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Opinion

2.1 million residents, Rs 5 lakh profit: PM Modi to launch AB-PMJAY SEHAT scheme for JK tomorrow

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Prime Minister Narendra Modi will launch the SEHAT Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) plan for residents of Jammu and Kashmir on Saturday. It will provide benefits to 2.1 million eligible individuals based on the 2011 Socio-Economic and Caste Census (SECC). According to officials, eligible beneficiaries will get Universal Health Care Coverage (UHC) based on the 2011 SECC database.

AB-PMJAY is a flagship central government health plan, launched in 2018, providing coverage of up to Rs 500,000 per family each year for secondary and tertiary care hospitalization.

A senior government official said that all residents of Jammu and Kashmir will be covered by the scheme, regardless of their socioeconomic status, they will be covered by the scheme with the launch of AB-PMJAY SEHAT. “The government is gathering details of beneficiary families that may be missing from the SECC 2011 database. This will ensure that all beneficiaries are registered as soon as possible so that they can take advantage of free health services,” the official told ANI.

The official said that according to ANI, the information technology platform of the National Health Authority (NHA), like the beneficiary identification system, has been customized to implement the scheme. AB-PMJAY has brought together at least 219 hospitals, including 34 private hospitals, to provide health services to the residents of Jammu and Kashmir under the scheme. Medical procedures such as oncology, cardiology, nephrology, etc. they are included in the scheme, the official said. Beneficiaries can take advantage of the services of any of the 24,148 hospitals located throughout the country under the portability function of AB-PMJAY.

These are the key features of PMJAY:

1. The government says that PM-JAY is the largest health insurance / insurance scheme in the world, which is fully funded by it. It provides coverage of Rs 500,000 per family per year for secondary and tertiary care hospitalization in public and private paneled hospitals in India.

2. The Rs 5,000,000 benefit is on a family floating basis, which means that it can be used by one or all members of the family. The RSBY had a family limit of five members. However, based on the learnings from those schemes, PM-JAY has been designed in such a way that there is no limit on the size of the family or the age of the members.

3. More than 107.4 million poor and vulnerable families (approximately 500 million beneficiaries) are eligible for these benefits.

4. PM-JAY provides cashless access to healthcare services for the beneficiary at the point of service ie the hospital. PM-JAY plans to help mitigate the catastrophic spending on medical treatment that pushes nearly 6 million Indians into poverty each year.

5. Covers up to three days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medications.

6. There are no restrictions on the size, age or sex of the family.

7. All pre-existing conditions are covered from day one.

8. The benefits of the plan are transferable to the whole country, meaning a beneficiary can visit any public or private hospital in India for cashless treatment.

9. Services include approximately 1,393 procedures that cover all costs related to treatment, including but not limited to medications, supplies, diagnostic services, physician’s fees, room expenses, surgeon expenses, occupational therapy expenses, and ICU. , etc.

10. Health services are reimbursed to public hospitals at the same level as private hospitals.

These are the benefits of PM-JAY:

1. Medical examination, treatment and consultation

2. Before hospitalization

3. Medicines and medical consumables

4. Intensive and non-intensive care services

5. Diagnostic and laboratory investigations

6. Medical implantation services (when needed)

7. Accommodation benefits

8. Food services

9. Complications that arise during treatment

10. Post-hospital follow-up care up to 15 days

(Source: Pradhan Mantri Jan Arogya Yojana website)

Reference site

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