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.
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.
