According to NSSO 2015, in-patient hospitalization expenditure in India has increased nearly 300% during the last 10 years. More than 80% of the expenditure is met out of pocket (OOP). About 68% of rural households depend on their household income for medical expenditures and about 75% of the urban households rely on their income/savings for financing the hospital expenditure. OOP expenditure in India is over 60% which can lead nearly 6 million families into poverty due to catastrophic expenditures. To avoid this, Ayushman Bharat Yojna was introduced in 2018.
What is Ayushman Bharat Yojana (PMJAY)?
As the name suggests, Ayushman Bharat in Hindi means a long life for the people of India. It is the world’s largest health insurance scheme financed by the Government of India and it aims to cover around 50 crore beneficiaries. The basic objective of the scheme is to achieve the vision of universal health coverage by providing good quality access to healthcare and also by reducing the financial burden on poor or deprived households.
National Health Protection Scheme (NHPS) and Rashtriya Swasthya Bima Yojana (RSBY) are two schemes that were subsumed into Ayushman Bharat upon its inception.
Who will be eligible for this scheme?
The eligibility would be identified from the Socio-Economic Caste Census 2011. Only the poor and deprived households and families which are already a part of RSBY would be able to avail the benefits of this scheme.
How much health cover would be provided?
A cover of ₹ 5 Lakh would be provided as a family floater.
Are there any restrictions on the number of members or age?
No, since the scheme aims to cover as many people as possible, there is neither a restriction on the number of family members nor the age.
What are the features of PMJAY?
- Cover of ₹ 5 Lakh for almost all the secondary and tertiary health care.
- 3 days pre-hospitalization and 15 days post-hospitalization expenses are covered.
- No restriction on family size, age, or gender.
- All pre-existing diseases are covered from Day 1.
- Medical implants.
- Benefits of this scheme are portable across the country.
- A defined transportation allowance will be paid.
What is the minimum duration of hospitalization required to avail the benefits?
A minimum of 24 hours of hospitalization is required with the rationale for hospitalization provided by authorized hospital authorities. The diagnostics need to match packages listed under PMJAY.
How many packages or treatments are covered under PMJAY?
A total of 1393 packages are included out of which 1083 are surgical, 309 are medical packages and 1 is unspecified. More detailed information can be found here.
Can we claim multiple surgical packages?
Yes, multiple surgical packages can be claimed but they are subjected to the approval of the competent authorities.
How can I apply or register for PMJAY?
GoI has recently started an online portal because of which, you can make your PMJAY card online, yourself. Through this portal, you can find your name in the scheme list and after doing basic KYC, you can download the card for you and your family. If you want to know the procedure in detail, click here.
Conclusion
Since its inception, PMJAY has played an important role in strengthening the weak and deprived section of our society. During the pandemic, approximately 8.3 lakh cases were registered under PMJAY which helped us to reduce the death toll overall.
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