Ayushman Bharat|Health Card|Arogya Card

Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card

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Ayushman Bharat, a flagship scheme of Government of India was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC).

This initiative has been designed on the lines as to meet SDG and its underlining commitment, which is “leave no one behind”.Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card




  • प्रधानमंत्री जन आरोग्य योजना के अंतर्गत 10 करोड़ से अधिक परिवारों को लाभ मिलेगा|

  • अपने मोबाइल नम्बर से लॉगिन कर पता करें आपका परिवार प्रधानमंत्री जन आरोग्य योजना में सम्मिलित है या नहीं|

  • प्रधानमंत्री जन आरोग्य योजना का लाभ लेने के लिए आपको कोई आवेदन करने की ज़रूरत नहीं है|

  • अगर आपका परिवार प्रधानमंत्री जन आरोग्य योजना लिस्ट में सम्मिलित है तो आप चिकित्सा उपचार के लिए किसी भी सूचिबद्ध अस्पताल में प्रति वर्ष 5 लाख रुपये तक का लाभ उठा सकते हैं|

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  • Your family name could be covered in the PMJAY beneficiary list.

  • To check out if you are a beneficiary, you can login here using your mobile number.

  • You do not need to enroll anywhere to claim benefits under the scheme.

  • To claim benefits under the scheme you can get yourself identified at the nearest empanelled hospital or Community Service Centre (CSC) Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card




Ayushman Bharat | Health Card |Arogya Card

Ayushman Bharat is an attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service.

Ayushman Bharat aims to undertake path breaking interventions to holistically address health (covering prevention, promotion and ambulatory care), at primary, secondary and tertiary level.

Ayushman Bharat adopts a continuum of care approach, comprising of two inter-related components, which are – Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card

  • Health and Wellness Centres (HWCs)
  • Pradhan Mantri Jan Arogya Yojana (PM-JAY)

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1. Health and Wellness Centers (HWCs) Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card


Ayushman Bharat | Health Card |Arogya Card

In February 2018, the Government of India announced the creation of 1,50,000 Health and Wellness Centres (HWCs) by transforming existing Sub Centres and Primary Health Centres.

These centres would deliver Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card Comprehensive Primary Health Care (CPHC).

Bringing healthcare closer to the homes of people covering both maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.

Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card

Ayushman Bharat | Health Card |Arogya Card

Health and Wellness Centers, are envisaged to deliver an expanded range of services to address the primary health care needs of the entire population in their area, expanding access.universality and equity close to the community.

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The emphasis of health promotion and prevention is designed to bring focus on keeping people healthy by engaging and empowering individuals and communities to choose healthy behaviours and make changes that reduce the risk of developing chronic diseases and morbidities.



2. Pradhan Mantri Jan Arogya Yojana (PM-JAY) Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card


The second component under Ayushman Bharat is PM-JAY, which aims at providing health insurance cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crores poor and vulnerable families (approximately 50 crore beneficiaries).

Ayushman Bharat | Health Card |Arogya Card

There is no cap on the family size under the scheme.  Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card This scheme was earlier known as National Health Protection Scheme (NHPS) before it was rechristened to PM-JAY.

This scheme was launched on 23rd September 2018 by the Hon’ble Prime Minister Shri Narendra Modi in Ranchi, Jharkhand.

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PM-JAY has been rolled out for the bottom 40% of poor and vulnerable population. The households included are 

based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.

The scheme Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card subsumed then existing Rashtriya Swasthya Bima Yojana (RSBY), launched in 2008.

Therefore, the coverage mentioned under PM-JAY also includes families that were covered in RSBY but were not present in the SECC 2011 database.

PM-JAY is completely funded by the Government, and cost of implementation is shared between Central and State Governments.



इस योजना का लाभ लेने के लिए कोई पैसा खर्च करने की ज़रुरत नहीं है |

                                                  आधार कार्ड,राशन कार्ड ,मोबाइल नंबर,अपना पहचान पत्र ले जाना ना भूलें

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Key Features of PM-JAY Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card


Ayushman Bharat | Health Card |Arogya Card

  • PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government.

  • PM-JAY provides cover of Rs. 5 lakhs per family per year, for secondary and tertiary care hospitalization across public and private empaneled hospitals in India.

  • Over 10.74 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits. Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card

  • PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card

  • PM-JAY will help reduce catastrophic expenditure for hospitalizations, which pushes 6 crore people into poverty each year, and will help mitigate the financial risk arising out of catastrophic health episodes.

  • No restrictions on family size, age or gender.

  • All pre–existing conditions are covered from day one.

  • Covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines

  • Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital for cashless treatment.

