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The Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Ayushman Bharat PM-JAY is the largest health assurance scheme in the world which aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 12 crores of poor and vulnerable families (approximately 55 crore beneficiaries) that form the bottom 40% of the Indian population. The households included are based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively. PM-JAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened. It subsumed the then-existing Rashtriya Swasthya Bima Yojana (RSBY) which had been launched in 2008. The coverage mentioned under PM-JAY, therefore, also includes families that were covered in RSBY but are not present in the SECC 2011 database. PM-JAY is fully funded by the Government and the cost of implementation is shared between the Central and State Governments.
- PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government.
- It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
- Over 12 crore poor and vulnerable entitled families (approximately 55 crore beneficiaries) are eligible for these benefits.
- PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
- PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.
- There is no restriction on the family size, age, or gender. All pre-existing conditions are covered from day one.
- Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
- Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
- Services include approximately 1,929 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician's fees, room charges, surgeon charges, OT and ICU charges, etc.
आयुष्मान कार्ड (PMJAY) कैशलेस चिकित्सा योजना के सम्बन्ध में।
The Pandit Deendayal Upadhyay Rajya Karmchari Cashless Chikitsa Yojna.
This scheme shall be operated under the rules defined in The Uttar Pradesh Government Servant(Medical Attendance) Rules – 2011, (as amended in 2014, 2016 and 2021). The definition of Government Servant is available under “GO/Guidelines”. A cashless medical treatment facility has been provided to the government servants, retired government servant and their dependent families of Uttar Pradesh state by the GO dated 07 January 2022 issued by the Government of Uttar Pradesh. This facility will be available in all private hospitals and government hospitals empanelled under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. Cashless medical treatment of up to Rs.5 lakh per annum will be available to each beneficiary family in private empanelled hospitals. Whereas cashless treatment will be available without any financial limit in Government medical institutions/hospitals. To get the benefit of the scheme, it is mandatory for every eligible beneficiary to have a State Health Card. Cashless treatment will be available in the empanelled hospitals after ensuring the identity of the beneficiary with the help of State Health Card.
पण्डित दीनदयाल उपाध्याय राज्य कर्मचारी कैशलेस चिकित्सा योजना के सम्बन्ध में।
यह योजना उत्तर प्रदेश सरकारी सेवक (चिकित्सा परिचर्या) नियमावली 2011, (यथासंशोधित 2014, 2016 एवं 2021) में निहित नियमों के अधीन संचालित होगी। “सरकारी सेवक” की परिभाषा “GO/Guidelines” के अंतर्गत उपलब्ध है।
उत्तर प्रदेश शासन द्वारा जारी शासनादेश दिनांक 07 जनवरी, 2022 में उत्तर प्रदेश राज्य के सरकारी सेवकों, सेवानिवृत्त सरकारी सेवकों तथा उनके आश्रित परिजनों को कैशलेस चिकित्सा सुविधा का प्राविधान किया गया है। यह सुविधा आयुष्मान भारत प्रधानमंत्री जन आरोग्य योजना के अन्तर्गत आबद्ध समस्त निजी चिकित्सालयों तथा सरकारी चिकित्सालयों में उपलब्ध होगी। निजी आबद्ध चिकित्सालयों में प्रत्येक लाभार्थी परिवार को प्रतिवर्ष रूपये-पाॅच लाख तक की कैशलेस चिकित्सा उपलब्ध होगी। जबकि सरकारी चिकित्सा संस्थानों/चिकित्सालयों में बिना किसी वित्तीय सीमा के कैशलेस चिकित्सा उपलब्ध होगी। योजना का लाभ प्राप्त करने हेतु प्रत्येक पात्र लाभार्थी के पास स्टेट हेल्थ कार्ड उपलब्ध होना अनिवार्य है, जिसकी सहायता से आबद्ध चिकित्सालयों में लाभार्थी की पहचान सुनिश्चित करने के उपरान्त कैशलेस चिकित्सा उपलब्ध हो सकेगी।
इस योजना की खास बातें —
