The Government of India, in order to ensure maximum health care available to all citizens, launched the path-breaking initiative known as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY). More commonly referred to as BIS PMJAY, this scheme is under the administration of the National Health Authority (NHA). The aim of this program is to provide free access and financial protection to health care facilities for millions of underprivileged families across the country. Although comprehensive, it is essential to understand who is eligible for benefit under the BIS PMJAY.
BIS PMJAY: An Overview
Before diving into the eligibility criteria, let’s revisit what BIS PMJAY is. Launched in 2018 by Prime Minister Narendra Modi, BIS PMJAY aims to offer health protection coverage to the poorest, underprivileged households, and families who are vulnerable to serious health issues. It provides a defined benefit coverage of up to INR 5 lakh per family per year for secondary and tertiary care hospitalization.
Determining Eligibility for BIS PMJAY
Under BIS PMJAY, the beneficiaries are entitled to cashless and paperless treatment at all public and empaneled private hospitals. The healthcare services include pre and post-hospitalization costs, diagnostics, medicines, and ambulance services, eliminating the need for any out-of-pocket expenditure from the beneficiaries. The scheme not only covers critical ailments but also provides daycare services like cataract surgery and dialysis. For easy access to these services, beneficiaries can use the Bajaj Finserv app to find empaneled hospitals and manage their healthcare needs seamlessly.
For rural areas, the criteria include several factors like families living in a one-room shelter with kuccha walls and kuccha roofs, households with no adult members aged between 16 to 59, female-headed households with no male adult member aged between 16 to 59, households having at least one member with a disability, SC/ST households, landless households harboring major income from manual casual labor.
On the contrary, in urban areas, the eligibility is based on occupation and comprises mainly of beggars, rag-pickers, domestic workers, street vendors, construction workers, plumber, painter, welders, security guards, transport workers, and other similar occupations according to the SECC data.
PMJAY Beneficiaries: Overview
Under BIS PMJAY, the beneficiaries are entitled to cashless and paperless treatment at all public and empaneled private hospitals. The healthcare services include pre and post-hospitalization costs, diagnostics, medicines, and ambulance services, eliminating the need for any out-of-pocket expenditure from the beneficiaries. The scheme not only covers critical ailments but also provides daycare services like cataract surgery and dialysis.
The Role of National Health Authority (NHA)
The National Health Authority administers the BIS PMJAY. The NHA ensures that the beneficiaries receive the benefits seamlessly and are not exploited. It also works towards empaneling hospitals, improving the quality of healthcare services, and monitoring the overall implementation of the scheme. Under the NHs jurisdiction, the State Health Agencies (SHAs) ensure the enrollment of beneficiaries, identification, and the settlement of health benefit packages.
BIS PMJAY helps to uplift economically vulnerable families who lack access to high-quality healthcare facilities. Continuous awareness regarding the eligibility criteria and benefits amongst the citizen is a vital step in making the scheme a success. With the PMJAY beneficiary NHA playing a pivotal role, the social objective of health secure India gets a strong fulfillment.
Conclusion
BIS PMJAY is an unprecedented step towards universal health coverage in India. It empowers the poor and vulnerable by providing them access to quality healthcare services. With a comprehensive understanding of the BIS PMJAY and its eligibility criteria, one can ensure maximum benefit from this revolutionary scheme, contributing to a healthier India.
