AB-PMJAY 2024 For All Citizens 70 & Above
India, with its vast and diverse population, has long grappled with the challenge of providing equitable healthcare to all its citizens. Rising healthcare costs, inadequate access to quality medical services in rural areas, and the burden of out-of-pocket expenses have historically put millions of Indians in financial distress.
Addressing this challenge, the Government of India launched the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) on September 23, 2018, which is widely regarded as the world’s largest government-sponsored healthcare scheme.
AB-PMJAY Version II – In a recent announcement in Sep-2024 by Indian Government approved a fund of INR 3,437 crore to expand this scheme to all citizens aged 70 years & above to get INR 5 Lakhs health cover irrespective of gender and income.
Introduction to Ayushman Bharat and the Need for Universal Healthcare
India’s healthcare system, before the launch of the Ayushman Bharat initiative, faced numerous challenges. Many people, particularly in rural areas, had limited access to quality healthcare, and private healthcare services were often prohibitively expensive. Out-of-pocket expenditures made up a significant portion of healthcare spending, leading to impoverishment for many families. Recognizing the need for a more comprehensive healthcare plan, Ayushman Bharat was conceptualized as a part of the Government of India’s vision of universal healthcare, with a focus on affordability and accessibility for every citiz
The Ayushman Bharat Yojana has two key components:
Health and Wellness Centres (HWCs): Over 150,000 Health and Wellness Centres are being set up to deliver comprehensive primary healthcare services, including maternal and child health services, and non-communicable disease screening.
Pradhan Mantri Jan Arogya Yojana (PM-JAY): The flagship component that provides secondary and tertiary healthcare coverage for hospitalizations to vulnerable and economically weaker sections of society.
Objectives of AB-PMJAY
The primary objectives of the Ayushman Bharat PMJAY scheme are:
Provide Health Coverage:
AB-PMJAY aims to provide financial protection to around 50 crore poor and vulnerable individuals in the country by offering coverage for secondary and tertiary care hospitalization.
Reduce Financial Burden:
The scheme strives to reduce the financial burden on low-income families who often face exorbitant medical expenses due to unforeseen health issues.
Increase Access to Quality Healthcare :
One of the goals is to expand the access to quality healthcare services, especially for rural populations, through empaneled public and private hospitals.
Strengthen Healthcare Infrastructure:
With more people able to access healthcare services, AB-PMJAY indirectly incentivizes the development of healthcare infrastructure, improving the overall quality of care.
Who is Eligible for Ayushman Bharat PM-JAY?
One of the major questions surrounding AB-PMJAY is: who qualifies for the scheme? The eligibility for the scheme is determined based on the socio-economic status of families as per the Socio-Economic Caste Census (SECC) 2011 data.
Eligibility Criteria for Rural and Urban Areas
Rural Area Eligibility: The scheme targets deprived rural families, based on the following parameters:
Households without adult members between the ages of 16 and 59.
Families living in one-room accommodations with kuccha (non-concrete) walls and roofs.
Families without any able-bodied adult male members.
Scheduled Caste/Scheduled Tribe households.
Landless households deriving a major part of their income from manual labor.
Urban Area Eligibility: In urban areas, the scheme covers individuals based on occupational categories. Some eligible occupations include:
Ragpickers.
Domestic workers.
Street vendors and cobblers.
Construction workers and laborers.
Sanitation workers and security guards.
Rickshaw drivers, transport workers, and shop workers.
No Premium Payment
One of the most attractive aspects of AB-PMJAY is that beneficiaries are not required to pay any premium for the coverage, making healthcare truly affordable for the poorest sections of society.
What is the Coverage Offered Under AB-PMJAY?
AB-PMJAY offers an extensive healthcare coverage package that ensures no one is left behind. The scheme is designed to cover the following aspects:
Financial Coverage
The scheme provides cashless and paperless healthcare coverage of up to INR 5 lakhs per family, per year for hospitalization costs. This coverage extends across secondary and tertiary care treatments, ensuring that beneficiaries receive high-quality care without the worry of high out-of-pocket expenses.
Inclusions and Exclusions
The coverage under AB-PMJAY includes:
Hospitalization costs: Both pre-hospitalization (up to 3 days before admission) and post-hospitalization expenses (up to 15 days after discharge).
Major surgeries: Cardiac surgeries, joint replacement, cancer treatments, and neurosurgeries are covered.
Day care treatments: Procedures that do not require prolonged hospital stays, such as chemotherapy or dialysis.
Diagnostic and laboratory services: All necessary tests and scans are covered.
However, some exclusions exist, such as:
OPD (Out-Patient Department) services that do not involve hospitalization.
Cosmetic surgeries, unless medically necessary due to accidents or burns.
Fertility treatments.
How to Avail of Ayushman Bharat PMJAY Benefits?
The process for availing of the AB-PMJAY scheme is straightforward and accessible to the general public. Here’s how beneficiaries can access healthcare services under the scheme:
Step 1: Checking Eligibility
Beneficiaries can verify their eligibility through multiple platforms:
PM-JAY Website: Visit the official Ayushman Bharat PMJAY website (https://pmjay.gov.in) and click on the “Am I Eligible” option. Enter your mobile number and an OTP to check if your family is listed.
