Nearly fifty percent of the treatments under PMJAY are availed by women
About Pradhan Mantri Jan Arogya Yojana (PM-JAY)
- Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the second component under Ayushman Bharat(first is Health and Wellness Centres)
- This scheme was launched on 23rd September, 2018 in Ranchi, Jharkhand by the Hon’ble Prime Minister of India
- PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government
- The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.
- PM-JAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened.
- It subsumed the then existing Rashtriya Swasthya Bima Yojana (RSBY) which had been launched in 2008.
- PM-JAY is fully funded by the Government and cost of implementation is shared between the Central and State Governments.
Key features of PM-JAY
- It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
- Over 10.74 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
- PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
- PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.
- It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
- There is no restriction on the family size, age or gender.
- All pre–existing conditions are covered from day one.
- Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
- Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
- Public hospitals are reimbursed for the healthcare services at par with the private hospitals
Benefits covered under the scheme
- PM-JAY provides cashless cover of up to INR5,00,000 to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment.
- Medical examination, treatment and consultation
- Medicine and medical consumables
- Non-intensive and intensive care services
- Diagnostic and laboratory investigations
- Medical implantation services (where necessary)
- Accommodation benefits
- Food services
- Complications arising during treatment
- Post-hospitalization follow-up care up to 15 days
- The benefits of INR 5,00,000 are on a family floater basis which means that it can be used by one or all members of the family.
- The RSBY had a family cap of five members.
- However, based on learnings from those schemes, PM-JAY has been designed in such a way that there is no cap on family size or age of members.
- In addition, pre-existing diseases are covered from the very first day.
- This means that any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.