Ayushman Bharat Yojana

Ayushman Bharat is a Government of India scheme which has been launched under the recommendations of National Health Policy, 2017. The scheme aims to achieve the vision of Universal Health Coverage (UHC). This scheme has been designed in a way to achieve the Sustainable Development Goals (SDGs) and its commitment which is to ‘Leave no one behind’.

Ayushman Bharat aims to shift to a comprehensive need-based health care services from the sectoral and segment approach of healthy services. Ayushman Bharat has two interrelated components which are:

1. Health and Wellness Centres (HWCs).
2. Pradhan Mantri Jan Arogya Yojna (PMJAY).

Health and Wellness Centres (HWCs)

The government of India, in February 2018 announced the construction of 1,50,000 Health and Wellness Centres (HWCs). These centers aim to offer Comprehensive Primary Health Care (CPHC) which will bring healthcare services close to the houses of people. Under this, it covers both the maternal and child health services and non-communicable diseases, and while also including drugs and diagnostic services free of cost.

These centers will deliver a diversified range of services to meet the primary health care needs of the people in their area. The motive behind health promotion and prevention is designed in a way to focus on making people healthy by encouraging them to focus on healthy behaviors and changing their habits which can decrease the risk of developing morbidities and chronic disease.

Pradhan Mantri Jan Arogya Yojna (PMJAY)

Pradhan Mantri Jan Arogya Yojna was launched by the Prime minister of India on 23 September 2018 in Ranchi, Jharkhand as a second part of the Ayushman Bharat Yojana.

Ayushman Bharat PMJAY is the world’s largest health assurance scheme which aims to provide a health cover of up to Rs. 5 lakhs per family every year to more than 50 crore beneficiaries that comprise the bottom 40% of the Indian population. It also includes the families covered under the existing Rashtriya Swasthya Bima Yojana (RSBY) which was launched in 2008. PM Jan Arogya Yojana is funded by the Indian Government and its implementation costs are shared between central and state governments.

Features of PMJAY:

• It is the world's largest health insurance scheme offered & funded by the Government.
• The coverage under this scheme is Rs. 5 lakhs per family every year for secondary & tertiary hospitalization across the empanelled private & public hospitals in India.
• The benefits of the scheme can be availed by beneficiaries from day one.
• More than 50 crore beneficiaries comprising over 10.74 crore poor and vulnerable families are eligible to avail the scheme benefits.
• The scheme offers pre-hospitalization coverage of up to 3 days and post-hospitalization of up to 15 days for meeting medical & diagnostic expenses.
• The scheme also provides cashless health care services.
• Beneficiaries can get the benefit of cashless healthcare treatment in any of the empanelled public or private hospitals across the country.
• It gives the benefit of including every member of the family without any restrictions with respect to age, gender, or number of members.
• The earlier launched RSBY had a family cap of a maximum of 5 members in a family. Whereas, PMJAY is designed in a way that there is no cap on members in a family eligible for the scheme.

Benefits under PMJAY:

PMJAY offers a cashless coverage of up to Rs. 5 lakhs per year to each eligible family for listed secondary and tertiary care conditions. The benefits are on a floater basis which can be used by one or all members of the family. Benefits covered under the scheme are:

• Pre hospitalization expenses.
• Medical consumables.
• Pre hospitalization and post-hospitalization expenses.
• Non-Intensive & Intensive care services.
• Treatment and consultation expenses.
• Medical Examination.
• It also covers any complications during treatment.
• Accommodation and food services.
• Follow up care of up to 15 days post-hospitalization.
• Laboratory expenses

Eligibility criteria for PMJAY:

Rural Beneficiaries:

The government has set up 6-deprivation eligibility criteria for families in rural areas. Those who fall under at least one of the 6 mentioned deprivations will be eligible to apply for PMJAY:

D1: Families who live only in one room which has kucha walls and roof.

D2: Families who do not have any adult members between 16 to 59 years of age.

D3: Female-led families who do not have any adult male member between 16 to 59 years of age.

D4: Families who have any disabled member and no abled adult member.

D5: SC or ST Families.

D6: Landless families who have their major income from manual casual labor.

Urban Beneficiaries:

For families in urban areas, people who fall under the below mentioned occupational categories are eligible to avail benefits of the PMJAY scheme:

• Beggar.
• Ragpicker.
• Cabbler, Hawker, Street vendor, or any other service providing vendors on street.
• Sanitation worker, Sweeper or Mali.
• Tailor, Handcraft worker, Artisan, or Home-based worker.
• Plumber, Manson, Painter, Labour, Welder, Security Guard, Construction Worker, Coolie, or any other head load worker.
• Washerman or Chowkidar.
• Mechanic, Electrician, Assembler, or Repair Worker.
• Domestic worker.
• Driver, Conductor, Helper of Driver & Conductors, Cart puller, Rickshaw puller, or Transport worker.
• Delivery Assistant, Waiter, Attendant, Shop worker, Assistant, Peon in Small enterprises, or Helper.