2.1 million residents, Rs 5 lakh benefit: PM Modi to launch AB-PMJAY SEHAT scheme for J-K tomorrow

AB-PMJAY is a flagship health scheme of the central government, which was launched in 2018, and provides a cover of up to Rs 500,000 per family every year for secondary and tertiary care hospitalisation.
Prime Minister Narendra Modi speaks during at the centenary celebrations of Visva-Bharati University through video conference in New Delhi on Thursday.(ANI Photo)
Prime Minister Narendra Modi speaks during at the centenary celebrations of Visva-Bharati University through video conference in New Delhi on Thursday.(ANI Photo)
Updated on Dec 25, 2020 04:53 PM IST
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Hindustan Times, New Delhi | By hindustantimes.com | Edited by Meenakshi Ray

Prime Minister Narendra Modi will launch the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) SEHAT scheme for the residents of Jammu and Kashmir on Saturday. It will provide benefits to 2.1 million eligible people on the basis of Socio-Economic and Caste Census (SECC) 2011. According to officials, eligible beneficiaries will get the Universal Healthcare Coverage (UHC) as per the SECC 2011 database.

AB-PMJAY is a flagship health scheme of the central government, which was launched in 2018, and provides a cover of up to Rs 500,000 per family every year for secondary and tertiary care hospitalisation.

A senior government official said all residents of Jammu and Kashmir will be covered under the scheme irrespective of their socio-economic status will be covered under the scheme with the launch of AB-PMJAY SEHAT. “The government is collecting details of beneficiary families who may be missing from the SECC 2011 database. This will ensure that all beneficiaries are enrolled at the earliest so that they can avail free healthcare services,” the official told ANI.

The official said, according to ANI, National Health Authority’s (NHA) information technology platform like beneficiary identification system has been customised to implement the scheme. AB-PMJAY has empanelled at least 219 hospitals, including 34 private hospitals, for providing health services to residents of Jammu and Kashmir under the scheme. Medical procedures such as oncology, cardiology, nephrology etc are included in the scheme the official said. Beneficiaries can avail services from any of the 24,148 emplaned hospitals across the country under AB-PMJAY’s portability feature.

Here are the key features of PMJAY:

1. The government says PM-JAY is the world’s largest health insurance/assurance scheme which is fully financed by it. It provides a cover of Rs 500,000 per family per year for secondary and tertiary care hospitalisation across public and private empanelled hospitals in India.

2. The benefit of Rs 5,00,000 is on a family floater basis, which means that it can be used by one or all members of the family. The RSBY had a family cap of five members. However, based on learnings from those schemes, PM-JAY has been designed in such a way that there is no cap on family size or age of members.

3. More than 107.4 million poor and vulnerable entitled families (approximately 500 million beneficiaries) are eligible for these benefits.

4. PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital. PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.

5. It covers up to three days of pre-hospitalisation and 15 days post-hospitalisation expenses such as diagnostics and medicines.

6. There is no restriction on the family size, age or gender.

7. All pre-existing conditions are covered from day one.

8. Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.

9. Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.

10. Public hospitals are reimbursed for the healthcare services at par with the private hospitals.

Here are the benefits under PM-JAY:

1. Medical examination, treatment and consultation

2. Pre-hospitalisation

3. Medicine and medical consumables

4. Non-intensive and intensive care services

5. Diagnostic and laboratory investigations

6. Medical implantation services (where necessary)

7. Accommodation benefits

8. Food services

9. Complications arising during treatment

10. Post-hospitalisation follow-up care up to 15 days

(Source: Pradhan Mantri Jan Arogya Yojana website)

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Sunday, October 24, 2021