  • 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. Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card

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



Benefit Cover Under PM-JAY


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Benefit cover under various Government-funded health insurance schemes in India have always been based on an upper ceiling limit and varied between an annual cover of INR30,000 to INR3,00,000 per family across various States, creating a fragmented system.

PM-JAY provides cashless cover of up to INR5,00,000 to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all the expenses incurred for the following components of the treatment.

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  • Medical examination, treatment, and consultation

  • Pre-hospitalization

  • Medicine and medical consumables

  • Non-intensive and intensive care services

  • Diagnostic and laboratory investigations

  • Medical implant services (where necessary)

  • Accommodation benefits

  • Food services

  • Complications arising during treatment

  • Post-hospitalization follow-up care up to 15 days

Ayushman Bharat | Health Card |Arogya Card

Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card The benefits of INR 5,00,000 are 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 learning from those experiences, PM-JAY was designed in such a way that there is no cap on family size and age of members.

In addition, pre-existing diseases are covered from the very first day. This means that any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for those medical conditions under the scheme.

Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card

Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card

 

Coverage under PM-JAY


Including the poorest and most vulnerable population of any country in the health insurance programme is often the most challenging because they cannot pay any premium and are the hardest to reach.

Many times they are also not literate and, therefore, require a very different approach for awareness generation. This is true for most Lower and Middle-Income Countries (LMIC) and India is not an exception.

Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card



 

Ayushman Bharat | Health Card |Arogya Card

Thus, PM-JAY has been rolled out for the bottom 40 per cent of poor and vulnerable population. In absolute numbers, this is close to 10.74 crore (100.74 million) households.

The inclusion of households is based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas, respectively.

This number also includes families that were covered in the RSBY but were not present in the SECC 2011 database.

The SECC involves ranking of the households based on their socio-economic status. Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card .

Ayushman Bharat | Health Card |Arogya Card

It uses exclusion and inclusion criteria and accordingly decides on the automatically included and automatically excluded households.

Rural households which are included (not excluded) are then ranked based on their status of seven deprivation criteria (D1 to D7). Urban households are categorised based on occupation categories.

In line with the approach of the Government to use the SECC database for social welfare schemes, PM-JAY also identifies targeted beneficiary families through this data.

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Rural Beneficiaries


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Out of the total seven deprivation criteria for rural areas, PM-JAY covered all such families who fall into at least one of the following six deprivation criteria (D1 to D5 and D7)

and automatic inclusion(Destitute/ living on alms, manual scavenger households, primitive tribal group, legally released bonded labour) criteria: Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card

  • 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

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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

  • Electrician/ Mechanic/ Assembler/ Repair worker

  • Washer-man/ Chowkidar

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Even though PM-JAY uses the SECC as the basis of eligibility of households, many States are already implementing their own health insurance schemes with a set of beneficiaries already identified.

Thus, States have been provided the flexibility to use their own database for PM-JAY. However, they will need to ensure that all the families eligible based on the SECC database are also covered.

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Expansion of coverage by States under PM-JAY and convergence


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Various States have been implementing their own health insurance/assurance schemes over the past couple of decades.

Most of these schemes provide cover for tertiary care conditions only. Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card.

Ayushman Bharat | Health Card |Arogya Card

The benefit cover of these schemes is mostly available within the State boundaries except some smaller States have empanelled a few hospitals outside the State boundaries.

Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card Very few States had converged their schemes with the erstwhile RSBY scheme and many of them were operating independently.

Ayushman Bharat | Health Card |Arogya Card

This was due to the lack of flexibility in the design of the RSBY, which although initially helped in quick scale-up but became a challenge over a period of time and offered limited flexibility to the States.

Even though these schemes were targeting the poor and vulnerable, there were large variations across States in terms of eligibility criteria and databases.

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Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card Few States were using the food subsidy database while some others had created a separate database for their welfare schemes.Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card

Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card

The primary objectives for launching PM-JAY were to ensure comprehensive coverage for catastrophic illnesses, reduce catastrophic out-of-pocket expenditure,

improve access to hospitalisation care, reduce unmet needs, and to converge various health insurance schemes across the States.

Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card PM-JAY will also establish national standards for a health assurance system and is providing national portability of care.

Ayushman Bharat | Health Card |Arogya Card

At the implementation level, the States are given the flexibility to use their own database if they were already implementing a health insurance/ assurance scheme and were covering more families than those eligible as per the SECC 2011 database.

However, such States shall ensure that all families eligible as per the SECC data are covered and not denied benefits. Ayushman Bharat | Health Card |Arogya Card|Health Insurance Card



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