Entitlement Criteria under Ayushman Bharat -PMJAY : As Reply Given By Govt. in Loksabha

Supriya Sadanand Sule

DNV Senthilkumar. S.

Subhash Ramrao Bhamre

Kuldeep Rai Sharma

Amol Ramsing Kolhe

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:-

(a) whether the Government is implementing Pradhan Mantri Jan Arogya Yojana and if so, the details thereof;

(b) the eligibility criteria fixed by the government to avail the benefits under the yojana;

(c) whether the government has taken steps to create awareness about the yojana since it aims to extend better healthcare services for the lowest strata of society and if so, the details thereof;

(d) whether only few people have availed or are now undergoing treatment for COVID-19 under Pradhan Mantri Jan Arogya Yojana and if so, the details thereof and the reasons therefor alongwith the corrective measures taken in this regard;

(e) whether the government has reviewed the performance of this yojana; and

(f) if so, the outcome thereof and the corrective steps taken on the shortcomings?

(a) Yes.

The Government is implementing Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana from 23.09.2018 to provide health cover of Rs. 5 Lakhs per family per year, for secondary and tertiary care hospitalizations to around 10.74 crore poor and vulnerable families (approx.. 50 crore individuals).

As on 14.09.2020 the scheme is being implemented in 32 States/UTs. The States of Telangana, Odisha, West Bengal and National Capital Territory of Delhi are not implementing the scheme. Further, over 12.55 crore beneficiaries have been verified under the scheme. 1.23 crore hospital admissions worth Rs. 15,733 Crore have been authorized through a network of 23,331 hospitals empanelled under the scheme.

(b) AB-PMJAY covers deprived families in rural areas and families of workers of identified occupational categories in urban areas, as per the Socio-Economic Caste Census (SECC) -2011 data. Further, all such beneficiary families under erstwhile Rashtriya Swasthya Bima Yojana that do not figure in the targeted groups as per SECC data are also covered under AB-PMJAY. Details of entitlement criteria of the scheme are at the Annexure.

(c) Under AB-PMJAY, a comprehensive media and outreach strategy to spread awareness and empowering the beneficiaries about their entitlements and rights under the scheme has been followed. This includes the use of media vehicles such as outdoor media, digital display at ticket counters across various railway stations, announcements at major bus stations, passenger train branding, national and regional press coverage, op-eds and advertorials in print media, radio campaign, telecast of beneficiary testimonials via Doordarshan, mass messaging through SMS, traditional media etc.

Additionally, social media platforms are also being utilised to reach out to the secondary and primary audiences including the intended beneficiaries and other stakeholders. Outreach programme like school contact programs, activation programs at village level, van campaigns etc. are also being undertaken suitably in consultation with respective State Health Agencies.

(d) As on 14.09.2020 under AB-PMJAY, over 4.03 Lakh hospitalizations have been authorized towards the treatment and testing of Covid-19.

The institutional response towards COVID-19 is being directed by the States/UTs and many States/UTs are providing free treatment to COVID-19 patients through designated hospitals in their respective jurisdictions irrespective of entitlement under any scheme.

Necessary advisories have been issued to State Health Agencies to ensure that no beneficiary is deprived of his/her entitlement to avail free treatment under the AB-PMJAY.

(e) & (f) The progress of AB-PMJAY is continuously assessed and monitored on real time basis. A dashboard with various key performance indicators (KPI) has been designed to constantly monitor the scheme. The performance of the scheme is objectively evaluated in terms of e-cards issued, number of hospital admissions, quality of treatment provided, timely settlement of claims etc.

Additionally, National and regional review meetings are conducted with all the stakeholders, including State Health Agencies, on a periodic basis.

Based on the feedback received, various steps have been taken to ensure that the benefit reaches to the eligible beneficiary –

• Drives of e-cards generation have been undertaken in States/UTs in a mission mode.

• ‘Open BIS policy’ has been devised which enables States to engage services of different public or private entities in addition to the network of Common Service Centres (CSC) Village level Entrepreneur (VLEs) and Arogya Mitras (AMs) to facilitate the beneficiary identification process.

• Health Benefit Packages (HBPs) under the scheme have been rationalised as HBP 2.0

• States/UTs have been requested to empanel tertiary care hospitals in their State in addition to the existing network of empanelled hospital.

• Further, all the Ministries and departments have been directed by the Government of India to empanel all public hospitals under AB-PMJAY.