Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) recently marked six years of its launch, showcasing significant achievements in transforming healthcare access in India.

About Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY):

• Ayushman Bharat PM-JAY was launched in 2018, under the National Health Policy 2017, with the goal of achieving Universal Health Coverage (UHC).
• It provides health insurance to over 12 crore families (about 55 crore individuals), making it the world’s largest health assurance scheme.
• It is a component of Ayushman Bharat, the other being Ayushman Arogya Mandir (renamed from Health and Wellness Centres in 2023).
• World’s Largest Health Assurance Scheme: PM-JAY provides health assurance to the most vulnerable sections of society.
• Coverage: Cashless hospital coverage of ₹5 lakhs per family per year for secondary and tertiary care across public and private empanelled hospitals.
• Target: Aims to cover 12 crore families, benefiting approximately 55 crore people.

Key Features of Ayushman Bharat PM-JAY

• Largest Health Assurance Scheme: Fully funded by the Government of India.
• Cashless Treatment: Beneficiaries can access cashless healthcare services at the point of care.
• Mitigates Catastrophic Health Expenditure: Helps prevent millions from falling into poverty due to healthcare costs.
• Pre- and Post-Hospitalization Coverage: Covers up to 3 days pre-hospitalization and 15 days post-hospitalization expenses.
• No Restrictions on Family Size or Age: Inclusive for all, with coverage from day one for pre-existing conditions.
• Nationwide Portability: Beneficiaries can access treatment at any empanelled hospital across India.
• Comprehensive Service Package: Coverage includes 1,949 medical procedures across 27 specialties.

Expansion for Senior Citizens (2024)

• Free Health Coverage for Seniors (70+): From September 2024, all senior citizens aged 70 and above will receive free ₹5 lakh coverage under PM-JAY.
• Top-up for Existing Beneficiaries: Seniors already covered will receive an additional ₹5 lakh exclusive top-up cover.
• New Cards: A distinct card will be provided to senior citizens for easier access to benefits.

Achievements of Ayushman Bharat PM-JAY (As of September 2024)

• 35.4 crore Ayushman cards issued, covering nearly 55 crore beneficiaries.
• Operational in 33 States and Union Territories (excluding NCT Delhi, West Bengal, and Odisha).
• 7.79 crore hospital admissions authorized, providing ₹1,07,125 crore in financial coverage.
• Gender Equity: 49% of Ayushman cards and 3.61 crore hospital admissions utilized by women.
• 11.9 lakh hospitalizations authorized under the portability feature, enabling beneficiaries to access healthcare across India.

Financial Impact on Families and Hospitals

• Reduction in Out-of-Pocket Expenditure: 21% reduction in healthcare expenses and 8% decrease in emergency loans for medical needs.
• Affordable Life-Saving Treatments: Key procedures like dialysis and cataract surgeries have become affordable for low-income families.
• Boost for District Hospitals: Substantial financial gains for district hospitals, enhancing their capacity to serve communities.

Medical Procedures under PM-JAY

• Coronary Angioplasty
• Cataract Surgeries
• Breast Cancer Treatments
• Urinary Tract Stone Removal

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