पंडित दीन दयाल उपाध्याय राज्य कर्मचारी कैशलेस चिकित्सा योजना, उत्तर प्रेदश राज्य के मौजूदा कर्मचारियों और रिटायर हो चुके कर्मचारियों के लिए है।
इस योजना में राज्य सरकार द्वारा कर्मचारियों को एक हेल्थ कार्ड जारी किया जाता है।
इसमें एक साल में लाभार्थी और उसका परिवार पांच लाख रुपये तक का इलाज निजी अस्पतालों में और बिना किसी आर्थिक सीमा के सरकारी अस्पतालों में इलाज करा सकते हैं।
पंडित दीन दयाल उपाध्याय राज्य कर्मचारी कैशलेस चिकित्सा योजना के तहत आयुष्मान भारत प्रधानमंत्री जन आरोग्य योजना के अन्तर्गत आबद्ध समस्त निजी और सरकारी अस्पतालों में इलाज करा सकते हैं।
कैशलेस योजना केवल भर्ती होने वाले मरीजों के लिए है।
The Ayushman CAPF
Ayushman CAPF’ is a convergence scheme being implemented on the Ayushman Bharat PM-JAY IT platform. A joint initiative by the Ministry of Home Affairs and the National Health Authority, which will provide cashless healthcare services to the serving CAPF personnel from all seven forces, viz. Assam Rifles, BSF, CISF, CRPF, ITBP, NSG, and SSB, and their dependents through the Ayushman Bharat PM-JAY IT platform. Launched on 23rd January 2021 in Assam, this ‘Ayushman CAPF’ scheme will be implemented across the country in a phased manner.
The convergence between Ayushman Bharat and CAPF is a first-of-its-kind initiative leveraging the strengths of the existing robust IT framework, access to the network of various private hospitals, and portability of services across the country.
This initiative will help in moving away from any paper-based manual process of availing healthcare benefits by CAPF personnel and their families to a paperless service at NHA’s IT platform.
In addition, a 24×7 call center, online grievance management system, fraud, and abuse control system, and real-time monitoring dashboards are other key features of the scheme.
Eligibility
Serving personnel and their dependents from Assam Rifles, Border Security Force (BSF), Sashastra Seema Bal (SSB), Central Reserve Police Force (CRPF), Central Industrial Security Force (CISF), National Security Guard (NSG), and Indo-Tibetan Border Police (ITBP) will be covered under the scheme.
Key features
- Onboarding all CGHS empaneled Health Care
- Organizations (HCOs) on the NHA IT platform
- Transfer of paper-based processes to online workflows
- Paperless verification of beneficiaries
- Referral mechanism
- Claim processing (intimation, submission, scrutiny, and approval/rejection of claims)
- Online transfer of payments
- One-time e-KYC authentication on Beneficiary Identification System (BIS)
- Seamless access for serving personnel and their dependents to healthcare services
- Cashless & paperless treatment and diagnostics facilities at the empaneled HCOs upon referral from the CAPF / government Hospitals / CGHS wellness center
- Health Benefits Packages (HBP) offer more than 1853 procedures across 45 specialties
- Less waiting time for availing healthcare services
How to Avail Cashless Benefits under Ayushman CAPF
Get an Ayushman CAPF Card
Beneficiaries may collect the Ayushman CAPF e-card from the respective forces. The card may be activated at an empaneled private hospital, post authentication using a copy of the Force ID and Aadhaar or Government photo ID. Alternatively, an Ayushman CAPF e-card can be obtained from Pradhan Mantri Aarogya Mitra (PMAM) stationed at PM-JAY empaneled private hospital upon presenting the above-mentioned documents.
Availing of Cashless Medical Treatment
The beneficiary may avail medical treatment at CAPF or Government-owned facilities free of cost, as per the existing guidelines. CAPF or Government-owned facilities may refer the beneficiary to the CGHS & PM-JAY empaneled private hospital wherein the beneficiary may avail of cashless OPD/ IPD treatment, including diagnostics at CGHS or CAPF empaneled private hospitals. Additionally, beneficiaries may be available for cashless IPD treatment at other PM-JAY empaneled private hospitals. The beneficiary would be required to register at the hospital using the activated Ayushman CAPF card/ ID.
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