Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana


India is a developing country with an average growth rate of 7.2 over the past decade. In which,  Many sectors are improving with a fast pace. One of them is Health care sector. It is expected to raise up to 280 billions till 2020. But nearly half of the Indian citizens are unable to get required medical treatment. The raise in the cost of medical expenses and diagnostics procedure made the citizens to pay heavy costs from their own pockets.

Realizing this problem government of India initiated National Health Protection Mission constituting National Health Authority (NHA). Under NHA, government started Ayushman Bharat Scheme. Popularly known as Modicare or Pradhan Mantri Jan Arogya Yojana.

To achieve National Health Protection Mission , government opted for two strategies

Creation of Health Care centres and Implementation of Ayushman Bharat Scheme.


Health Care centres

One of the main agenda involves the creation of 1.5 Lakhs Health and Wellness Centres which helps citizens to get a comprehensive Primary Health care (CPHC).

The  Health and Wellness Centres provide  services

  • Maternal and Child health services.
  • Services for communicable disease and non-communicable diseases.
  • Essential drugs for the treatment and diagnostic services are provided

On 14th April 2018, PM launched the first Health and Wellness Centre in Chhattisgarh, at Bijapur, Jangla.


Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (ModiCare)

Whats is AB-PMJAY

Ayushmaan Bharat is a National health protection scheme which provides a financial coverage of Rs.500,000 per family per year.It’s launched in August 2018 headed by PM Narendra Modi and Health Minister JP Nadda. The scheme covers the secondary and tertiary care hospitalization of the patients. It is also popularly known as Pradhan Mantri Jan Arogya Yojana or Modicare or National Health Protection Scheme.


Need of AB-PMJAY

As India is a developing country, with a population of 1.3 billion people when a country is in developing state, it has to focus on many sectors, among them one of the main sectors is health care sector. Indian Healthcare sector is growing rapidly from past 20 years. But the lower levels of the Indian society is unable to meet the medical needs.

Main problem is that out of the pocket expenditure and low financial protection by the Indian people 63.8% of the population are paying money from their own pockets for the medical expenses. Most of them are poor and middle class people who are borrowing the money from others and gets into the debts. As a result 4.6% of the population is pushed towards the PL(poverty lines). They are not covered under any medical insurance schemes (government and public).


Mission of AB-PMJAY

Pradhan Mantri Jan Arogya Yojana aims to reduce the financial burden on BPL families (below poverty line people) and vulnerable groups who fails to support the family in time of medical needs. The scheme aims to provide the quality medical services to the poor and BPL families, it seeks to achieve the Sustainable Development Goal -3 (SDG- 3) and accelerate the progress in  health care system towards achieving the Universal Health Coverage (UHC).


BENEFITS of PM Jan Arogya Yojana

Ayushmaan Bharat Yojana (PMJAY) is one of the largest health care schemes under the National Health Authority, launched by Prime Minister Narendra Modi. It covers 10.8 crore families who are poor, deprived and are  unable to access the quality medical services.

It will cover the medical and hospitalization expenses for all the secondary and tertiary care procedures. Scheme has 1350 medical packages under it’s belt, which includes surgeries, medical and day care treatments including diagnostic procedures, various primary medical tests and transport facilities such as ambulance in the time of emergency.

  • Under the scheme government covers up to Rs.500,000 per year per family.
  • Nearly 10.8 crore families will be benefited under this yojana across the country which covers nearly 50 crores of people.
  • There is no cap on the number of people in the family that will get the medical insurance. All the family members are eligible for the scheme.
  • Under the scheme, the priority is given to girl child, women and senior citizens.
  • It has 1,350 medical packages under its scheme.
  • All diseases which are identified by the AIMS authority, which are treatable and cured are covered under the scheme. No hospital can deny on providing the medical treatment.
  • The Hospitals are not allowed to charge additional money from the patients or benefactors under PMJAY for the treatment.
  • It is a cashless and paperless healthcare service system, the eligible families are given the e-cards known as PMJAY cards.
  • By using the cards one can get the medical treatment from any hospital which are empanelled under the Ayushman Bharat Yojana.


Eligibility criteria to obtain AB-PMJAY

The data for the eligibility of AB-PMJAY is collected by Socio Economic and Caste Census 2011. It uses the same technique which is used to collecte the data of the whole population under 2011 census.

It is categorised under Urban and Rural.

Rural eligibility criteria for AB-PMJAY

  • Household living in kucha house.
  • Female households with no adult male members.
  • SC/ST households
  • Landless families.
  • Manual scavengers, legally bonded labour etc.
  • Tribal groups

Urban eligibility criteria for AB-PMJAY

  • All the low level street vendors and manual workers such as cobblers, Sweepers.
  • Construction workers , masons, migrant labours.
  • Security guards, coolies , sanitation workers.
  • Transport workers such as drivers, conductors, rickshaw pullers etc.
  • Women workers under construction work and daily labour.
  • All the daily wage workers in the urban and semi urban areas.
  • Families with no proper shelters.

