- A component of Ayushman Bharat, a flagship healthcare scheme of the Government of India, PM-JAY aims to achieve universal health coverage.
- PM-JAY provides a health insurance coverage up to ₹5 lakhs per family in a year that can be claimed for meeting the expenses of secondary and tertiary medical care across 1,393 procedures.
- It works by providing cashless healthcare services to families through public and empanelled private hospitals.
Marking a shift from a segmented approach to providing healthcare services to the citizens, Ayushman Bharat endeavors to deliver a holistic and need-based healthcare service.
The scope of Pradhan Mantri Jan ArogyaYojana
PM-JAY will provide health insurance coverage up to ₹5 lakhs per family in a year. It can be claimed for secondary and tertiary care hospitalization. The scheme targets about 10.74 crore families in the poor and vulnerable segments of the society. About 50 crore beneficiaries are covered by this programme. Earlier called as National Health Protection Scheme (NHPS), PM-JAY was launched in Ranchi, Jharkhand on September 23, 2018 by
Important highlights of PM-JAY
The largest health insurance programme in the world
PM-JAY is notably the world’s largest health insurance programme that is fully financed and operated by a government, today. The scheme provides an insurance coverage of ₹5 lakhs per family per year which can be claimed for secondary and tertiary care hospitalization. The benefit will be disbursed through the public hospitals as well as empanelled private hospitals in the country.
What does it seek to cover?
PM-JAY offers access to cashless health care services for the beneficiary families at the point of service, namely, the hospital. PM-JAY will help bring down the ruinous expenditure spent on hospitalizations, which forces about 6 crore people under poverty line year-on-year. The programme’s objective is to mitigate the financial risks that result from disastrous health episodes.
The nature of coverage
With regard to the coverage, PM-JAY does not have any restrictions regarding the size of the family, and gender or age of the beneficiary. Right from the first day, the scheme covers all pre-existing conditions. The beneficiaries can move anywhere within the country to avail of the facility in any of the empanelled and public hospitals across the nation. The scheme will cover three days of pre-hospitalization and 15 days of post-hospitalization expenses that will also include diagnosis and medication.
Medical services included
The services include about 1,393 procedures that will cover all the costs connected to treatment that will include but is not limited to drugs, diagnosis, physician fees, surgeon charges, room fees, ICU and OT charges. The scheme will reimburse the cashless healthcare services offered by public hospitals on par with the private hospitals.
PM-JAY benefit cover
The total benefit of ₹5,00,000 per family per year can be used on a family floater basis which will mean that one or all members of the family can use it as per the arising needs. Whereas the RSBY has a cap of five members per family, PM-JAY does not have any cap on the family size or the age of the family members.