In order to achieve the vision of Universal Health Coverage (UHC), a national initiative launched by Indian Prime Minister Narendra Modi i.e. Ayushman Bharat Yojana, also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY) or Healthy India. This scheme is a part of National Health Policy 2017 that aims to help economically vulnerable Indians who are in need of healthcare facilities. as to meet SDG and its underlining commitment this initiative has been designed on the lines, which is “leave no one behind”.
Prime Minister Narendra Modi rolled out this health insurance scheme on 23 September 2018 to cover about 50 crore citizens in India and already has several success stories to its credit. As of September 2019, it was reported that 18,059 hospitals have been empaneled, over 5 Mi beneficiaries have been admitted and over 10 crore e-cards have been issued.
The Ayushman Bharat Yojana – National Health Protection Scheme, which has now been renamed as Pradhan Mantri Jan Arogya Yojana, is an attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service and plans to make secondary and tertiary healthcare completely cashless. The PM Jan Arogya Yojana beneficiaries get an e-card that can be used to avail services at an empaneled hospital, public or private, anywhere in the country. With it, you can walk into a hospital and obtain cashless treatment.
The coverage includes 3 days of pre-hospitalization and 15 days of post-hospitalization expenses and aims to undertake path breaking interventions to holistically address health (covering prevention, promotion and ambulatory care), at primary, secondary and tertiary level. Moreover, around 1,400 procedures with all related costs like OT expenses are taken care of. All in all, PMJAY and the e-card provide a coverage of Rs. 5 lakh per family, per year, thus helping the economically disadvantaged obtain easy access to healthcare services.
PMJAY Health Cover Categories: Eligibility Criteria for Rural & Urban People
scheme has certain pre-conditions by which it picks who can avail of the health cover benefit. While in the rural areas the list is mostly categorized on lack of housing, low income and other deprivations, the urban list of PMJAY beneficiaries is drawn up on the basis of occupation.
PMJAY in the rural areas, the PMJAY health cover is available to:
- Beggars and those surviving on alms
- Primitive tribal communities
- People living in scheduled caste and scheduled tribe
- no male member aged 16 to 59 years in Families
- Families with no individuals aged between 16 and 59 years
- Families having at least one no able-bodied adult member or physically challenged member
- by working as casual manual laborer Landless households who make a living
- Legally released bonded laborer
- Families living in one-room makeshift houses with no proper walls or roof
- Manual scavenger families
PMJAY in the urban areas, those who can avail of the government-sponsored scheme consist mainly of:
- Washer man / chowkidars
- Rag pickers
- Mechanics, electricians, repair workers
- Domestic help
- Sanitation workers, gardeners, sweepers
- Home-based artisans or handicraft workers, tailors
- Cobblers, hawkers and others providing services by working on streets or pavements
- Plumbers, masons, construction workers, porters, welders, painters and security guards
- Transport workers like drivers, conductors, helpers, cart or rickshaw pullers
- Assistants, peons in small establishments, delivery boys, shopkeepers and waiters
People not entitled for the Health Cover under Pradhan Mantri Jan Arogya Yojana:
- Those who own a two, three or four-wheeler or a motorized fishing boat
- Those who own mechanized farming equipment
- Those who have Kisan cards with a credit limit of Rs.50000
- Those employed by the government
- Those who work in government-managed non-agricultural enterprises
- Those earning a monthly income above Rs.10000
- Those owning refrigerators and landlines
- Those with decent, solidly built houses
- Those owning 5 acres or more of agricultural land
PMJAY Illness Coverage: List of Critical Diseases covered under PM Jan Arogya 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 empaneled public and private hospitals.
Some of the Critical illnesses that are covered are as follows.
- Prostate cancer
- 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 program
- Cosmetic related procedures
- Fertility related procedures
- Organ transplants
- Individual diagnostics (for evaluation)
Advantages of Health Insurance in India
The main advantage of having a health insurance policy is that you can avail medical treatment without suffering any strain on your finances. Moreover, as a significant number of Indians end up borrowing money informally to pay medical bills, utilizing the features of PMJAY helps avoid the risk of a debt trap.
Ayushman Bharat Yojana: PMJAY Patient Card Generation
Once you are eligible for the PMJAY benefits, you can work towards getting an e-card. Before this card is issued, your identity is verified at a PMJAY kiosk with the help of a document like your Aadhaar card or ration card. Family identification proofs that can be produced include a government certified list of members, PM letter and an RSBY card. Once the verification is completed, the e-card is printed along with the unique AB-PMJAY ID. You can use this as proof at any point in the future.