Ministry of Health and Family Welfare

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

Posted On: 23 JUL 2021 5:01PM by PIB Delhi

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was launched on 23rd September 2018. The salient features of AB-PMJAY are:

1.         AB-PMJAY is the world’s largest Government funded health assurance scheme.

 

2.         AB-PMJAY provides health assurance of up to Rs.5 Lakh per family per year for secondary and tertiary healthcare hospitalizations.

 

3.         AB-PMJAY is a completely cashless and paperless scheme.

 

4.         The benefits under AB-PMJAY are portable across the country.

 

5.         There is no cap on family size, or age or gender.

 

6.         The beneficiary families under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) have been identified from the Socio Economic Caste Census (SECC) of 2011 on the basis of select deprivation and occupational criteria across rural and urban areas. Details are as below:

Detailed list of criteria for eligibility under AB-PMJAY as per SECC 2011

Automatically included:

  • Households without shelter
  • Destitute/ living on alms
  • Manual scavenger families
  • Primitive tribal groups
  • Legally released bonded labour

 

Deprivation criteria in rural area:

D1: Only one room with kucha walls and kucha roof

D2: No adult member between age 16 to 59

D3: Female headed households with no adult male member between age 16 to 59

D4: Disabled member and no able-bodied adult member

D5: SC/ST households

D7: Landless households deriving major part of their income from manual casual labour

 

Occupational criteria in urban area:

  1. Rag picker
  2. Beggar
  3. Domestic worker
  4. Street vendor/ Cobbler/hawker / Other service provider working on streets
  5. Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and other head-load worker
  6. Sweeper/ Sanitation worker / Mali
  7. Home-based worker/ Artisan/ Handicrafts worker / Tailor
  8. Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller
  9. Shop worker/ Assistant/ Peon in small establishment/ Helper/ Delivery assistant / Attendant/ Waiter
  10. Electrician/ Mechanic/ Assembler/ Repair worker/Washer-man/ Chowkidar

 

7.         The number of eligible beneficiaries under SECC 2011 is 10.74 crore (50 crore people). 33 States/UTs implementing AB-PMJAY have further expanded the coverage of the scheme to include 13.44 crore families (65 crore people).

 

8.         AB-PMJAY is being implemented in all States and UTs barring West Bengal, NCT of Delhi and Odisha.

 

9.         The scheme is implemented across the country through a three-tier model. National Health Authority, an attached office of the Ministry of Health and Family Welfare with full functional autonomy, is the apex body implementing AB-PMJAY across the country. For effective implementation of AB-PMJAY at States/UTs level, State Health Agencies (SHAs) have been established. District Implementation Units (DIUs) have been set up for ensuring on-ground coordination between scheme stakeholders and for smooth implementation.

 

10.       AB-PMJAY is completely funded by the Government and costs are shared between Central and State Governments in the ratio as per the extant directives issued by Ministry of Finance.

 

11.       The States/UTs have been provided with the flexibility to implement the scheme in the operational model best suited to the local conditions. Thus, AB-PMJAY is being implemented in Insurance mode, Mixed mode and Trust mode.

 

As regards procedure involved, AB-PMJAY is an entitlement-based scheme. All the eligible beneficiary families are covered from day one of the implementation of the scheme in the States/UTs. AB-PMJAY does not require enrolment. However, beneficiary verification process is being undertaken to verify the genuineness of the beneficiary. Ayushman cards are issued to all eligible beneficiaries as part of this process to ensure easy availing of health benefits.

Targets are not fixed for AB-PMJAY as the scheme operates on the basis of beneficiary demand for healthcare services. All the eligible beneficiaries of the implementing States/UTs are entitled for free healthcare services under the scheme from the day of launch of the scheme.

A total of 1.96 crore hospital admissions worth Rs. 24,315 crores have been authorized through a network of approximately 23,000 Empanelled Health Care Providers (EHCPs).

