Pradhan Mantri Jan Aarogya Yojana (PMJAY)
Pradhan Mantri Jan Aarogya Yojana(PMJAY) is one of the components of
Ayushman Bharat which addresses the secondary and tertiary health care by providing free and cashless healthcare through network of both public and private hospitals. This is the “world’s largest government funded healthcare program” targeting more than 50 crore beneficiaries.
Ayushman Bharat – Pradhan Mantri Jan AarogyaYojana (AB-PMJAY) by the Prime Minister, Shri Narendra Modi on 23rd September, 2018 at Ranchi, Jharkhand.
BENEFITS UNDER THE SCHEME:
- Ayushman Bharat- Pradhan Mantri Jan ArogyaYojana (PMJAY) will provide a cover of up to Rs. 5 lakhs per family per year, for secondary and tertiary care hospitalization.
- Over 10.74 crore vulnerable entitled families (approximately 50 crore beneficiaries) will be eligiblefor these benefits.
- PMJAY will provide cashless and paperless access to services for the beneficiary at the point of service.
- Entitled families will be able to use the quality health services they need without facing financial hardships.
- When fully implemented, PMJAY will become the world’s largest fully government-financed health protection scheme. It is a visionary step towards advancing the agenda of Universal Health Coverage (UHC).
Pradhan Mantri Jan ArogyaYojana: Hospitalization cover from inpatient care to post hospitalisation care:
- The objectives of the Yojana are to reduce out of pocket hospitalisation expenses, fulfil unmet needs and improve access of identified families to quality inpatient care and day care surgeries.
- The Yojana will provide a coverage up to Rs. 5,00,000 per family per year, for secondary and tertiary care hospitalization through a network of Empanelled Health Care Providers (EHCP).
- The EHCP network will provide cashless and paperless access to services for the beneficiaries at the both public and private hospitals.
- The services will include 1350 procedures covering pre and post hospitalization, diagnostics, medicines etc.
- The Yojana beneficiaries will be able to move across borders and access services across the country through the provider network seamlessly.
Beneficiary Selection (PMJAY)
PMJAY primarily targets the poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data for both rural and urban areas as well as the active families under the RashtriyaSwasthyaBimaYojana (RSBY).
Pradhan MantriAarogyaMitra (PMAM):
The scheme is creating a cadre of certified frontline health service professionals called Pradhan MantriAarogyaMitras (PMAMs) who will be primary point of facilitation for the beneficiaries to avail treatment at the hospital and thus, act as a support system to streamline health service delivery.
IT systems developed for AB-PMJAY
- Beneficiary Identification System (BIS) and Transaction Management System (TMS) systems.
- Transaction Management System (TMS) has been developed to facilitate transactions from hospitals (such as filing pre-authorization requests and claims submission).