Prime Minister Narendra Modi has launched Pradhan Mantri Jan Arogya Yojana (PMJAY) on 23 September 2018. This PMJAY Scheme is a mega National Health Protection Scheme (NHPS) for poor people. PMJAY will provide Rs. 5 Lakh health insurance for secondary and tertiary hospitalization. This Ayushman Bharat Yojana will benefit around 50 crore poor people and provide them cashless and paperless treatment in hospitals.
All the insured people can make claims for treatment in all empanelled hospitals and avail treatment at NHPM Treatment Package Rates. Pradhan Mantri Jan Arogya Yojana is applicable for all Rural and Urban Beneficaries whose name appears in SECC-2011 Data. There will be No Ayushman Bharat Yojana Online Application Forms and anti fraud guidelines are also framed against people who demand money to provide insurance benefits.
People can visit any Health and Wellness Center to avail PMJAY benefits. All the AB-NHPM beneficiaries will be given Ayushman Family Cards and Arogya Mitras will be trained for assistance. Check complete details regarding PMJAY Scheme here.
About Pradhan Mantri Jan Arogya Yojana (PMJAY)
The important features and highlights of Pradhan Mantri Jan Arogya Yojana are as follows:-
- Health Insurance cover of Rs. 5 lakh per family per year.
- Around 10.74 crore poor and vulnerable families whose name appears in the SECC-2011 Data are eligible. There is no cap on family size and age.
- States are given the flexibility to decide the mode of implementation.
- Benefits will be portable across the country.
- Around 85% of rural families and 60% of urban families have already been identified.
- To be launched on 25 September 2018 – on the birth anniversary of Pandit Deendayal Upadhyay.
Key Milestones in PMJAY Implementation
Here we are providing you the key milestones in the PMJAY Implementation:-
— It was announced on 1 February 2018 in Union Budget 2018.
— State Level Consultation was held on 15 Feb and 16 February 2018.
— Cabinet Approves Ayushman Bharat Yojana on 21 March 2018.
— Ayushman Bharat Diwas – Starting Date of Beneficiary Identification) on 30 April 2018.
— National Health Agency (NHA) incorporated on 11 May 2018.
— First MoU was signed on 14 May 2018.
— Ministers Conclave was held on 14 June 2018.
— Hospital Empanelment Portal was live on 4 July 2018.
— Pradhan Mantri Jan Arogya Yojana (PMJAY) was announced on 15 August 2018.
— Proposed launch of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana is on 25 September 2018.
AB-PMJAY Modes of Implementation
State can chooese in which mode they want to implement this Ayushman Bharat – Pradhan mantri Jan Arogya Yojana (AB-PMJAY). There are 3 modes – Insurance Mode, Trust Mode and Mixed Mode. The name of the states along with the PMJAY mode of implementation chosen is shown below:-
7 states have choosen to implement this AB-PMJAY Scheme in Insurance Mode, 18 in Trust Mode, 9 in Mixed Mode and 2 states have still not decided.
Strict Action Against Fake PMJAY Websites
All the people should clearly note the following points regarding Ayushman Bharat – PMJAY:-
- No enrollment is required for beneficiaries to avail benefits of National Health Protection Scheme.
- He / She must not make any payment to obtain services at empanelled hospitals.
- Criminal cases will be charged at fraudulent websites and agents trying to collect money from the beneficiaries.
Informing the Pradhan Mantri Jan Arogya Yojana Beneficiaries
The complete procedure to inform the Pradhan Mantri Jan Arogya Yojana Beneficiaries is given below:-
- Family letter would be given to the Identified families.
- Call Centre “14555” will be open for the Pradhan Mantri Jan Arogya Yojana beneficiaries.
- Website and App will be launched on 5 September 2018.
- People can get info. on Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana through 10,000 hospitals, 3 lakh Common Service Centers and by Mass Media.
