Ayushman Bharat Yojana, also known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), is a flagship healthcare scheme launched by the Government of India.
It was introduced in September 2018 with the aim of providing financial protection and healthcare access to millions of underprivileged and economically vulnerable citizens in India. The scheme has two main components:
The Ayushman Bharat Yojana is a significant step towards achieving the goal of Universal Health Coverage (UHC) in India, aiming to make quality healthcare accessible and affordable to all, particularly those who are most in need.
It is an essential initiative to address the healthcare challenges faced by India’s large population, improve health outcomes, and reduce the financial burden on families due to healthcare expenses.
Ayushman Bharat provides healthcare access to all Indian citizens, regardless of location or income.
The scheme offers insurance coverage of up to Rs 5 lakh per family per year for medical expenses.
Beneficiaries can access medical services at empanelled hospitals without the need for cash transactions.
Healthcare services are available across India, allowing beneficiaries to seek treatment in any state.
It covers pre-existing conditions, includes public and private hospitals, and simplifies the application process for beneficiaries.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana
The foundation for Ayushman Bharat was laid with the implementation of RSBY in 2008. RSBY was a government-run health insurance program aimed at providing health insurance coverage to below-poverty-line (BPL) families, specifically for hospitalization expenses. It was a precursor to PM-JAY and laid the groundwork for the later scheme.
The NHP 2017 emphasized the need for Universal Health Coverage (UHC) and outlined the government’s commitment to providing accessible and affordable healthcare services to all citizens. It served as a guiding document for the development of Ayushman Bharat.
Ayushman Bharat was officially announced by Prime Minister Narendra Modi on 15th August 2018 during his Independence Day speech. The scheme was introduced as a significant step towards achieving UHC in India.
In April 2018, the government launched the first phase of Ayushman Bharat by inaugurating Health and Wellness Centers (HWCs) across the country. These centers aimed to provide comprehensive primary healthcare services and promote preventive healthcare.
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The insurance component of Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (PM-JAY), was officially launched on September 23, 2018. PM-JAY aimed to provide health insurance coverage to vulnerable and economically disadvantaged families, offering financial protection against high healthcare costs.
Since its launch, Ayushman Bharat has gone through various phases of expansion and implementation. The government has worked to empanel more hospitals, extend coverage, and improve the reach of the scheme.
Ayushman Bharat has achieved several milestones since its inception, including the enrollment of millions of beneficiaries and the successful coverage of various medical treatments and hospitalizations.
Ayushman Bharat Yojana comprises two main components:
Health and Wellness Centers (HWCs): The government plans to establish 1,50,000 Health and Wellness Centers (HWCs) by 2022. These centers are a cornerstone of comprehensive primary healthcare, offering affordable services, especially for underprivileged communities.
Pradhan Mantri Jan Arogya Yojana (PMJAY): PMJAY is the insurance arm of Ayushman Bharat, providing coverage of up to Rs 5 lakh per family per year. It is the world’s largest health insurance program, targeting around 50 crore underprivileged individuals. Beneficiary identification is based on the Socio-Economic Caste Census 2011 (SECC 2011) data, and it incorporates elements of the National Health Protection Scheme (NHPS) and the Rashtriya Swasthya Bima Yojana (RSBY).
Key Features of PMJAY
PMJAY is entirely funded by the government, sharing expenses between the Central and State Governments. Some of its noteworthy features include:
High Coverage: Beneficiaries can claim up to Rs 5 lakh per family per year.
Cashless Access: The scheme provides cashless access to healthcare services at empanelled hospitals.
Comprehensive Coverage: PMJAY covers a wide range of medical expenses, including diagnostics, surgeries, room charges, and medication.
Portability: Beneficiaries can access healthcare services across India.
Eligibility Criteria for PMJAY
Eligibility for PMJAY is determined based on the SECC 2011 database, considering factors like occupation, income, location, and living conditions. While it aims to benefit approximately 10 crore families, the program is estimated to help over 50 crore individuals.
Eligibility Categories
PMJAY Rural: This category includes individuals and families from various vulnerable groups such as SC/ST communities, beggars, families without healthy adults, and more.
PMJAY Urban: Urban beneficiaries encompass individuals with specific occupations like ragpickers, beggars, domestic workers, street vendors, construction workers, and many others.
Ineligibility Categories
Certain categories of families are not eligible for PMJAY benefits. These include those with motorized vehicles, Kisan Credit Cards with substantial credit, government employees, and more.
Benefits of PMJAY
Under PMJAY, beneficiaries receive healthcare coverage for various medical treatments, including emergency care, communicable and non-communicable diseases, maternal and child health services, mental health care, dental care, eye care, and more. The scheme covers pre-hospitalization and post-hospitalization expenses, making it comprehensive.
How to Apply for Ayushman Bharat Yojana Card
To avail of cashless healthcare services, beneficiaries can obtain the Ayushman Bharat Yojana Card, also known as the AB-Golden Card.
The application process involves registering on the PMJAY website, obtaining an HHD code, and visiting a Common Service Centre (CSC) for verification. The card costs Rs. 30 and is essential to access scheme benefits.
Covered Illnesses
PMJAY covers a broad spectrum of diseases, including but not limited to prostate cancer, coronary artery bypass grafting, pulmonary valve replacement, and various surgeries.
However, it does not include outpatient care, drug rehabilitation, cosmetic procedures, fertility treatments, or organ transplants.
The Ayushman Bharat Yojana is a monumental effort to improve healthcare access for millions of Indians, offering financial protection and a safety net for those who need it most.
It represents a significant stride towards achieving Universal Health Coverage and enhancing the well-being of the nation.
Who is eligible for Ayushman Bharat Yojana?
Eligibility for Ayushman Bharat Yojana is primarily based on the Socio-Economic Caste Census (SECC) 2011 database. It considers factors such as income, occupation, and living conditions. Families falling within specified categories and socioeconomic criteria are eligible.
What is the coverage amount under the Pradhan Mantri Jan Arogya Yojana (PMJAY) component?
PMJAY provides health insurance coverage of up to Rs 5 lakh per family per year. This coverage includes various medical treatments, hospitalization expenses, and related healthcare services.
How can I apply for the Ayushman Bharat Yojana Card (AB-Golden Card)?
To apply for the AB-Golden Card, you need to register on the PMJAY website, obtain an HHD code, and visit a Common Service Centre (CSC) for verification. Once verified, you can acquire the card for a nominal fee.
Are pre-existing health conditions covered under PMJAY?
Yes, PMJAY provides coverage for pre-existing health conditions and chronic diseases. Unlike some insurance schemes, it does not exclude individuals with pre-existing conditions from availing of benefits.
Can I access healthcare services under Ayushman Bharat Yojana anywhere in India?
Yes, one of the key features of PMJAY is portability, which means you can access healthcare services at any empanelled hospital across India. This ensures that beneficiaries are not restricted to healthcare facilities in their home state.
Are private hospitals included in the Ayushman Bharat Yojana network?
Yes, Ayushman Bharat Yojana includes a network of both public and private hospitals. This diverse network ensures that beneficiaries have access to a wide range of healthcare providers, offering them more choices for their medical needs.
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