Pradhan Mantri Jan Arogya Yojana

A scheme that aims to help economically vulnerable Indians who are in need of healthcare facilities is Ayushman Bharat Yojana also known as Pradhan Mantri Jan Arogya Yojana (PMJAY).

Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a Centrally Sponsored Scheme having central sector component under Ayushman Bharat Mission anchored in the Ministry of Health and Family Welfare (MoHFW).This scheme was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC). 

On 23 September 2018 Prime Minister Narendra Modi rolled out this health insurance to cover about 50 crore citizens in India and already has several success stories to its credit.  

It was reported that 18,059 hospitals have been empanelled, over 4,406,461 lakh beneficiaries have been admitted and over 10 crore e-cards have been issued as of September 2019.Ayushman Bharat is an attempt to move from sectorial and segmented approach of health service delivery to a comprehensive need-based health care service.

Providing a cover of Rs. 5 lakh per family the PMJAY scheme aims to provide healthcare to 10 crore families, who are mostly poor and have lower middle income, through a health insurance scheme.  

The 10 crore families comprise 8 crore families in rural areas and 2.33 crore families in urban areas. Broken into smaller units, this means the scheme will aim to cater to 50 crore individual beneficiaries.

However, the scheme has certain pre-conditions by which it picks up the citizens who can avail of the health cover benefit. While in the rural areas the list is mostly categorized on lack of housing, meagre income and other deprivations, the urban list of PMJAY beneficiaries is drawn up on the basis of occupation.

PMJAY scheme for Rural People:

A staggering 85.9% of rural households do not have access to any healthcare insurance or assurance as per the 71st round of the National Sample Survey Organisation. Additionally, 24% of rural families access healthcare facilities by borrowing money. PMJAY’s aim is to help this sector avoid debt traps and avail services by providing yearly assistance of up to Rs. 5 lakh per family.

The scheme will come to the aid of economically disadvantaged families as per data in the Socio-Economic Caste Census 2011. Here too, households enrolled under the Rashtriya Swasthya Bima Yojana (RSBY) will come under the ambit of the PM Jan Arogya Yojana.

The PMJAY health cover is available in the rural areas to:

• The people living in scheduled caste and scheduled tribe households.
• The families with no male member aged 16 to 59 years.
• The beggars and those surviving on charity.
• Thefamilies with no individuals aged between 16 and 59 years
• The families having at least one physically challenged member and no able-bodied adult member.
• The landless households who make their living by working as casual manual labourers.
• The primitive tribal communities.
• The legally released bonded labourers.
• The families living in one-room makeshift houses with no proper walls or roof.
• The manual scavenger families.

PMJAY scheme for Urban People:

82% of urban households do not have access to healthcare insurance or assurance as per the National Sample Survey Organisation. Further, 18% of Indians in urban areas have addressed healthcare expenses by borrowing money in one form or the other.

Pradhan Mantri Jan Arogya Yojana helps these households avail healthcare services by providing funding of up to Rs. 5 lakh per family, per year. PMJAY will benefit urban workers’ families in the occupational category present as per the Socio-Economic Caste Census 2011. Further, any family enrolled under the Rashtriya Swasthaya Bima Yojana will benefit from the PM Jan Arogya Yojana as well.

Here is the list  who can avail the government-sponsored scheme in the urban areas.

• Washerman / chowkidars
• Rag pickers
• Mechanics, electricians, repair workers.
• Domestic help.
• 5Sanitation workers, gardeners, sweepers.
• Home-based artisans or handicraft workers, tailors.
• Cobblers, hawkers and others providing services by working on streets or pavements.
• Plumbers, masons, construction workers, porters, welders, painters and security guards.
• Transport workers like drivers, conductors, helpers, cart or rickshaw puller.s
• Assistants, peons in small establishments, delivery boys, shopkeepers and waiters.

List of people not entitled for the Health Cover under Pradhan Mantri Jan Arogya Yojana:

• Those who own a two, three or four-wheeler or a motorised fishing boat
• Those who own mechanised farming equipment
• Those who have Kisan cards with a credit limit of Rs.50000
• Those employed by the government
• Those who work in government-managed non-agricultural enterprises
• Those earning a monthly income above Rs.10000
• Those owning refrigerators and landlines
• Those with decent, solidly built houses
• Those owning 5 acres or more of agricultural land

Critical illnesses that are covered are under this scheme are as follows.

• Prostate cancer
• Coronary artery bypass grafting
• Double valve replacement
• Carotid angioplasty with stent
• Pulmonary valve replacement
• Skull base surgery
• Laryngopharyngectomy with gastric pull-up
• Anterior spine fixation
• Tissue expander for disfigurement following burns

List of exclusions under the scheme are as follows

• OPD
• Drug rehabilitation programme
• Cosmetic related procedures
• Fertility related procedures
• Organ transplants
• Individual diagnostics (for evaluation)