Pradhanmantri Jan Arogya Yojana (PM-JAY) for UPSC Prelims & Mains Exam

Pradhanmantri Jan Arogya Yojana UPSC: The Pradhanmantri Jan Arogya Yojana (PM-JAY), which is also known as Ayushman Bharat, is a national healthcare initiative launched by the Government of India to provide health insurance coverage to economically vulnerable sections of society. It offers financial protection to families for secondary and tertiary healthcare needs.

For UPSC aspirants, it is very important to understand the PM-JAY or Ayushman Bahart, due to its role in improving the healthcare of the country. It is a very important scheme and the questions can be asked in general studies, especially in governance, social justice and healthcare-related issues.

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Pradhanmantri Jan Arogya Yojana

The PM-JAY was launched on September 23, 2018 in Ranchi, Jharkhand, by the Hon’ble Prime Minister of India, Shri Narendra Modi. It is one of the two components under Ayushman Bharat. It was launched with the objective of providing healthcare services to poor and vulnerable families who don’t have access to quality healthcare services.

PM-JAY covers over 12 crore families with approximately 55 crore beneficiaries and provides Rs 5 lakh per family per year for hospitalisation expenses. It is fully funded by the government and covers a wide range of medical treatments and the cost of implementation is shared between the central and state governments.

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What are the Key Features of PM-JAY?

PM-JAY is the world’s least funded healthcare scheme and is fully financed by the government and it provides approximately a cover of Rs 5 lakhs per family per year for secondary and tertiary care hospitalisation across public and private empaneled hospitals in India. It provides cashless access to health care services directly at the hospitals. Some of the key features of the scheme are listed below.

• It covers up to 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses such as diagnostics and medicines.
• There is no restriction on the family size, age or gender.
• Benefits of the scheme are portable across the country, i.e., a beneficiary can visit any empaneled public or private hospital in India to avail cashless treatment.
• Services include approximately 1,929 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.
• Public hospitals are reimbursed for the healthcare services on par with the private hospitals.

What are the Benefits Provided under PM-JAY?

PM-JAY provides cashless cover of up to Rs 5 lakh to each eligible family per annum for the below-listed care conditions. Check the list of benefits below..

Medical examination, treatment and consultation

• Pre-hospitalisation
• Medicine and medical consumables
• Non-intensive and intensive care services
• Diagnostic and laboratory investigations
• Medical implantation services (where necessary)
• Accommodation benefits
• Food services
• Complications arising during treatment
• Post-hospitalisation follow-up care up to 15 days

What is the Eligibility Criteria for PM-JAY?

The database of the SECC (Socio Economic and Caste Census) 2011 plays a very important role in determining the eligibility criteria of the scheme for rural and urban areas, respectively. The eligibility is determined based on deprivation and occupational criteria as per SECC 2011, and families are automatically included based on these criteria. Check the list below for rural and urban people criteria.

Rural Beneficiaries of PM-JAY

Out of the 7 derivative criteria listed below, families who fall under any of the following six (D1 to D5 and D7) and automatic inclusion (destitute/living on alms, manual scavenger households, primitive tribal groups, legally released bonded labour) are eligible.

• D1: Only one room with kucha walls and kucha roof
• D2: No adult member between ages 16 to 59
• D3: households with no adult male member between ages 16 to 59
• D4: Disabled member and no able-bodied adult member
• D5: SC/ST households
• D7: Landless households deriving a major part of their income from manual casual labour

Urban Beneficiaries of PM-JAY

For urban areas, the following 11 occupational categories of workers are eligible for the scheme:

• Ragpicker
• Beggar
• Domestic worker
• Street vendor/cobbler/hawker / other service provider working on streets
• Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security Guard/ Coolie and other head-load worker
• Sweeper/Sanitation Worker/Mali
• Home-based worker/artisan/handicrafts worker/tailor
• Transport worker/driver/conductor/helper to drivers and conductors/cart puller/rickshaw puller
• Shop worker/assistant/peon in small establishment/helper/delivery assistant / Attendant/ Waiter
• Electrical/Mechanic/Assembler/Repair Worker
• Washerman/Chowkidar

Implementation of PM-JAY

The PM-JAY is implemented in various public and private hospitals. And it is an IT-enabled scheme, making the entire process online. PM-JAY is managed by the National Health Authority (NHA) at the national level, which is responsible for the strategic management and implementation of the scheme, including the empanelment of hospitals and overseeing claim processes. Beneficiaries are provided with e-cards to access healthcare services, while the health benefits packages ensure that standardised care is available across hospitals.

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