PMJAY Ayushman Bharat Yojana
PMJAY Ayushman Bharat Yojana: Ayushman Bharat, a flagship scheme of Government of India, was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC). This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to “leave no one behind.”
Ayushman Bharat is an attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service. This scheme aims to undertake path breaking interventions to holistically address the healthcare system (covering prevention, promotion and ambulatory care) at the primary, secondary and tertiary level. Ayushman Bharat adopts a continuum of care approach, comprising of two inter-related components, which are:
Health and Wellness Centres (HWCs)
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
What’s Coverage under PMJAY Ayushman Bharat Yojana?
Thus, PM-JAY has been rolled out for the bottom 40 per cent of poor and vulnerable population. In absolute numbers, this is close to 10.74 crore (100.74 million) households. The inclusion of households is based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas, respectively. This number also includes families that were covered in the RSBY but were not present in the SECC 2011 database.
Out of the total seven deprivation criteria for rural areas, PM-JAY covered all such families who fall into at least one of the following six deprivation criteria (D1 to D5 and D7) and automatic inclusion(Destitute/ living on alms, manual scavenger households, primitive tribal group, legally released bonded labour) criteria:
D1- Only one room with kucha walls and kucha roof
D2- No adult member between ages 16 to 59
D3- Households with no adult male member between ages 16 to 59
D4- Disabled member and no able-bodied adult member
D5- SC/ST households
D7- Landless households deriving a major part of their income from manual casual labour
For urban areas, the following 11 occupational categories of workers are eligible for the scheme:
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
Which People are not Entitled for the Health Cover under PMJAY Ayushman Bharat Yojana?
The individuals who claim a two, three or four-wheeler or a mechanized angling pontoon
The individuals who claim motorized cultivating gear
The individuals who have Kisan cards with a credit breaking point of Rs.50000
Those utilized by the legislature
The individuals who work in government-oversaw non-horticultural undertakings
Those acquiring a month to month salary above Rs.10000
Those owning fridges and landlines
Those with tolerable, decidedly constructed houses
Those owning 5 sections of land or a greater amount of rural land
Where can People go and get their Treatment In PMJAY Ayushman Bharat Yojana?
There will be a total of 1350 types of surgeries, screenings and procedures in India. Every poor citizen of the country will get free benefits from major illnesses and major operations as well as hospitalization. The operation included bypass surgery, cataract, corneal grafting, orthoplasty, chest fracture, urological surgery, cesarean delivery, dialysis, spine surgery, brain tumor surgery and various cancer surgeries.
In which Hospital will People get Benefits under PMJAY Ayushman Bharat Yojana?
All the government and hospitals in the country connected with Ayushman Bharat Yojana will get benefit of Ayushman Bharat Yojana. The connection of 8,000 hospitals has been completed in Ayushman Bharat Yojana and the Government aims to connect 20,000 hospitals. So that the poorest family living in any corner of the country can access health services near their home. In India, more than 1700 government and private hospitals will provide medical treatment under aging India.
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How To Apply PMJAY Ayushman Bharat Yojana?
There is no special Ayushman Bharat registration procedure pertaining to PMJAY. This is because PMJAY applies to all beneficiaries as identified by the SECC 2011 and those who are already part of the RSBY scheme. However, here’s how you can check if you are eligible to be a beneficiary of PMJAY.
1. Visit https://www.pmjay.gov.in/ and click on ‘Am I Eligible’
2. Enter your mobile number and the CAPTCHA code and click on ‘Generate OTP’
3. Then select your state and search by name/ HHD number/ ration card number/ mobile number
4. Based on the search results you can verify if your family is covered under PMJAY
Alternatively, to know if you are eligible for PMJAY you can approach any Empanelled Health Care Provider (EHCP) or dial the Ayushman Bharat Yojana call centre number: 14555 or 1800-111-565
Which Critical Diseases covered under PMJAY Ayushman Bharat Yojana?
PMJAY helps households access secondary and tertiary care via funding of up to Rs. 5 lakh per family, per year. This assistance is valid for day care procedures and even applies to pre-existing conditions. PMJAY extends coverage for over 1,350 medical packages at empanelled public and private hospitals.
Some of the Critical illnesses that are covered are as follows.
Coronary artery bypass grafting
Double valve replacement
Carotid angioplasty with stent
Pulmonary valve replacement
Skull base surgery
Laryngopharyngectomy with gastric pull-up
Anterior spine fixation
Tissue expander for disfigurement following burns
PMJAY has a minimal list of exclusions. They are as follows:
Drug rehabilitation programme
Cosmetic related procedures
Fertility related procedures
Individual diagnostics (for evaluation)
PM-JAY is completely funded by the Government and costs are shared between Central and State Governments. The Government of India decides a national ceiling amount per family that is used to determine the maximum limit of the central share of the contribution. The actual premium discovered through open tendering process or the maximum ceiling of the estimated premium decided by Government of India for the implementation of PM-JAY, whichever is less, would be shared between Central Government and States/UTs in the ratio as per the extant directives issued by Ministry of Finance, from time to time. In addition, administrative cost for implementing the scheme at the State level is also provided under the scheme and shared between Centre and State in the same sharing pattern.
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