State wise details of Ayushman-cards issued, authorized hospitals admissions by count and amount under AB-PMJAY and schemes converged with AB-PMJAY are as follows:

 

 

State/UT

Ayushman cards issued#

Authorized Hospital Admissions

Value of authorized hospital admissions

(in Rs)

Andaman and Nicobar Islands

               33,844

                                      651

                             16,011,653

Andhra Pradesh*

                       11

                           1,245,956

                      35,454,214,219

Arunachal Pradesh

               22,726

                                   1,812

                             31,559,579

Assam

        12,420,824

                               252,251

                        3,749,546,919

Bihar

          6,869,237

                               287,389

                        2,770,023,718

Chandigarh

               63,524

                                 11,406

                             81,696,009

Chhattisgarh

        13,240,939

                           1,551,997

                      15,108,847,365

Dadra and Nagar Haveli | Daman and Diu

             416,028

                                 67,444

                           455,095,733

Goa

               21,867

                                 10,282

                           331,417,452

Gujarat

          7,641,318

                           2,426,337

                      36,636,319,474

Haryana

          2,616,418

                               290,815

                        3,588,146,295

Himachal Pradesh

          1,075,101

                                 96,035

                        1,077,353,995

Jammu and Kashmir

          4,794,200

                               200,034

                        1,860,995,910

Ladakh

               93,516

                                   1,615

                             18,187,716

Jharkhand

          8,992,890

                               867,385

                        8,767,034,692

Karnataka

          9,782,602

                           1,581,386

                      17,576,957,813

Kerala

          6,621,730

                           2,478,238

                      19,135,502,001

Lakshadweep

                 1,636

                                           1

                                       1,800

Madhya Pradesh

        24,791,352

                               853,881

                      12,140,065,052

Maharashtra

          7,162,216

                               479,528

                      12,416,017,419

Manipur

             313,634

                                 36,759

                           453,214,817

Meghalaya

          1,655,716

                               287,303

                        2,210,910,884

Mizoram

             356,647

                                 55,878

                           576,271,260

Nagaland

             258,083

                                 19,194

                           277,952,667

Puducherry

             250,454

                                   6,184

                             31,688,824

Punjab

          7,021,511

                               756,583

                        8,631,451,965

Rajasthan*

 -

                           1,336,147

                        7,809,870,450

Sikkim

               36,667

                                   4,012

                             37,808,637

Tamil Nadu

        24,727,508

                           3,102,787

                      38,240,413,903

Tripura

          1,255,479

                                 99,404

                           670,014,773

Uttar Pradesh

        14,189,874

                               769,531

                        7,965,274,653

Uttarakhand

          3,973,158

                               308,192

                        3,960,546,591

West Bengal@

 -

                                 17,636

                           170,981,470

Undefined&

             762,296

                               122,244

                           903,192,165

 

 

Note:
* - Details of individual beneficiary card holders are not available for Rajasthan and Andhra Pradesh
# - Total Ayushman cards data also includes 4.68 Crore beneficiary cards issued by State using State IT systems
@ - West Bengal was initially implementing the scheme. On 10th January 2019, the State Government decided to withdraw from the implementation of the scheme

& - State related information for some transactions is not available as certain implementation data had been shared offline

 

 

The funds allocated for the scheme for the current financial year 2021-22 are Rs. 6400 crore.

Following the onset of Covid-19, AB-PMJAY provided valuable support to the healthcare ecosystem by ensuring that beneficiary registration process was kept active and empanelled hospitals continued to provide services to the scheme beneficiaries. However, there was a noticeable impact on the uptake of the scheme on account of factors such as restriction of mobility, restrictions on elective surgeries, reluctance from scheme beneficiaries to visit hospitals due to fear of infection and designation of public facilities as dedicated COVID centres. During the period from 01stMarch 2020 –19thJuly 2021, a total of approx. 1.05 crore hospital admissions worth approx. Rs. 11,862 crore have been authorized under AB-PMJAY.

As on 20.07.2021, a total of 16.14 crore Ayushman cards have been issued to the scheme beneficiaries.

 

AB-PMJAY provides services only for inpatient treatment, therefore, only hospitals providing inpatient services are empanelled under this scheme.

Accordingly, NHA has developed guidelines for empanelment of hospitals under the scheme. The empanelment of hospitals under AB-PMJAY is done for general treatment and for treatment under particular speciality. The guidelines for empanelment of hospitals under AB-PMJAY can be accessed on PMJAY website.   (https://pmjay.gov.in/sites/default/files/2020-06/Empanelment-and-De-empanelment-guidelines.pdf )

            Since the empanelment of hospitals under AB-PMJAY is primarily done by the respective State/UT Governments, flexibility has been provided to the State/UT Governments to modify the empanelment criteria based on local requirements including supply and demand.

