Scheme Name: Ayushman Bharat Yojana or Pradhan Mantri Jan Arogya Yojana (PMJAY) or National Health Protection Scheme (AB-NHPM/PMJAY)
About Ayushman Bharat Scheme
- Launched in September 2018, under the Ayushman Bharat Mission of MoHFW in India
- AB-PMJAY is the world’s largest government-funded health insurance scheme and its key feature is to provide hospitalisation cover up to Rs 5 lakh per entitled family per year.
- Ayushman Bharat – National Health Protection Mission was created by subsuming the on-going centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).
- National Health Agency (NHA), is an autonomous entity, constituted for focused approach and effective implementation of PM-JAY. The State Governments are expected to similarly set up State Health Agencies (SHA) to implement PM-JAY
- It aims to to reduce the financial burden on poor and vulnerable groups arising out of catastrophic hospital episodes and ensure their access to quality health services was conceived. PM-JAY will cover medical and hospitalization expenses for almost all secondary care and most of tertiary care procedures.
- It aims cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization.
- PM-JAY will cover medical and hospitalization expenses for almost all secondary care and most of tertiary care procedures. PM-JAY has defined 1,350 medical packages covering surgery, medical and day care treatments including medicines, diagnostics and transport.
Benefits of PM-JAY
- Government provides health insurance cover of up to Rs. 5,00,000 per family per year.
- More than 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries) covered across the country.
- All families listed in the SECC database as per defined criteria will be covered. No cap on family size and age of members.
- Priority to girl child, women and and senior citizens.
- Free treatment available at all public and empaneled private hospitals in times of need.
- Covers secondary and tertiary care hospitalization.
- 1,350 medical packages covering surgery, medical and day care treatments, cost of medicines and diagnostics.
- All pre-existing diseases covered. Hospitals cannot deny treatment.
- Cashless and paperless access to quality health care services.
- Hospitals will not be allowed to charge any additional money from beneficiaries for the treatment.
- Eligible beneficiaries can avail services across India, offering benefit of national portability. Can reach out for information, assistance, complaints and grievances to a 24X7 helpline number – 14555
Reference: About PM-JAY
Ayushman Bharat Scheme in Nagaland
- Launched in all districts of Nagaland on 23 September 2018
- Families featuring in the defined Socio Economic & Caste Census (SECC) 2011 database of the State as well as existing enrolled Rashtriya Swasthya Bima Yojana (RSBY) 2016 beneficiary families are entitled for this scheme.
- According to information by State Health Agency (SHA), AB-PMJAY, the scheme covered 2.33 lakh poor and vulnerable households in Nagaland.
- As per June 2019 report uploaded on the PMJAY portal:
- Total PM-JAY eligible families in Nagaland: 233,000 (59%)
- 54 public and 5 private hospitals are empanelled in the State
- 64704 e-cards generated
- Total claims submitted (till May 2019): 517
Click for Ayushman Bharat Nagaland Report Here.
As per reports from State Health Agency (SHA), AB-PMJAY Nagaland in local dailies in June 2019:
- Faith Hospital, Dimapur provided the highest number of treatments to beneficiaries with 194 pre-authorisations, followed by Naga Hospital Authority Kohima (167), CIHSR Dimapur (108) and Mon District Hospital (107).
- Till June 30, a total of 37,127 households have been covered through beneficiary identification system and 75,316 cards generated out of target to cover 2.33 lakh households. The target coverage was still low at 16%.