Ayushman Bharat PM-JAY
Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY)is a flagship programme launched by Hon’ble Prime Minister Shri Narendra Modi, on 23rd September, 2018 at Ranchi. The programme is aimed to cover over 10 crore poor and vulnerable families in the country (approx. 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalisation. Announcement for this scheme was made by Hon’ble Union Finance Minister in his budget speech on 01 Feb 2018. In J&K the scheme was launched on 1st December 2018.
Key Features of Ayushman Bharat Pradhan Mantri -Jan Arogya Yojana (PM-JAY):
- PM-JAY is the world's largest health insurance/ assurance scheme fully financed by the government.
- It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
- Over 5.97 lakh poor and vulnerable entitled families (approximately 30.89 lakh beneficiaries) are eligible for these benefits.
- PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
- PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.
- It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
- There is no restriction on the family size, age or gender.
- All pre–existing conditions are covered from day one.
- Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
- Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician's fees, room charges, surgeon charges, OT and ICU charges etc.
- Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
Benefit Cover Under PM-JAY
PM-JAY provides cashless cover of up to Rs 5,00,000 to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment.
- Medical examination, treatment and consultation
- Pre-hospitalization
- Medicine and medical consumables
- Non-intensive and intensive care services
- Diagnostic and laboratory investigations
- Medical implantation services (where necessary)
- Complications arising during treatment
- Post-hospitalization follow-up care up to 15 days