As on 20th July 2021, approx. 23,000 hospitals have been empaneled under AB-PMJAY by various State/UT Governments. The State/UT wise details of the empaneled hospitals are at Annexure-III.

Under Ayushman Bharat Health and Wellness centre, Government of India is committed to establish 1,50,000 Health and Wellness Centres (AB-HWCs) by upgrading the Sub Health

Centres (SHCs) and rural and urban Primary Health Centres (PHCs) to bring health care closer to the community.

As on 20th July 2021, 77,406 AB-HWCs are operational across the country. Details are at Annexure - IV.

Details of financial assistance provided to States/UTs are at Annexure – V.

AB-PMJAY provides treatment corresponding to a total of 1669 procedures under 26 different specialties including chronic diseases like Cancer, Diabetes, Heart Disease and other non-communicable diseases and renal and corneal transplant. The specialty wise breakup of packages is provided under Annexure – VI.

Chemotherapy and Radiotherapy packages, along with surgical oncology are covered as part of cancer treatment under the scheme.

Additionally, there is a category of unspecified packages which can be booked for procedures which are not defined in the Health Benefit Packages (HBPs).

 The following measures have been adopted by NHA to offer state-of-the-art healthcare service delivery under AB-PMJAY

 

  • Public hospitals empanelled under AB-PMJAY are reimbursed for treatment provided under the scheme at par with cost reimbursed to their private sector counterparts. These funds can be leveraged by such institutions to carry out infrastructural development and establish state-of-the-art facilities. NHA has issued necessary guidelines and instructions to the SHAs and public hospitals to encourage the same. Many States have effectively used the funds allotted to public hospitals for infrastructure upgradation and for providing better amenities to beneficiaries.
  • A targeted approach is being followed to empanel the top corporate hospitals in the country under AB-PMJAY.
  • NHA has partnered with Quality Council of India to develop a quality certification program for empanelled hospitals. AB-PMJAY quality certifications include Bronze, Silver and Gold Quality certifications. Hospitals achieving PMJAY Gold, Silver and Bronze certifications are provided 15%, 10% and 5% higher package rates respectively. As on 19th July, 2021 over 200 empanelled hospitals have been Quality Certified under the scheme.
  • Further, if an empanelled hospital attains entry level NABH accreditation, it is incentivized by reimbursing the cost of treatment at a rate which is 10 per cent higher that the standard package rates. Similarly, a PMJAY empanelled hospital attaining full NABH accreditation is paid 15 percent higher rate.

These incentives have been designed to promote state-of-the-art healthcare service delivery under AB-PMJAY. 

Beneficiary families under AB-PMJAY have been identified from the SECC-2011 database on the basis of 6 deprivation criteria and 11 occupational criteria across rural and urban areas respectively. Details are at Annexure – I.

Representations have been received regarding the inclusion of families under AB-PMJAY. However, the beneficiary database under the scheme has been frozen with the approval of the Union Cabinet.

At the same time, it may be noted that the 33 States/UTs implementing the scheme have expanded the scope of AB-PMJAY to include other categories of beneficiaries beyond SECC 2011 at their own cost. As on 20th July, 2021, approximately 13.44 crore beneficiary families are covered under AB-PMJAY.

With respect to Assam, it may be noted that in addition to AB-PMJAY, the Government is implementing a local health insurance scheme known as “Atal Amrut Abhiyan” (AAA).

AAA is an enrolment-based scheme, providing insurance coverage of up to Rs. 2 Lakh per year to every entitled family in the State. Moreover, those families belonging to the APL category with income between Rs. 1.2 Lakh and 5 Lakh per annum can also avail the benefit of AAA by paying a nominal premium of Rs. 100/- per year per member. Thus, eligible beneficiaries can avail services under either of these schemes.

National Health Authority has entered into a collaboration with WHO to carry out research and evaluation studies. In this regard, a study on “Mainstreaming quality in empaneled hospitals under PMJAY” is being conducted in three States viz. Haryana, Gujarat and Uttar Pradesh.