Mobile App: The Ayushman Bharat mobile app allows beneficiaries to check their eligibility status easily.
Common Service Centres (CSCs): For those without internet access, CSCs provide an offline method to check eligibility.
Step 2:Find an Empaneled Hospital
AB-PMJAY services are offered through empaneled hospitals, which include both public and private facilities. You can find empaneled hospitals through:
The PM-JAY website or mobile app.
Physical lists of hospitals available at CSCs and other public health centers.
Step 3: Avail of Cashless Treatment
Once you reach an empaneled hospital, you need to:
Show your Ayushman Bharat card or any other valid ID (like Aadhaar or Ration Card).
Hospital authorities will verify your eligibility and enroll you for cashless treatment under the scheme.
After verification, you will receive a completely cashless treatment without the need to pay anything out of pocket.
Step 4: Post-Treatment Care
The coverage also includes post-hospitalization care for 15 days. Medicines, follow-up visits, and rehabilitation are provided free of cost.
Key Benefits of Ayushman Bharat PM-JAY
AB-PMJAY is transforming healthcare in India by offering several benefits:
Financial Protection
AB-PMJAY removes the burden of catastrophic health expenses for poor families, reducing their risk of slipping into poverty due to medical costs. With up to INR 5 lakh coverage, beneficiaries are protected from the high costs of secondary and tertiary care treatments.
Easy Access to Healthcare
By empaneling both public and private hospitals, AB-PMJAY offers beneficiaries access to a wide range of healthcare providers, ensuring that quality care is available even in rural areas.
Comprehensive Coverage
The scheme covers over 1,500 medical procedures, including surgeries and high-cost treatments like heart surgeries and cancer care. This ensures that even the most critical health conditions can be treated without financial stress.
Cashless and Paperless
AB-PMJAY operates on a completely cashless and paperless model, where beneficiaries do not need to worry about upfront payments or dealing with bureaucratic processes. This significantly enhances ease of access.
Special Focus on Vulnerable Groups
Women, children, and the elderly are prioritized under AB-PMJAY. Special care is taken to ensure that these vulnerable groups have easy access to quality healthcare services.
The Role of Empaneled Hospitals
AB-PMJAY empaneled hospitals play a pivotal role in the scheme’s implementation. These hospitals are chosen based on stringent criteria to ensure they meet specific quality standards. They provide services like:
Cashless treatment: Beneficiaries do not need to pay any money to avail of services in these hospitals.
Standardized care: Treatment protocols are regulated to ensure uniform quality of care across all empaneled hospitals
Assured services: Hospitals must offer specific services, including specialized care for cardiac conditions, cancer, and orthopedic procedures.
The Impact of AB-PMJAY on Indian Healthcare
Since its inception, AB-PMJAY has made a significant impact on India’s healthcare system. The scheme has been instrumental in bringing millions of families under the umbrella of healthcare services, many of whom had never received formal medical care.
Improved Health Outcomes
By providing access to free medical services, especially in critical areas like cancer care and heart disease, AB-PMJAY has saved countless lives and improved the overall health outcomes of many poor families.
Boost to Private Sector Hospitals
AB-PMJAY has encouraged private sector hospitals to expand their services in rural and underserved areas, contributing to improved healthcare infrastructure.
Reduced Financial Hardship
For many families, AB-PMJAY has alleviated the financial burden of healthcare. By providing free services, the scheme has saved families from spending their life savings on medical bills.
Challenges Faced by AB-PMJAY
While Ayushman Bharat PM-JAY has made significant strides, it also faces challenges, including:
Fraudulent Claims: The scheme has seen instances of fraudulent hospital claims, where treatments are inflated or billed without proper verification.
Awareness Gaps: Despite its extensive coverage, many eligible families remain unaware of the scheme and its benefits, particularly in remote areas.
Infrastructure Constraints: The healthcare infrastructure in some regions is inadequate, making it difficult to deliver quality healthcare services.
Future Prospects of AB-PMJAY
To realize its vision of universal healthcare, AB-PMJAY will need to address the challenges it faces and expand its reach. The government is continually working to improve the scheme by:
Strengthening Awareness Campaigns: Ensuring more people, particularly in rural areas, are aware of their entitlements under the scheme.
Enhancing Fraud Detection: Implementing more sophisticated systems to detect and prevent fraud.
Expanding Empanelment: Increasing the number of empaneled hospitals, particularly in underserved areas, to ensure widespread access to quality healthcare.
Conclusion
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana represents a major step forward in India’s journey towards universal healthcare.
By offering cashless, paperless, and comprehensive health coverage to over 50 crore individuals, the scheme is not only saving lives but also alleviating the financial burden on millions of families. As the government continues to strengthen and expand the scheme, AB-PMJAY holds immense potential to revolutionize healthcare delivery in India, bringing the nation closer to its goal of health for all.
Disclaimer
The information provided in this blog is for general awareness purposes only and does not constitute professional or medical advice. While every effort has been made to ensure the accuracy of the information, the evolving nature of government schemes and policies means that certain details may change over time. Readers are encouraged to verify eligibility, benefits, and other aspects of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) through official channels such as the PM-JAY website, Common Service Centres (CSCs), or helplines. This blog is intended to provide a broad overview and should not be relied upon for specific legal or policy-related matters.