Introduction:

Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a flagship health insurance scheme launched by the Government of India on 23 September 2018.

It takes pride in being the world’s largest health insurance scheme which is fully covered by the government.

Insurance Coverage

• Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) aims to provide health coverage to over 50 crore beneficiaries, primarily targeting poor and vulnerable families.
• AB-PMJAY provides health insurance coverage of up to ₹5 lakh per family per year for secondary and tertiary care hospitalisation.

Beneficiary Identification under Pradhan Mantri Jan Arogya Yojana

• Beneficiaries are identified based on the Socio-Economic Caste Census (SECC) database. The National Health Authority (NHA) has provided flexibility to States/UTs to use non- Socio-Economic Caste Census (SECC) beneficiary family databases with similar socio-economic profiles for tagging against the leftover (unauthenticated) SECC families.

• Cashless Treatment: The scheme facilitates cashless treatment in public and empaneled private hospitals across India.

Medical Services Covered:

Pradhan Mantri Jan Arogya Yojna covers medical expenses for various illnesses and procedures including surgery, diagnostics, medicines, and pre-and post-hospitalization expenses.

• Portability: The scheme offers portability, allowing beneficiaries to avail services across all states and union territories.

Funding

The Central Government sponsors the scheme.

The central and state governments share the funds.  Funding for the scheme follows a shared model:

1. 60:40 ratio for all states and Union Territories (UTs) with their own legislature.
2. In Northeast states, Jammu and Kashmir, Himachal Pradesh, and Uttarakhand, the ratio is 90:10.
3. UTs without a legislature receive 100% funding from the Central government.

• No Cap on Family Size: There is no restriction on family size or age for enrollment under AB-PMJAY.
• Technology Integration: AB-PMJAY utilises technology extensively for beneficiary identification, hospital empanelment, and claims management.

• Empowerment of Women: The scheme aims to empower women as the head of the household can enroll the family under AB-PMJAY.

• Empanelled Hospitals: Hospitals are empaneled based on certain criteria to ensure quality healthcare services are provided to beneficiaries.

• Impact:PMJAY has significantly expanded access to healthcare services for millions of underprivileged families across India. This has enhanced their quality of life.

• Awareness Campaigns: The government conducts awareness campaigns to educate eligible beneficiaries about the benefits of the scheme and how to enroll.

• Continuous Improvement: The scheme undergoes regular evaluation and updates to address challenges. Evaluation improves effectiveness in providing healthcare services to the masses.

Nodal Agency

• The National Health Authority (NHA) operates as an independent body established under the Society Registration Act, 1860. The aim is to efficiently executing PM-JAY in collaboration with state administrations.
• The State Health Agency (SHA) serves as the highest authority tasked with overseeing the implementation of AB PM-JAY at the state level.