07/23/2021 | Press release | Distributed by Public on 07/23/2021 05:55

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

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was launched on 23^rd 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 01^stMarch 2020 -19^thJuly 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 20^th 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 20^th 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 20^th 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 20^th 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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