Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Why in news?

• A report says that private hospitals account for over half of the empanelled hospitals, nearly two-thirds of claim volumes, and three-quarters of claim outlays in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY).

Mission:

• Ayushman Bharat is an umbrella of two major health initiatives, namely Health and wellness Centres and Pradhan Mantri Jan Arogya Yojana (PMJAY).

Pradhan Mantri Jan Arogya Yojana (PMJAY):

• It is a centrally sponsored scheme to provide health coverage up to Rs .5 lakh per family, per year for secondary and tertiary hospitalization
• It is an entitlement-based scheme covering poor and vulnerable families based on deprivation and occupational criteria as per Socio Economic Caste Census data.
• It will target about 10.74 crore poor, deprived rural families and is considered the world’s largest health insurance scheme.
• Ayushman Bharat Pradhan Mantri Jan Arogya Yojana will aim to provide free access to healthcare for 40% of people in the country.
• It provides cashless and paperless access to services for the beneficiary at the point of service in any (both public and private) empanelled hospitals across India.

Other features of PM-JAY:

• It provides a cover of 5 lakh per family per year for medical treatment in empanelled hospitals, both public and private.
• It offers cashless payment and paperless recordkeeping through the hospital or doctor's office.
• Using criteria from the Socio Economic and Caste Census 2011 to determine eligibility for benefits.
• There is no restriction on family size, age or gender.
• All previous medical conditions are covered under the scheme.
• It covers 3 days of pre-hospitalisation and 15 days of post-hospitalisation, including diagnostic care and expenses on medicines.
• The scheme is portable, and a beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their state and anywhere in the country.

Health and Wellness Centers

• Under this 1.5 lakh existing sub centers will bring health care system closer to the homes of people in the form of Health and wellness centers.
• These centers will provide comprehensive health care, including for non-communicable diseases and maternal and child health services
• These will also provide free essential drugs and diagnostic services.

About National Health Authority:

• It was created through an executive order of the cabinet, for better implementation of Pradhan Mantri Jan Arogya Yojana (PM-JAY).
• It replaced "National Health Agency" as an attached office to Ministry of Health & Family Welfare.
• NHA’s governing board will be chaired by the Minister for Health and Family Welfare, while its members will include NITI Aayog CEO and NHA CEO.
• NHA will be responsible for PM-JAY’s operational guidelines, fixing the ceiling of premium amounts, and developing mechanisms for strategic purchase of healthcare from the private sector.
• It is also tasked with building a health information technology platform and working with the Insurance Regulatory and Development Authority.

Prelims Question

Consider the following statements regarding National health authority:
1.It will be responsible for Pradhan Mantri Jan Arogya Yojana (PM-JAY).
2.It is a statutory body created through an act of parliament.
Which among the above statements is/are correct?
(a)1 only 
(b)2 only 
(c)Both 1 and 2
(d)Neither 1 nor 2

Answer to prelims question