Ayushman Bharat or Pradhan Mantri Jan Arogya Yojana (PMJAY) is a fundamental restructuring of the manner in which beneficiaries access healthcare services at the primary, secondary and tertiary care levels. In PMJAY, There is no cap on family size and age as well as restriction on preexisting conditions. PMJAY will help reduce out of pocket hospitalisation expenses, fulfil unmet needs and improve access of identified families to quality inpatient care and day care surgeries PMJAY will provide a coverage up to Rs. 5,00,000 per family per year, for secondary and tertiary care hospitalization through a network of Empaneled Health Care Providers (EHCP). The EHCP network will provide completely cashless and paperless access to services for the beneficiaries at the both public and private hospitals. The services will include 1350 procedures covering pre and post hospitalization, diagnostics, medicines etc. PMJAY beneficiaries will be able to move across borders and access services across the country through the provider network seamlessly. The scheme is entitlement based. No formal enrolment process is required.
PMJAY will target poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) 2011 data, both rural and urban. Additionally, all such enrolled families under RashtriyaSwasthayaBimaYojana (RSBY) that do not feature in the targeted groups as per SECC data will be included as well.
During survey in Hailakandi district on PMJAY out of total 323 numbers of revenue villages, total 55,736 numbers of household in rural area were counted under PMJAY scheme where 98.7% family head name were found, 78.50% ration card were found, 83.7% mobile numbers and 45.10% house hold with new family members were detected. In urban area, during survey out of 25 numbers of ward (Hailakandi and Lala) total 1987 numbers of house hold were detected and 99.9% family head name and 87.7% ration card were found. Similarly, 98.2% mobile number and 55.4% house hold with new family members were found.
Total 48,929 numbers of PMJAY cards received from the state head quarter on 21.09.2018 and distributed accordingly among rural and urban beneficiaries.
Key features of Ayushman Bharat scheme:
1. Ayushman Bharat will provide a cover of Rs 5 lakhs per family per year for secondary and tertiary medical care facilities.
2. If you are eligible under the health insurance scheme, you get automatic coverage. Eligibility is based on Socio-Economic Caste Census (SECC) database.
3. In case of hospitalization, you or your family members do not need to pay anything under the scheme provided you go to any government or empanelled private hospital.