The process of availing care under PM-JAY

If a person is got into an accident or suffering from any disease, can avail the PM-JAY if he is eligible for the scheme from the hospitals which are empanelled under Pradhan Mantri Jan Arogya Yojana (Modicare). Which covers upto the Rs.5 lakhs of the expenses including secondary and tertiary care procedures for a family every year.

When a patient is brought to the hospital in an emergency condition or in a casual visit, one must approach the  Pradhan Mantri Arogya Mitra(PMAM) help desk.

1: The identification of the patient will happen through the Aadhar card ( Individual ID Number) and the family Identity card ( Ration card or Pink Card, depending on the different state schemes).

2: The PMAM authorities will check the eligibility of the patient in the database (National Health Authority database, data collected by SECC).

3: If the patient is eligible for the Ayushmaan Bharat – Pradhan Mantri Jan Arogya Yojana then, he will be given treatment.

4: If there is any pre-request by the patient under any medical packages among the 1350 identified medical packages, he/she will be given the required medical treatment.

5: After the treatment, it covers the medicals bills such as medicine bills, ambulance cost, regular OP procedure cost. This amount is deducted from the account of AB-JAY account given to the family.

6: The empanelled hospital will claim the amount for the treatment given by the hospital.

Note : Pradhan Mantri Arogya Mitra (PMAM) authorities are available in every AB-PMJAY empanelled hospital. They are recruited under NHA and SHA by third party agencies.


Initial Success of AB-PMJAY

Ayushmaan Bharat is a great scheme to cover all the poor and vulnerable families who cannot afford proper medical care. It aims to provide the benefits to nearly 10.8 crores families under this scheme.

  1. No of hospitals empanelled under AB-PMJAY

To  implement the scheme, government constituted National Health Authority (NHA) and request to the states to constitute a State Health Authority Body (SHA). The hospitals which are willing to collaborate and jointly work under Ayushman Bharat scheme, they can register by visiting officials site of the AB- PMJAY and going through regular verification procedure.

Till date number of hospitals empanelled are 15,256 across the country.

  1. No of benefactors till date under AB-JAY

The Ayushman Bharat is one of the worlds’ largest healthcare schemes, that aims to provide the healthcare benefits to nearly 50 crore people in the country. It is quickly gaining the popularity among the citizens, people are actively engaging in the scheme.

Till date number of e-cards issued to the families are 2,88,07,760.

Number of Beneficiaries admitted and benefited from the Pradhan Mantri Jan Arogya Yojana are 18,20,686.

Still NHA and SHA are working hard to aware the citizens and identify the families through different awareness programs.  


Expenditure by the Government

Current Health expenditure by the government is 1.5% of our country’s GDP. In 2018 government sanctioned Rs.2000 crores for the Ayushman Bharat (PM-JAY). In 2019 budget it raised to Rs.6400 crores. Next time in the year of 2020 the government is likely to spend Rs.10,000 crores for the Ayushman Bharat scheme.

  • Central government and state government contribution for the scheme is 60:40 ratio.
  • 90:10 ratio for the North-eastern hilly states.
  • 100% central government sponsor for UT without legislature and 60:40 for Union territories with legislature.

Nearly 10 lakhs people benefited from the scheme, it is an initial success for the government, many senior citizens undergone knee replacement surgeries. Children with heart problems are also treated under priority basis. This warm and satisfactory feedback from citizens made the government to increase the expenditures of the scheme.


FAQs

1)What is Modicare or PM-JAY?

Pradhan Mantri Jan Arogya Yojana is the Health care scheme launched in August 2018 by PM Narendra Modi, to provide the Health benefits and cover the medical expenditure. The scheme covers Rs.5 lakhs per family per year.

2)What are the benefits available under Modicare or PM-JAY?

The scheme covers Rs.5 lakhs of medical expenses including secondary and tertiary care expenses with 1350 medical packages available under the scheme.

3)What are the health services available under PM-JAY?

There are about 1350 medical packages available under this medical Scheme, starting from maternal and child care to knee replacement and heart surgeries.

4)What is the enrolment process and time period for the process?

There is no enrollment process available for the scheme. The survey done by SECC 2011, is the current database. It identified 10.8 crore families that will be benefited under PM-JAY.


CA Abhishek Soni

Abhishek Soni is a Chartered Accountant by profession & entrepreneur by passion. He is the co-founder & CEO of Tax2Win.in. Tax2win is amongst the top 25 emerging startups of Asia and authorized ERI by the Income Tax Department. In the past, he worked in EY and comes with wide industry experience from telecom, retail to manufacturing to entertainment where he has handled various national and international assignments.