AB-PMJAY: What is it?
- Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a Centrally Sponsored Scheme under Ministry of Health and Family Welfare (MoHFW).
- It is an umbrella of two major health initiatives, namely
- Health and wellness Centres and
- National Health Protection Scheme.
Health and wellness Centres
- Under this component, 5 lakh existing health sub centres will be referred as Health and wellness centres and their primary responsibility will be to bring health care system closer to the people.
- These centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services.
National Health Protection Mission
- This component will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries).
- Ayushman Bharat – National Health Protection Mission has subsumed two centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).
- AB-PMJAY provides a cover of 5 lakh per family per year for almost all secondary care and most of tertiary care procedures.
- There is no cap on family size and age in the scheme to ensure that nobody is left out (especially women, children and elderly).
- The benefit cover will also include pre and post-hospitalisation
- A defined transport allowance per hospitalization will also be paid to the beneficiary.
- Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
- The beneficiaries can avail benefits in both public and empanelled private facilities.
- Hospitals belonging to Employee State Insurance Corporation (ESIC) may also be empanelled based on the bed occupancy ratio parameter.
- To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis.
- The beneficiaries will be selected on the basis of SECC (Socio-Economic Caste Census) data.