Why in News?
Nearly a year after its launch, Tamil Nadu has not implemented the expanded Ayushman Bharat PM-JAY for citizens aged 70 and above. Disagreements with the Centre over coverage and financial burden have stalled the scheme, leaving around 43 lakh seniors currently unable to access ₹5 lakh annual treatment benefits.
Description:
- Part of Ayushman Bharat (launched on 23 Sept 2018, Ranchi).
- Flagship health assurance scheme of GoI → aims at Universal Health Coverage.
- Designed as per National Health Policy 2017; aligned with SDGs (“leave no one behind”).
Key Features:
- World’s largest government-funded health assurance scheme.
- Coverage: ₹5 lakh per family / year → for secondary & tertiary hospitalization.
- Entitlement: ~12 crore poor & vulnerable families (≈55 crore people).
- Based on SECC-2011 (rural & urban deprivation/occupation); also covers erstwhile RSBY families.
- Cashless & paperless access at empanelled public/private hospitals across India.
- No cap on family size, age, gender; pre-existing diseases covered from Day-1.
- Benefits portable pan-India; includes 3-day pre & 15-day post hospitalization.
- ~1,900+ procedures covered (surgery, ICU, implants, diagnostics, drugs, physician fees).
- Public hospitals reimbursed at par with private.
Beneficiaries & Eligibility:
- Bottom 40% of Indian population.
- Identified via SECC 2011 deprivation & occupational criteria.
- No enrollment fee / premium for beneficiaries.
- All senior citizens aged 70 or above, regardless of economic status, are eligible for free medical treatment up to ₹5 lakh under this scheme. (added in 2024)
Funding & Implementation:
- Fully funded by GoI; cost shared Centre: State = 60:40 (90:10 for NE & Himalayan; 100% for UTs).
- Implemented by National Health Authority (NHA).
- States adopt Insurance Model / Trust Model / Mixed Model.
Related Initiatives:
- Ayushman Bharat – Health & Wellness Centres (HWCs) → 1.5 lakh centres for primary healthcare.
- PM-JAY MA (Mukhya Mantri Amrutam Yojana) – Gujarat-specific integration.
- National Digital Health Mission – to integrate health records.
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