitals, ensuring equitable care delivery across all sectors.
Expansion of AB PM-JAY to all senior citizens aged 70 years and above:
On 11th September 2024, the Union Cabinet chaired by the Prime Minister (PM) Narendra Modi has approved the expansion of AB PM-JAY, offering comprehensive health coverage to all the senior citizens aged 70 years and above.
- As per the new provision of scheme, all senior citizens of the age 70 years and above irrespective of their socio-economic status will receive health coverage of up to Rs 5 lakh per family.
- Aim: To benefit nearly 4.5 crore families with 6 crore senior citizens.
Key Features:
i.Under AB PM-JAY, a unique card will be issued to the senior citizens aged 70 and above, to access the benefits of the scheme.
ii.Senior citizens from families already covered under AB PM-JAY will receive an additional top-up of Rs5 lakh exclusively for themselves, separate from the rest of the family.
- While, those who are not part of the existing scheme will receive Rs 5 Lakh per annum on a family basis.
iii.Senior citizens who are already enrolled in public health schemes such as Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), or Ayushman CAPF will have the option to either continue with their existing scheme or they can choose AB PM-JAY.
iv.Also, the senior citizens aged 70 and above, who are enrolled under private health insurance policies or Employees’ State Insurance scheme will be eligible to avail the benefits of AB PM-JAY.
Key Achievements of AB PM-JAY:
i.As of 9th September 2024, over 35.4 crore Ayushman cards have been issued, which has empowered millions of families with health coverage.
- Women account 49% of the total Ayushman cards issued, and 3.61 crore hospital admissions have been used by women through their Ayushman cards.
ii.At present, the scheme is operational in 33 states and Union Territories (UTs), except in 3 states namely, NCT Delhi, West Bengal (WB), and Odisha.
iii.So far, the scheme has covered 7.37 crore hospital admissions, providing financial coverage of over Rs 1 lakh crore.
iv.The beneficiaries of the scheme have been able to avail the benefit of portability feature of scheme, which allows them to avail treatment at any empanelled hospital across India.
- So far, 11.9 lakh hospitalizations worth Rs 3,100 crore have been made under this features of scheme. Thus, enhancing accessibility for beneficiaries nationwide.
v.Total 30,529 hospitals across the country have been successfully empanelled under the scheme, of which 17,063 are public hospitals and 13,466 are private hospitals.
