AB-PMJAY and COVID treatment | IASbaba

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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



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