Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY)
PWOnlyIAS
November 18, 2023
Context:
The National Health Authority (NHA) reports that over 59 million hospital admissions have been authorized under the Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) scheme since the launch of the scheme five years ago.
Current Updates on Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) Scheme
The top six specialties with respect to consultations amount to a combined total of around Rs 15,651 crore since the scheme’s launch.
Currently, the scheme provides 919 Health Benefits Packages (HBPs), covering 1,670 procedures under 26 specialties.
What is the Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) scheme?
The Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) is a Centrally Sponsored Scheme having a central sector component under the Ayushman Bharat Mission anchored in the Ministry of Health and Family Welfare (MoHFW).
Umbrella Scheme: It is an umbrella of two major health initiatives, namely Health and Wellness Centres and the National Health Protection Scheme.
Objectives: Ensuring comprehensive coverage for catastrophic illnesses, reducing out-of-pocket expenditure, and improving access to hospitalization care.
Health and Wellness Centres: Under this 1.5 lakh existing sub-centers will bring the health care system closer to people’s homes in the form of Health and wellness centres.
These centres will provide comprehensive health care for non-communicable diseases and maternal and child health services.
What are the Benefits Provided Under Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana?
Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana(AB-PMJAY) provides a defined benefit cover of Rs. 5 lakh per family per year. This cover will take care of almost all secondary care and most of tertiary care procedures.
Eligibility criteria: AB-PMJAY is an entitlement-based scheme with entitlement decided based on deprivation criteria in the SECC database.
Hospitals Covered: The beneficiaries can benefit from public and empanelled private facilities. All public hospitals in the States implementing AB-PMJAY will be deemed empanelled for the Scheme.
Includes pre and post-hospitalisation expenses.
Pre-existing Conditions: Will be covered from day one of the policy.
Cashless Benefits: Beneficiaries can take cashless benefits across the country.
Implementation Strategy: A National Health Authority (NHA) has been set up at the national level. States/ UTs are advised to implement the scheme by a dedicated entity called State Health Agency (SHA).
NHA:
It has been set up to implement Pradhan Mantri Jan Aarogya Yojana (PM-JAY), at the national level.
An attached office of the Ministry of Health and Family Welfare with full functional autonomy,
It is governed by a Governing Board chaired by the Union Minister for Health and Family Welfare.
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