• Union Health Minister J.P. Nadda and Odisha Chief Minister Mohan Charan Majhi distributed co-branded cards of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and Gopabandhu Jan Arogya Yojana, in Cuttack on April 11. The Ayushman Vaya Vandana Yojana was also launched during the event.

• Nadda said 3.52 crore people of Odisha will benefit from AB-PMJAY.

• The minister informed that more than 8.19 crore people have availed services under the scheme and Rs 1.26 lakh crore have been spent under the same to provide healthcare services to the people of the country.

• Around 61 crore people are covered under the scheme now. 

• The previous Naveen Patnaik-led BJD government had not implemented AB-PMJAY in Odisha.

• The BJD had launched its health assurance scheme, the Biju Swasthya Kalyan Yojana (BSKY) in August 2018 which was renamed Gopabandhu Jan Arogya Yojana (G-JAY) by the BJP government.

• On January 13, Odisha’s Department of Health and Family Welfare signed an agreement with National Health Authority (NHA) to implement AB-PMJAY scheme in the state.  

• On April 5, Delhi government signed the MoU with NHA to become the 35th state/Union Territory to implement the scheme. West Bengal is now the only state which has not implemented it.

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.

• The National Health Authority is the apex body responsible for the implementation of the Ayushman Bharat health insurance scheme.

• AB-PMJAY scheme has witnessed continuous expansion of the beneficiary base.

• Initially, 10.74 crore poor and vulnerable families comprising the bottom 40 per cent of India's population were covered under the scheme.

• In January 2022, the Union government revised the beneficiary base from 10.74 crore to 12 crore families considering India's decadal population growth of 11.7 per cent over the 2011 population.

• The scheme was further expanded to cover 37 lakh ASHAs/AWWs/AWHs working across the country and their families for free healthcare benefits.

• Currently, 55 crore individuals corresponding to 12.34 crore families are covered under the scheme. Further, many states have expanded beneficiary base on their own.

• The scheme is implemented in 35 states/UTs except West Bengal.

• All members of the eligible families irrespective of age are covered under the scheme.

• 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.

Features of AB-PMJAY:

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

• It is an entitlement-based scheme. Eligible beneficiaries can directly visit any empanelled public or private hospital to avail cashless treatment. Ayushman cards are issued to the beneficiaries to create awareness about the scheme. 

• As of June 30, 2024, more than 34.7 crore Ayushman cards have been created under the scheme in the country.

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

• The scheme has covered 8.19 crore hospital admissions, including 49 per cent women beneficiaries. The public has benefited to the extent of over Rs 1.13 lakh crore under the scheme, the government said.

• Nearly 2,000 medical procedures across 27 specialties are covered under AB-PMJAY, including major surgeries like bypass surgeries and knee replacements.

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