Candidates can also check their name in PM Jan Arogya Yojana list of beneficiaries at mera.pmjay.gov.in
Obtaining Care under Pradhan Mantri Jan Arogya Yojana
The following steps would be followed to obtain care under Pradhan Mantri Jan Arogya Yojana:-
— Patient Hospitalization – Firstly, the hospitalization of Patients would be done.
— Beneficiary Identification & Registration – To confirm person is an eligible beneficiary under PMJAY using software. Moreover, confirmation of identity preferably through Aadhaar.
— Pre-Authorization Request & Approval – Hospitals will select package and will check balance in the card. Then they will submit the supporting evidences necessary for treatment.
— Treatment – Then patient would be given appropriate treatment.
— Discharge – After appropriate treatment, discharge would be given to the patients.
— Claim Request & Settlement – Discharge summary and post treatment evidence would be submitted. Electronics payment would be made by the govt. to the banks. After getting treatment, hospitals will ask for feedback from the patients.
How will the Ayushman Bharat-PMJAY Beneficiary be Identified at the Hospital
Firstly Beneficiary will have to Hospital Help-Desk at which Identity verification needs to be done. For this, Aadhaar Card or an other ID needs to be provided. Next, the individual will be verified and it will be checked whether he / she is eligible or not. For this, A Beneficiary Identification System (BIS) using letter with family card. Then e-card will be given to the beneficiaries and shown to doctor for treatment.
Timely Payments for Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana
All the hospitals will be ensured timely payments for treatment. Timely payments are ensured and will be done as follows:-
- Funds to be transferred directly through National Health Agency (NHA) / State Health Agency (SHA).
- Each SHA will have to open a dedicated ESCROW account.
- There are penal provisions for delay in release of grant by Center / State in ESCROW Accounts.
- Banking triggers for release of payments to hospitals.
- Key Performance Indicators for timely settlement of hospital claims.
Anti Fraud Guidelines for AB-Pradhan Mantri Jan Arogya Yojana
NHA Methodolog for Guidelines has been released now. This includes Prevention, Detection and Deterrence. Prevention will include Beneficiary Identification, Provider Emapanelment and Pre-Authorization. Detection will include Data Analytics, Social Monitoring, Audits etc. Deterrence will include Contract Management, Anti-Fraud Cells and De-empanelment & exemplary penalties.
Vigilance of public and social audit will also be essential for detection and prevention of fraud.
Information policy would be based on international best practices and India specific regulations. 94 controls set at various levels for secure handling of sensitive personal data. Strong measures have been taken to ensure and obtain, store and use Data Privacy. It would be based on International best practices and India specific regulations.
Pradhan Mantri Jan Arogya Yojana (PMJAY) Packages Rates
Around 1300 packages have been approved and 20+ specialities have been covered. Initial draft by DGHS, Peer reviewed by NITI Aayog and extensive stakeholder consultation. Around 50% package mandated for pre-authorization. There are outcome based incentives for hospitals like NABH Entry Hospitals to get 10% incentives, NABH Full Accrediation to get 15% incentives, Aspirational Districts to get 10% incentives.
Pradhan Mantri Arogya Mitra (PMAM) Training
Pradhan Mantri Arogya Mitra (PMAM) training is being conducted in collaboration with Ministry of Skill Development. Training has been initiated in 15 States / UTs.
PM Jan Arogya Yojana Pilot Launch
National Health Agency (NHA) has developed 3 important IT tools for PMJAY. These includes Sinple Registration process for Hospitals Empanelment, Demographic & Bio-metric based verification of beneficiaries, Real Time & Secure Transactions at hospitals. Pilot project has been started in 16 States / UTs to test and help the platform to evolve a foolproof, transparent and user friendly IT system.
PM Jan Arogya Yojana Golden Cards
Beneficiaries are entitled to get Golden Cards to avail treatment in any govt. / private empanelled hospitals. This golden card will appear as follows:-
The government’s ambitious Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana, that will pay up to Rs five lakh in hospitalisation costs to poor and vulnerable families, will also cover drugs and diagnostic expenses three days prior to and 15 days post hospitalisation.