AB-PMJAY and COVID treatment
Part of: GS Prelims and GS- II – Health
In news Under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), the Union government’s health insurance scheme, approximately 20.32 la7kh COVID-19 tests and 7.08 lakh treatments were authorised from April 2020 to July 2021.
- The cover allowed beneficiaries to avail free testing and treatment across all empanelled hospitals — both public and private.
- Besides this, State governments were provided with the flexibility of modifying the Ayushman packages as per the local requirements.
About Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)
- This scheme is a Centrally sponsored scheme with some Central sector components.
- PMJAY offers a sum insured of 5 lakh per family for secondary care (which doesn’t involve a super specialist) as well as tertiary care. For the beneficiaries, this is a free scheme.
- It is an entitlement-based scheme that targets the beneficiaries as identified by latest Socio-Economic Caste Census (SECC) data.
- Individuals can walk into any empanelled hospital that can process cashless payments.
- Once identified by the database, the beneficiary is considered insured.
- The insurance cost is shared by the centre and the state mostly in the ratio of 60:40.
- There are about 1,400 packaged rates for various medical procedures under the scheme.
- These packaged rates also mention the number of average days of hospitalization for a medical procedure and supporting documents that are needed.
- Under no circumstances can hospitals charge the beneficiary. The scheme also has prescribed a daily limit for medical management.
- National Health Agency has been constituted as an autonomous entity under the Society Registration Act, 1860 for effective implementation of PMJAY in alliance with state governments.
- This includes formulation of PMJAY policies, development of operational guidelines, implementation mechanisms, coordination with state governments, monitoring and oversight of PMJAY amongst other.
News Source: TH