Ayushman Bharat Yojana 2020: Central Government Health Scheme AB PM-JAY

By | May 13, 2020

Ayushman Bharat Yojana 2020: Central Government Health Scheme AB PM-JAY:

Ayushman Bharat Yojana

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a part of the Indian government’s National Health Policy which aims to provide free health coverage at the secondary and tertiary level to its bottom 40% poor and vulnerable population. PM-JAY is the world’s largest and fully state sponsored health assurance scheme which covers a population of the combined size of USA, Mexico and Canada. It was launched in September 2018, under the aegis of Ministry of Health and Family Welfare in India.

Ayushman Bharat Yojana (AB PM-JAY) 2020 benefits:

  • PM-JAY is a health assurance scheme that covers 10.74 crores households across India or approx 50 cr Indians.
  • It provides a cover of 5 lakh per family per year for medical treatment in empanelled hospitals, both public and private.
  • It provides cashless and paperless service to its beneficiaries at the point of service, i.e the hospital.
  • E-cards are provided to the eligible beneficiaries based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011).
  • There is no restriction on family size, age or gender.
  • All previous medical conditions are covered under the scheme.
  • It covers 3 days of 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.
  • The Central government has decided to provide free testing and treatment of Coronavirus under the Ayushman Bharat Yojana.

Central Government Health Scheme is available in the following states:

Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Goa
Gujarat
Haryana
Himachal Pradesh
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal

There have been media reports of misuse of the Ayushman Bharat scheme by unscrupulous private hospitals through submission of fake medical bills. Under the Scheme, surgeries have been claimed to be performed on persons who had been discharged long ago and dialysis has been shown as performed at hospitals not having kidney transplant facility.There are at least 697 fake cases in Uttarakhand State alone, where fine of Rs one crore has been imposed on hospitals for frauds under the Scheme.

However, unlike the earlier RSBY (Rashtriya Swasthya Bima Yojana) era, plagued by lax monitoring of insurance fraud, AB-PMJAY involves a robust information technology infrastructure overseeing transactions and locating suspicious surges across the country. Many hospitals have been blacklisted and the constantly evolving fraud-control system will play a major role in streamlining the scheme as it matures.

Initial analysis of high-value claims under PMJAY has revealed that a relatively small number of districts and hospitals account for a high number of these, and some hint of an anti-women bias, with male patients getting more coverage. Despite all efforts to curb foul-play, the risk of unscrupulous private entities profiteering from gaming the system is clearly present in AB-PMJAY.

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