 

Annexure – III

 

State/UT list of empanelled hospitals in AB-PMJAY

 

State/UT

PHC

CHC

Other Govt. Hospitals

Private Hospitals

Total Hospitals

Andaman and Nicobar Islands

 

 

3

0

3

Andhra Pradesh

 

 

774

565

1339

Arunachal Pradesh

2

3

35

1

41

Assam

12

15

185

159

371

Bihar

265

152

193

266

876

Chandigarh

 

1

7

18

26

Chhattisgarh

720

162

133

442

1457

Dadra and Nagar Haveli | Daman and Diu

0

3

4

0

7

Delhi

 

 

32

64

96

Goa

7

6

6

13

32

Gujarat

310

222

1367

530

2429

Haryana

 

95

81

391

567

Himachal Pradesh

3

35

111

82

231

Jammu and Kashmir

1

44

138

43

226

Ladakh

 

7

3

0

10

Jharkhand

2

143

130

514

789

Karnataka

 

 

2894

542

3436

Kerala

1

33

158

520

712

Lakshadweep

 

2

4

0

6

Madhya Pradesh

8

277

167

419

871

Maharashtra

 

 

296

669

965

Manipur

4

9

46

11

70

Meghalaya

112

27

25

18

182

Mizoram

54

4

31

5

94

Nagaland

34

20

30

14

98

Odisha

 

 

30

1

31

Puducherry

 

4

8

11

23

Punjab

2

133

109

634

878

Rajasthan

 

2

594

189

785

Sikkim

 

 

10

1

11

Tamil Nadu

 

 

1541

1580

3121

Telangana

 

 

12

17

29

Tripura

79

22

37

2

140

Uttar Pradesh

19

820

263

1612

2714

Uttarakhand

 

62

62

101

225

West Bengal

 

 

61

7

68

 

Annexure – IV

 

Functional Health and Wellness Centres as on 20th July 2021

 

S.No.

STATE

Functional HWCs as on 20th July 2021

 

 

SHC-HWC*

PHC-HWC**

UPHC-HWC***

TOTAL

 

1

Andaman & Nicobar Islands

58

17

5

80

 

2

Andhra Pradesh

2,904

1,145

243

4,292

 

3

Arunachal Pradesh

136

63

4

203

 

4

Assam

1,539

617

53

2,209

 

5

Bihar

1,057

1,019

98

2,174

 

6

Chandigarh

0

28

 

28

 

7

Chhattisgarh

2,457

634

45

3,136

 

8

Dadra & Nagar Haveli

52

8

 

60

 

 

Daman & Diu

26

4

 

30

 

9

Goa

53

54

5

112

 

10

Gujarat

4,468

1,469

316

6,253

 

11

Haryana

430

360

100

890

 

12

Himachal Pradesh

554

497

14

1,065

 

13

Jammu & Kashmir

915

378

16

1,309

 

14

Jharkhand

1,378

177

54

1,609

 

15

Karnataka

3,298

2,166

365

5,829

 

16

Kerala

1,520

859

93

2,472

 

17

Ladakh

69

20

 

89

 

18

Lakshadweep

0

3

 

3

 

19

Madhya Pradesh

5,098

1,124

145

6,367

 

20

Maharashtra

6,376

1,824

457

8,657

 

21

Manipur

154

55

2

211

 

22

Meghalaya

182

78

19

279

 

23

Mizoram

120

53

8

181

 

24

Nagaland

168

48

7

223

 

25

Odisha

316

1,229

90

1,635

 

26

Puducherry

80

39

2

121

 

27

Punjab

2,270

328

93

2,691

 

28

Rajasthan

160

1,957

280

2,397

 

29

Sikkim

74

16

1

91

 

30

Tamil Nadu

3,027

1,381

460

4,868

 

31

Telangana

1,875

634

223

2,732

 

32

Tripura

241

33

5

279

 

33

Uttar Pradesh

6,644

1,656

435

8,735

 

34

Uttarakhand

536

359

38

933

 

35

West Bengal

4,041

783

339

5,163

 

Total

52,276

21,115

4,015

77,406

 

Delhi does not implement HWC Programme

*- Sub Health Centre Health and Wellness Centre

**- Primary Health Centre Health and Wellness Centre

***- Primary Health Centre Health and Wellness Centre

 

