Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is the flagship health protection scheme of the Government of India, covering over 10.74 crore poor and deprived families (about 53 crore beneficiaries), for secondary and tertiary care after hospitalisation. , provides free treatment up to Rs.5 lakh per family per year. The objective of the scheme is to reduce the financial burden on the poor and underprivileged people arising out of excessive hospitalization expenses and ensure their access to free and quality health services. To do.
National Health Authority (NHA) is the apex agency of the Government of India, responsible for the roll-out and implementation of Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) across the country. So far, 33 States/UTs, three States are implementing this scheme, except West Bengal, National Capital Territory of Delhi and Odisha.
Since its inception on 23 September 2018, 1.94 crore hospital treatments have been authorized under the scheme across the country for which Rs 23,950 crore have been authorized. As on 14 July 2021, more than 16.09 crore eligible beneficiaries have been provided Ayushman cards.
There are 918 Health Benefit Packages (HBPs) with fixed rates covering 1,669 procedures along with COVID treatments and diagnostic tests. As of now, a large network of over 23,000 public and private hospitals across the country have been empaneled with AB PM-JAYK.
Salient Features of the Scheme:
- Health care coverage Rs 5,00,000 per eligible family per annum.
- No limit on family size and age of family members.
- Cashless access to health care services for the beneficiary at any empaneled hospital across the country.
- Initially 74 crore beneficiary families were covered under SECC data, later states/UTs expanded their beneficiary base due to which currently more than 13.17 crore beneficiary families are eligible under the scheme.
- The beneficiaries are selected from the Socio-Economic Caste Census (SECC) 2011 survey based on the deprivation and occupational parameters of rural and urban population base respectively.
- All pre-existing diseases are covered from the first day of hospitalization.
- This includes 1,669 procedures covering costs related to surgery, medical and day-care treatments, cost of drugs and diagnosis, etc.
As per the information available with the National Health Authority, by 03 July 2021
Under AB PM-JAYK, a total of about 17.5 lakh trials and about 6.88 lakh treatments worth Rs 2640 crore have been authorized for COVID-19 related treatments.
AB PM-JAYHow to become a beneficiary and get Ayushman card to take advantage of the scheme?
Here are some of the major initiatives taken by the NHA for beneficiaries to check eligibility and enroll for the scheme:
- 24×7 National Toll-Free Call Center: NHA launches 24×7 national toll-free helpline
“14555” / 1800-111-565 is installed. Backed with a state-of-the-art multilingual call centre, it allows beneficiaries across the country to reach out for any information, service request support or lodge complaint. National Institute to generate awareness and collect beneficiary experience feedback for grievance redressal The helpline is also an important service centre.
- Beneficiary Self Help Portal: A user friendly web portal “https://mera.pmjay.gov.in/” has been started so that people can find out their eligibility under PM-JAYK. The portal also provides information about the empaneled hospitals.
- PM-JAY Mobile App: The mobile app enables the beneficiaries to track their eligibility, nearest listed hospital and self help through frequently asked questions (FAQs).
allows detection. As a handy personal tool,
It helps the beneficiaries to know the benefits related to their eligibility and get closer
Grants access to the enlisted hospital. The app can be downloaded from https://play.google.com/store/apps/details?id=org.nha.pmjay.
- in empaneled hospitals PM-JAY Helpdesk: Beneficiaries can visit the PM-JAI Help Desk in the nearest Government/Private hospital empaneled by AB PM-JAY and initiate the process. Beneficiaries can click here (https://hospitals.pmjay.gov.in/Search/empnlWorkFlow.htm?actionFlag=ViewRegisteredHosptlsNew) to view the list of empaneled nearby hospitals.
- Beneficiaries can also visit their nearest Common Service Center (CSC) to get their Ayushman card made free of cost.
How a beneficiary can use Ayushman card to avail free and cashless treatment?
Once the beneficiary is verified and Ayushman card is generated, he/she can access the post-hospitalization services at any PM-JAY empaneled hospital across the country. At the time of admission to the hospital, the beneficiary is required to visit the hospital with a copy of Ayushman card or AB PM-JAY number. If Ayushman card is not available, any identity document can be provided.
The beneficiary can approach Pradhan Mantri-Arogya Mitras (PMAM) who are available in all empaneled hospitals to assist in hospital care. When a beneficiary contacts the empaneled hospital to avail cashless treatment under AB PM-JAY, PMAM will help the beneficiary in the admission process, pre-submit the request for authorization and subsequently with the necessary medication and advice Holiday will help.
How can the beneficiary register his complaint??
NHA has developed a Central Grievance Redressal Management System (CGRMS) to record, track and resolve grievances of all stakeholders in the AB PM-JAY ecosystem in an efficient, transparent and time bound manner. It is controlled using a three-tier system of governance at the district, state and national levels. There is a dedicated Nodal Officer at each level. Whenever such complaints are received, they are directed to the concerned person for redressal and closely monitored for timely and quality resolution.
