Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) was launched by Hon’ble Prime Minister on September 23, 2018. PM-JAY is an ambitious government scheme which intends to provide a health cover of up to Rs.5 lakh per family per year, for secondary and tertiary care
hospitalization to over 10.74 crore entitled families as per SECC 2011 (approximately 50 crore beneficiaries), in a cashless and paperless manner through public and private empaneled hospitals.
The National Health Authority (NHA) is committed to ensuring that beneficiaries are empowered and have access to accurate, complete and timely information in a transparent manner. With this spirit, NHA is sharing the Beneficiary Empowerment Guidebook with the State Health Agencies (SHAs) and other stakeholders. We sincerely hope that the SHAs and other stakeholders participating in PM-JAY will use this guidebook to empower the beneficiaries so that they are treated fairly and can fully avail of their rightful entitlements under PM-JAY.
India has achieved significant public health gains and enhancements in health care access and quality over the last three decades.
The health sector is amongst the most important and fasting growing sectors, expected to succeed in US$ 280 billion by 2020.
The Pradhan Mantri Jan Arogya Yojana (PM-JAY) popularly known as Ayushman Bharat was launched on September 25, 2018 which aims to secure the lives of 50 crore individuals that comprises of 10.74 cr poor families including both rural and urban areas with a defined benefit cover of Rs 5 lakh per family.
The scheme covers over nearly 40% of the population targeted towards poorest and the vulnerable. Apart from increasing access to quality and affordable healthcare and medication, other unmet needs of the population such as timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency will be catered to under the scheme.
At an equivalent time, India’s health sector faces immense challenges. It continues to be characterized by high out-of-pocket expenditure, low financial protection, low insurance coverage amongst both rural and concrete population.
It is a matter of grave concern that we incur a high out-of-pocket expenditure on account of health and medical costs. 62.58% of our population has got to buy their own health and hospitalization expenses and aren’t covered through any sort of health protection.
Besides using their income and savings, people borrow money or sell their assets to satisfy their healthcare needs, thereby pushing 4.6% of the population below the poverty level .
The Government of India is committed to making sure that its population has universal access to good quality health care services without anyone having to face financial hardship as a consequence.
Under the ambit of Ayushman Bharat, a Pradhan Mantri Jan Arogya Yojana (PM-JAY) to scale back the financial burden on poor and vulnerable groups arising out of catastrophic hospital episodes and ensure their access to quality health services was conceived.
PM-JAY seeks to accelerate India’s progress towards achievement of Universal Health Coverage (UHC) and Sustainable Development Goal – 3 (SDG3).
Pradhan Mantri Jan Arogya Yojana (PM-JAY)will provide financial protection (Swasthya Suraksha) to 10.74 crore poor, deprived rural families and identified occupational categories of urban workers’ families as per the newest Socio-Economic Caste Census (SECC) data (approx. 50 crore beneficiaries). it’ll have offer a benefit cover of Rs. 500,000 per family per annum (on a family floater basis).
PM-JAY will cover medical and hospitalization expenses for nearly all secondary care and most of tertiary care procedures.
PM-JAY has defined 1,350 medical packages covering surgery, medical and day care treatments including medicines, diagnostics and transport.
To ensure that no-one is overlooked (especially girl child, women, children and elderly), there’ll be no cap on family size and age within the Mission.
The scheme are going to be cashless & paperless at public hospitals and empanelled private hospitals. The beneficiaries won’t be required to pay any charges for the hospitalization expenses.
The benefit also includes pre and post-hospitalization expenses. The scheme is an entitlement based, the beneficiary is set on the idea of family being figured in SECC database.
When fully implemented, the PM-JAY will become the world’s largest government funded health protection mission.