Published on Mar 04, 2023
Ayushman Card or Pradhan Mantri Jan Arogya Yojana (PMJAY) will provide financial protection (Swasthya Suraksha) to 10.74 crore poor, deprived rural families and identified occupational categories of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data (approx. 50 crore beneficiaries). It will have offer a benefit cover of Rs. 500,000 per family per year (on a family floater basis).
PM-JAY will cover medical and hospitalization expenses for almost all secondary care and most of tertiary care procedures. PM-JAY has defined 1,350 medical packages covering surgery, medical and day care treatments including medicines, diagnostics and transport.
Under the ambit of Ayushman Bharat, a Pradhan Mantri Jan Arogya Yojana (PM-JAY) to reduce the financial burden on poor and vulnerable groups arising out of catastrophic hospital episodes and ensure their access to quality health services was conceived. PM-JAY seeks to accelerate India’s progress towards achievement of Universal Health Coverage (UHC) and Sustainable Development Goal - 3.
Just three private hospitals in Delhi have enrolled for the Modi government’s flagship health insurance scheme — Ayushman Bharat — with the Prime Minister’s Office (PMO) now worried about the poor empanelment rate in the national capital, ThePrint has learnt.
Of the 900 private hospitals in Delhi, the National Health Agency (NHA) — an arm of the Health Ministry implementing the scheme — has got on board just the Cygnus Sonia Hospital in Nangloi, Dr. Shroff’s Charity Eye Hospital and the Cygnus MLS Super Speciality Hospital.
The sticking issue continues to remain the same, with the hospitals arguing that reimbursement rates are as low as 11-15 per cent of the actual costs of surgeries or procedures.
But with just months left for the 2019 general elections, the Modi government is racing against time to empanel more hospitals to the initiative dubbed the world’s largest health insurance scheme.
“There is a lot of pressure from the PMO on the team of Ayushman Bharat to enrol Delhi’s private hospitals. It has been a discussion point in almost all the meetings,” said a senior NHA official negotiating with the hospitals. “This could be a setback to otherwise such a laudable and noble scheme.”
The government made some headway, recently announcing a tie-up with Medanta, a super specialty hospital run by Dr Naresh Trehan in Delhi-NCR, but the hospital is still not officially on board and is likely to tie up for only selective procedures, mostly related to heart health.
“We are still working out on the details of our association with the scheme. We are trying to cover as many areas as we can,” Dr Trehan told ThePrint through the phone.
Indu Bhushan, CEO, Ayushman Bharat, said many hospitals are showing interest in the scheme.
“Hospitals, in general, want the rates to be revised upwards. This is not surprising. Many hospitals, however, are prepared to work on these rates,” Bhushan said. He denied that there was pressure from the PMO.
Bhushan further said that apart from the three hospitals, three more — Lifeline Hospital, Dwarka; Kalra Hospital in Kirti Nagar and the Centre for Sight, Safdarjung Enclave — are in the process of being empanelled.
Four other hospitals have also given a positive response, Bhushan said.
1. Households living in only one room with kucha walls and kucha roof.
2. Households with no adult member between age 16 to 59
3. Female headed households with no adult male member between age 16 to 59
4. Households having at least one disabled member and no able-bodied adult member
5. SC/ST households
6. Landless households deriving major part of their income from manual casual labour
7. Households without shelter
8. Destitute/ living on alms
9. Manual scavenger families
10. Primitive tribal groups
11. Legally released bonded labour
• Beggars;
• Rag-pickers;
• Domestic workers;
• Street vendors/cobblers/hawkers/other service providers working on the streets;
• Construction workers/ plumbers/ masons/ labor/ painters/ welders/ security guards/coolies and other head-load workers;
• Sweepers/ sanitation workers/ malis;
• Home-based workers/ artisans/handicrafts workers/ tailors;
• Transport workers/ drivers/ conductors/helpers to drivers and conductors/cart pullers/ rickshaw pullers;
• Shop workers/ assistants/ peons in small establishments/ helpers/ delivery assistants / attendants/ waiters;
• Electricians/ mechanics/ assemblers/repair workers;
• Washer-men/ chowkidars;
• Other work/non-work ;
• Non-work (pension/ rent/ interest, etc.) .
Services under the scheme can be availed at all public hospitals and empaneled private health care facilities. Also, the basic empanelment criteria allows empanelment of a hospital with a minimum of 10 beds, with the flexibility providprovided to states to further relax this if required. Empanelment of the hospitals under AB-NHPM will be conducted through an online portal by the state government. Information about empaneled hospitals will be made available through different means such as government websites and mobile apps. Beneficiaries can also call the helpline number at 14555.
To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis. However, hospitals with NABH/NQAS accreditation can be incentivised for higher package rates subject to procedure and costing guidelines.
For the list of Hospitals, Kindly click the below link and Type as follows.
Visit https://hospitals.pmjay.gov.in/Search/empnlWorkFlow.htm?actionFlag=ViewRegisteredHosptlsNew
1. Select State
2. Select District
3. Select Hospital Type - Public, Private (Not for Profit) or Private(For Profit)
4. Select Speciality - General Medicine, Paediatric medical management, Neo-natal, Paediatric cancer, Emergency Room Packages, etc ......
5. Enter Captcha as shown
6. Lastly Enter Search.
Now you will get the list of Hospitals which is covered by Ayushman Bharat.
1. Government provides health insurance cover of up to Rs. 5,00,000 per family per year.
2. More than 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries) covered across the country.
3. All families listed in the SECC database as per defined criteria will be covered. No cap on family size and age of members.
4. Priority to girl child, women and and senior citizens.
5. Free treatment available at all public and empaneled private hospitals in times of need.
6. Covers secondary and tertiary care hospitalization.
7. 1,350 medical packages covering surgery, medical and day care treatments, cost of medicines and diagnostics.
8. All pre-existing diseases covered. Hospitals cannot deny treatment.
9. Cashless and paperless access to quality health care services.
10. Hospitals will not be allowed to charge any additional money from beneficiaries for the treatment.
11. Eligible beneificiares can avail services across India, offering benefit of national portability. Can reach out for information, assistance, complaints and grievances to a 24X7 helpline number - 14555
1. Go to NHA portal and Log in to mera.pmjay.gov.in
2. Enter your mobile number and captcha code.
3. A one-time password will be sent to your mobile number.
4. After entering the OTP, you will be taken to this screen.
5. Select the state: Fill all the fields like name, mobile number, ration card number, or Rashtriya Swasthya Bima Yojna URN number.
6. If your name is there in the list, it will show up on the right-hand side of the page.
7. Click on 'Family Members' tab to find the beneficiary details
• Respective special category certificates
• Age proof documents
• Family structure
• Identification details
• Contact information
• Scanned copy of Aadhar
• Income certificate
• Caste certificate
