Ayushman Bharat is a flagship scheme of the Government of India, which was launched to achieve the goal of Universal Health Coverage (UHC) as recommended by the National Health Policy 2017.
The initiative is designed to meet the Sustainable Development Goals (SDGs) and its underlined commitment to “leave no one behind”. Ayushman Bharat is an effort to move beyond the regional and fragmented approach to healthcare delivery towards comprehensive need-based healthcare.
The scheme aims to provide path-breaking interventions to holistically address the healthcare system (encompassing prevention, promotion, and ambulatory care) at primary, secondary, and tertiary levels.
Health and Wellness Center (HWC)
In February 2018, the Government of India announced the creation of 1,50,000 health and wellness centers (HWCs) by replacing existing sub-centers and primary health centers.
These centers aim to provide comprehensive primary health care (CPHC), bringing healthcare closer to people’s homes. They cover both maternal and child health services and non-communicable diseases, including free essential medicines and diagnostic services.
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
The second component under Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojana or PM-JAY, as it is popularly known. The Honorable Prime Minister of India, Shri Narendra Modi, launched the scheme on September 23, 2018, in Ranchi, Jharkhand.
Ayushman Bharat PM-JAY is the world’s largest health assurance scheme, providing health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalization to over 12 crore poor and vulnerable families (approximately 55 crore beneficiaries).
To provide, who constitute the bottom 40% of the Indian population. The included households are based on deprivation and occupational criteria of the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.
Benefit cover under PM-JAY
Benefit cover under various government-funded health insurance schemes in India has always been structured at an upper limit ranging from Rs 30,000 to Rs 3,00,000 per family in different states, leading to a fragmented system.
PM-JAY provides cashless cover of up to Rs 5,00,000 annually to each eligible family for listed secondary and tertiary care conditions.
- Medical tests, treatment, and consultation before hospitalization
- Medicines and Medical Consumables
- Non-intensive and intensive care services
- Clinical and laboratory investigations
- Medical transplant services (where necessary)
- Housing benefit
- Food Services
- Complications arising during treatment
- Follow-up care for 15 days after hospitalization
The benefit of Rs 5,00,000 is on a family floater basis, which means it can be used by one or all members of the family. The limit of family members in RSBY was five.
However, based on the learnings from those schemes, PM-JAY has been designed in such a way that there is no limit on family size or age of members. Additionally, pre-existing diseases are covered from day one.