Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

About Ayushman Bharat Scheme

1. It is to address health issues at all levels - primary, secondary and tertiary. It is the largest Govt funded Healthcare program of World with ~ 50 crore beneficiaries.
2. It is an integrated approach comprising of health insurance.

Components of PMJAY

• Create 1.5 lakh Health and Wellness Centers (for Primary healthcare)
  1. HWCs are created by converting existing PHC and subcenters.
  2. They are based on the preventive care concept. They provide comprehensive primary health care (CPHC) including a child and maternal health services, NCDs, and also diagnostic services and free essential drugs.
• PM Jan Arogya Yojana aka National Health Protection Scheme (For IIry and IIIry care)
  1. It is the largest insurance program of the World. Beneficiaries to get cashless treatment from any empanelled hospital (both public and private).
  2. It will give insurance cover of Rs. 5 lakh per year per family to 10 crore families based on SECC database.
  3. There is no cap on family size. It includes pre and post hospitalization expenses. It covers all pre existing conditions. Transport allowance included.
  4. It focuses on Cooperative Federalism and Flexibility to States. States would need to have State Health Agency to implement it.
  5. AB-PMJAY is a completely cashless and paperless scheme.
  6. The benefits under AB-PMJAY are portable across the country.
  7. There is no cap on family size, or age or gender.
• Cabinet has approved the restructuring of existing National Health Agency as "National Health Authority". It has now been made an attached office to MoHFW for better implementation of AB-PMJAY.
• The number of eligible beneficiaries under SECC 2011 is 10.74 crore (50 crore people). 33 States/UTs implementing AB-PMJAY have further expanded the coverage of the scheme to include 13.44 crore families (65 crore people).
• AB-PMJAY is being implemented in all States and UTs barring West Bengal, NCT of Delhi and Odisha.
• The scheme is implemented across the country through a three-tier model.
  1. National Health Authority, an attached office of the Ministry of Health and Family Welfare with full functional autonomy, is the apex body implementing AB-PMJAY across the country.
  2. For effective implementation of AB-PMJAY at States/UTs level, State Health Agencies (SHAs) have been established.
  3. District Implementation Units (DIUs) have been set up for ensuring on-ground coordination between scheme stakeholders and for smooth implementation.
• AB-PMJAY is completely funded by the Government and costs are shared between Central and State Governments in the ratio as per the extant directives issued by Ministry of Finance.
• The States/UTs have been provided with the flexibility to implement the scheme in the operational model best suited to the local conditions. Thus, AB-PMJAY is being implemented in Insurance mode, Mixed mode and Trust mode.
• As regards procedure involved, AB-PMJAY is an entitlement-based scheme. All the eligible beneficiary families are covered from day one of the implementation of the scheme in the States/UTs. AB-PMJAY does not require enrolment. However, beneficiary verification process is being undertaken to verify the genuineness of the beneficiary. Ayushman cards are issued to all eligible beneficiaries as part of this process to ensure easy availing of health benefits.
• Targets are not fixed for AB-PMJAY as the scheme operates on the basis of beneficiary demand for healthcare services. All the eligible beneficiaries of the implementing States/UTs are entitled for free healthcare services under the scheme from the day of launch of the scheme.

The beneficiary families under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) have been identified from the Socio Economic Caste Census (SECC) of 2011 on the basis of select deprivation and occupational criteria across rural and urban areas. Details are as below:

Detailed list of criteria for eligibility under AB-PMJAY as per SECC 2011

Automatically included:

• Households without shelter
• Destitute/ living on alms
• Manual scavenger families
• Primitive tribal groups
• Legally released bonded labour

Deprivation criteria in rural area:

• D1: Only one room with kucha walls and kucha roof
• D2: No adult member between age 16 to 59
• D3: Female headed households with no adult male member between age 16 to 59
• D4: Disabled member and no able-bodied adult member
• D5: SC/ST households
• D7: Landless households deriving major part of their income from manual casual labour

Occupational criteria in urban area:

• 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 other 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/Washer-man/ Chowkidar