Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a Centrally Sponsored Scheme having central sector component under Ayushman Bharat Mission anchored in the Ministry of Health and Family Welfare (MoHFW). It is an umbrella of two major health initiatives, namely Health and wellness Centres and National Health Protection Scheme. Health and Wellness Centres Under this 1.5 lakh existing sub centres will bring health care system closer to the homes of people in the form of Health and wellness centres. These centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services. List of Services to be provided at Health & Wellness Centre Pregnancy care and maternal health services Neonatal and infant health services Child health Chronic communicable diseases Non-communicable diseases Management of mental illness Dental care Eye care Geriatric care Emergency medicine National Health Protection Mission (AB-PMJAY) Benefits 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. To ensure that nobody is left out (especially women, children and elderly) there will be no cap on family size and age in the scheme. The scheme covers all the senior citizens aged 70 years and above irrespective of income. The senior citizens of the age 70 years and above belonging to families already covered under AB PM-JAY will get an additional top-up cover upto Rs 5 lakh per year for themselves (which they do not have to share with the other members of the family who are below the age of 70 years). The benefit cover will also include pre and post-hospitalisation expenses. It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines. All pre-existing conditions will be covered from day one of the policy. A defined transport allowance per hospitalization will also be paid to the beneficiary. Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country. The beneficiaries can avail benefits in both public and empanelled private facilities. All public hospitals in the States implementing AB-PMJAY, will be deemed empanelled for the Scheme. Hospitals belonging to Employee State Insurance Corporation (ESIC) may also be empanelled based on the bed occupancy ratio parameter. As for private hospitals, they will be empanelled online based on defined criteria. To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis. The package rates will include all the costs associated with treatment. For beneficiaries, it will be a cashless, paper less transaction. Keeping in view the State specific requirements, States/ UTs will have the flexibility to modify these rates within a limited bandwidth. Eligibility criteria The scheme covers all the senior citizens aged 70 years and above irrespective of income. Senior citizens of the age 70 years and above who are already availing benefits of other public health insurance schemes such as Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), Ayushman Central Armed Police Force (CAPF) may either choose their existing scheme or opt for AB PMJAY. It has been clarified that senior citizens of 70 years and above who are under private health insurance policies or Employees’ State Insurance scheme will be eligible to avail benefits under AB PM-JAY. The scheme covers all 37 lakh ASHAs/ AWWs/AWHs working across the country and their families for free healthcare benefits. Also, AB-PMJAY is provided as an entitlement based scheme for the poor and vulnerable families. The entitlement is decided on the basis of deprivation criteria in the SECC database. The different categories in rural and urban areas include families having only one room with kucha walls and kucha roof; families having no adult member between age 16 to 59; female headed households with no adult male member between age 16 to 59; disabled member and no able bodied adult member in the family; SC/ST households; landless households deriving major part of their income from manual casual labour, Families in rural areas having any one of the following: households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups, legally released bonded labour. For urban areas, 11 defined occupational categories are entitled under the scheme - Occupational Categories of Workers, Rag picker, Beggar, Domestic worker, Street vendor/ Cobbler/hawker / Other service provider working on streets, Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/, Coolie and another head-load worker, Sweeper/ Sanitation worker / Mali, Home-based worker/ Artisan/ Handicrafts worker / Tailor, Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller, Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter, Electrician/ Mechanic/ Assembler/ Repair worker, Washerman/ Chowkidar. As per the SECC 2011, the following beneficiaries are automatically excluded: Households having motorized 2/3/4 wheeler/fishing boat Households having mechanized 3/4 wheeler agricultural equipment Households having Kisan Credit Card with credit limit above Rs. 50,000/ - Household member is a government employee Households with non - agricultural enterprises registered with government Any member of household earning more than Rs. 10,000/ - per month Households paying income tax Households paying professional tax House with three or more rooms with pucca walls and roof Owns a refrigerator Owns a landline phone Owns more than 2.5 acres of irrigated land with 1 irrigation equipment Owns 5 acres or more of irrigated land for two or more crop season Owning at least 7.5 acres of land or more with a t least one irrigation equipment To check your eligibility, click here Process of availing care under PM-JAY Implementation Strategy At the national level to manage, a National Health Agency has been set up. States/ UTs are advised to implement the scheme by a dedicated entity called State Health Agency (SHA). Major Impact In-patient hospitalization expenditure in India has increased nearly 300% during last ten years. (NSSO 2015). More than 80% of the expenditure are met by out of pocket (OOP). Rural households primarily depended on their 'household income / savings' (68%) and on 'borrowings' (25%), the urban households relied much more on their 'income / saving' (75%) for financing expenditure on hospitalizations, and on '(18%) borrowings. (NSSO 2015). Out of pocket (OOP) expenditure in India is over 60% which leads to nearly 6 million families getting into poverty due to catastrophic health expenditures. This will lead to increased access to quality health and medication. In addition, the unmet needs of the population which remained hidden due to lack of financial resources will be catered to. This will lead to timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency, job creation thus leading to improvement in quality of life. Expenditure involved The expenditure incurred in premium payment will be shared between Central and State Governments in specified ratio as per Ministry of Finance guidelines in vogue. The total expenditure will depend on actual market determined premium paid in States/ UTs where AB-PMJAY will be implemented through insurance companies. In States/ UTs where the scheme will be implemented in Trust/ Society mode, the central share of funds will be provided based on actual expenditure or premium ceiling (whichever is lower) in the pre-determined ratio. Number of Beneficiaries AB-PMJAY covers the following beneficiaries. 12 crore poor and vulnerable families 37 lakh ASHAs/AWWs/AWHs working across the country and their families 4.5 Crore families with six (6) crore senior citizens States/Districts covered AB-PMJAY will be rolled out across all States/UTs in all districts with an objective to cover all the targeted beneficiaries. Source : National Health Agency Related resources Search for Empanelled Hospitals