Annexure – V

Central Release (allocation) for the activity Ayushman Bharat - Health & Wellness Centres for the FY 2018-19 to 2020-21 (Rupees in crore)

S. No.

Name of the State/UT

Allocation in 2018-19

Allocation in 2019-20

Allocation in 2020-21

1

Andaman & Nicobar Islands

                0.80

          0.85

          1.16

2

Andhra Pradesh

              43.51

        52.44

       59.38

3

Arunachal Pradesh

                8.15

          8.59

       14.80

4

Assam

              68.67

        97.60

       89.69

5

Bihar

              88.50

        88.78

     119.22

6

Chandigarh

                0.71

          0.84

          1.51

7

Chattisgarh

              36.42

        65.66

       28.08

8

Dadra & Nagar Haveli and Daman & Diu

                1.13

          1.64

          2.09

9

Delhi

                    -  

              -  

              -  

10

Goa

                0.79

          1.26

          0.88

11

Gujarat

              44.64

        49.98

       69.75

12

Haryana

              18.45

        24.03

       29.02

13

Himachal Pradesh

              16.08

        27.21

       25.87

14

Jammu & Kashmir

              32.66

        38.88

       39.27

15

Jharkhand

              26.02

        75.81

              -  

16

Karnataka

              47.98

        54.70

       75.51

17

Kerala

              18.43

        21.65

       27.73

18

Lakshadweep

                0.18

          0.26

          0.24

19

Madhya Pradesh

              87.74

        87.82

     140.35

20

Maharashtra

              91.27

        97.64

     138.60

21

Manipur

                5.44

          9.22

          8.06

22

Meghalaya

                8.64

        12.46

          9.17

23

Mizoram

                4.03

          5.19

          5.25

24

Nagaland

                5.01

          5.34

          6.22

25

Orissa

              48.34

        95.49

       77.06

26

Puducherry

              14.46

          0.22

              -  

27

Punjab

              19.69

        20.39

       22.17

28

Rajasthan

              83.70

        68.64

       62.63

29

Sikkim

                2.16

          1.62

          2.71

30

Tamil Nadu

              56.41

        89.12

       82.65

31

Tripura

              10.18

        13.57

          9.27

32

Uttar Pradesh

            176.10

      330.85

     279.52

33

Uttarakhand

              19.62

        30.31

       26.93

34

West Bengal

              59.47

        61.55

       99.44

35

Telangana

              46.14

        33.70

       35.94

36

Ladakh

 

 

          7.36

Total

        1,191.52

  1,573.31

  1,597.53

Note:  1. The above releases relate to Central Govt. Grants & do not include State share contribution.

 

Annexure – VI

 

Specialty wise breakup of packages and procedures under AB-PMJAY

 

S. No.

Specialty

HBP 2.1

Code

Packages

Procedures

1

Burns Management

BM

6

21

2

Cardiology

MC

21

27

3

Cardio-thoracic & Vascular surgery

SV

35

129

4

Emergency Room Packages

ER

3

4

5

General Medicine

MG

81

106

6

General Surgery

SG

105

159

7

Infectious Diseases

ID

3

3

8

Interventional Neuroradiology

IN

10

15

9

Medical Oncology

MO

72

264

10

Mental Disorders Packages

MM

10

10

11

Neo-natal care Packages

MN

10

10

12

Neurosurgery

SN

61

94

13

Obstetrics &Gynaecology

SO

60

80

14

Ophthalmology

SE

41

54

15

Oral and Maxillofacial Surgery

SM

14

19

16

Orthopedics

SB

74

134

17

Organ & Tissue Transplant

OT

1

6

18

Otorhinolaryngology

SL

35

79

19

Pediatric Medical management

MP

48

67

20

Pediatric surgery

SS

19

35

21

Plastic & reconstructive Surgery

SP

8

12

22

Polytrauma

ST

10

23

23

Radiation Oncology

MR

14

46

24

Surgical Oncology

SC

80

125

25

Urology

SU

96

146

26

Unspecified Surgical

US

1

1

 

Total

918

1669

 

The Union Minister of State for Health and Family Welfare, Dr. Bharati Pravin Pawar stated this in a written reply in the Lok Sabha here today.

 

****

 

MV

 

HFW/PQ/AB-PMJAY/23rdJuly2021/14



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