• Approximately six crore hospital admissions entailing an expenditure of Rs 77,298 crore have been authorised under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) till November 30, Union Health Minister Mansukh Mandaviya told Lok Sabha.

• A total of 26,774 hospitals, including 11,733 private facilities, across the country have been empanelled to provide healthcare services to the scheme beneficiaries, he said.

• As many as 4.98 crore claims have been submitted between financial years 2020-21 and 2023-24.

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

• Over the past few decades there has been improvement in various health indicators of India. However, the out-of-pocket expenditure, which pushes millions of people into poverty every year. 

• In order to address this and provide health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to poor and vulnerable section of the population, Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was launched, subsuming the erstwhile Rashtriya Swasthya Bima Yojana, on September 23, 2018. 

• It is the largest publicly funded health assurance scheme in the world.

• AB-PMJAY provides health cover to families which constitute the bottom 40 per cent of the population.

• The Union Budget has allocated Rs 7,200 crore for Ayushman Bharat PM-JAY for the financial year 2023-24.

• The funding of the scheme is shared between central and state governments. The ratio of central share to state share for all states except northeast states and Himalayan states and Union Territories with legislature, is 60:40. For northeast states and Himalayan states, the ratio is 90:10. In the case of Union Territories without legislatures, the central contribution of premium is 100 per cent.

• The AB-PMJAY scheme is completely cashless and paperless and without the concept of reimbursement. Beneficiaries can avail treatment under defined packages. 

• The Empanelled Healthcare Providers are paid based on specified health benefit packages with standardised rates.

• As per the latest health benefit packages (2022), a total of 1,949 procedures across 27 specialities are available for AB PM-JAY beneficiaries including diseases such as cancer, diabetes and heart ailments. Further, states and Union Territories have been given the flexibility to add state-specific packages over and above the national master.

• Also, they have been provided flexibility to change the cost of the package as per local requirements. 

• Leprosy as a package is not included under the scheme. However, 26 procedures related to skin diseases and 549 procedures related to cancer are covered under AB-PMJAY. 

• Further, to ensure that AB-PMJAY beneficiaries are not denied care for treatments/procedures that do not feature in the health benefit packages, one unspecified package has been included in it to avail treatment for such procedures under the scheme.

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