PRADHAN MANTRI JAN AROGYA YOJANA

About:

• AB-NHPM will subsume the on-going centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).
  
  
• It will be an entitlement-based scheme with entitlement decided on the basis of deprivation criteria in the Socio-Economic Caste Census (SECC) database.
  
  
• The target beneficiaries of the proposed scheme will be more than 10 crore families belonging to poor and vulnerable population based on SECC database covering both rural and urban.
  
  
• There is provision to partner with the States through co-alliance to ensure appropriate integration with the existing health insurance/ protection schemes of various Central Ministries/Departments and State Governments (at their own cost).
  
  
• Ayushman Bharat National Health Protection Mission Council (AB-NHPMC): It will be setup at apex level for giving policy directions and fostering coordination between Centre and States. It will be chaired by Union Health and Family Welfare Minister.
  
  

Benefit cover:

• The scheme has the benefit cover of Rs. 5 lakhs per family per year.
  
  
• To ensure that nobody is left out (especially women, children and elderly) there will be no cap on family size and age in the scheme.
  
  
• This cover will take care of almost all secondary care and most of tertiary care procedures. It will also include pre and post-hospitalisation expenses.
  
  
• A defined transport allowance per hospitalization will also be paid to the beneficiary.
  
  

Hospitals covered:

• The beneficiaries can avail benefits in both public and empanelled private facilities.
  
  
• All public hospitals in the States implementing AB-NHPM, will be deemed empanelled for the Scheme.
  
  
• Hospitals belonging to Employee State Insurance Corporation (ESIC) may be empanelled based on the bed occupancy ratio parameter.
  
  
• Private hospitals will be empanelled online based on defined criteria.