Pradhan Mantri Jan Arogya Yojana (PM-JAY) UPSC: Full Details

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Prime Minister Narendra Modi, in his address on the 77th Independence Day, shared the government’s commitment to enhancing access to affordable medicines. The Centre is diligently working to escalate the count of Jan Aushadhi Kendras, which are subsidized medicine outlets, from 10,000 to 25,000. These Kendras play a crucial role in ensuring that citizens, particularly the middle class, can access high-quality generic medicines at economical prices.

Pradhan Mantri Jan Arogya Yojana (PM-JAY) UPSC Full Details

Working to increase ‘Jan Aushadhi Kendras’ from 10,000 to 25,000: PM Modi

Revitalizing the Middle Class: Savings and Empowerment

PM Modi emphasized the transformative impact of Jan Aushadhi Kendras on the middle class. The savings achieved through these centers amount to a substantial Rs 20,000 crore. He further expressed the goal of reaching 25,000 Kendras, a significant increase from the existing 9,303 centers across India as of March 31. The Union health ministry intends to establish 10,000 centers by year-end, showcasing the commitment to accessible healthcare.

Affordability Redefined: Providing Essential Medicines at Nominal Cost

Highlighting the profound impact of Jan Aushadhi Kendras, PM Modi exemplified the drastic cost difference. While a monthly diabetes treatment expense can accumulate to Rs 3,000, the Kendras offer the same medicines, priced at Rs 100, for a mere Rs 10-15. This dramatic reduction underscores the initiative’s role in making essential medications accessible to a broader population.

A Legacy of Healthcare Transformation: Ayushman Bharat Scheme

PM Modi also underscored the accomplishments of the Ayushman Bharat scheme, a national public health insurance initiative. Notably, the Centre has invested Rs 70,000 crore in this scheme, a testament to its dedication to ensuring comprehensive healthcare coverage. Launched in September 2018, Ayushman Bharat comprises two vital components.

The Pradhan Mantri Jan Arogya Yojana caters to nearly 12.5 crore families, offering cashless hospitalization services of up to Rs 5 lakh. This safeguard ensures that families can access necessary medical care without facing financial constraints. The second component focuses on establishing health and wellness centers, transforming primary health facilities to offer holistic care to both rural and urban communities.

Acknowledging Healthcare Heroes and Lessons from Covid-19

PM Modi expressed profound appreciation for healthcare professionals, including nurses, doctors, and medical staff, for their unwavering commitment. He emphasized the pivotal role of a human-centric approach in global development, a lesson underscored by the Covid-19 pandemic. PM Modi’s commendation extended to the remarkable efforts of health workers, particularly Anganwadi and ASHA workers, who played an instrumental role in achieving the remarkable milestone of administering over 200 crore Covid-19 vaccinations.

In summation, Prime Minister Narendra Modi’s address highlights the pivotal role of Jan Aushadhi Kendras in revolutionizing healthcare accessibility, while also lauding the transformative impact of the Ayushman Bharat scheme and celebrating the dedication of healthcare workers in the face of adversity.

Pradhan Mantri Jan Arogya Yojana (PM-JAY)

What is Pradhan Mantri Jan Arogya Yojana

▪ The second component of Ayushman Bharat – the Pradhan Mantri Jan Arogya Yojna, commonly known as PM-JAY. This initiative was inaugurated on September 23, 2018, in Ranchi, Jharkhand, by India’s respected Prime Minister, Shri Narendra Modi.

▪ Ayushman Bharat PM-JAY stands as the world’s largest health assurance program. Its primary objective is to extend health coverage, offering Rs. 5 lakhs per family annually for hospitalization needs in secondary and tertiary care facilities.

▪ This crucial assistance targets over 12 crore impoverished and susceptible families, encompassing around 55 crore beneficiaries, constituting the bottom 40% of India’s population.

Selection of eligible households is determined based on the Socio-Economic Caste Census 2011 (SECC 2011) criteria, reflecting both deprivation and occupation, for rural and urban regions respectively.

Formerly recognized as the National Health Protection Scheme (NHPS), PM-JAY absorbed the pre-existing Rashtriya Swasthya Bima Yojana (RSBY) initiated in 2008. This transition allows for the inclusion of families previously covered by RSBY but not accounted for in the SECC 2011 database. Notably, PM-JAY operates on complete government funding, with implementation costs shared collaboratively by both Central and State Governments.

Pradhan Mantri Jan Arogya Yojana Eligibility

▪ Access to the program is not contingent upon registration; rather, it’s based on data collected by the Socio-Economic Caste Census of 2011 (SECC 2011).

▪ This initiative encompasses eight crore families in rural areas and two crore families in urban settings.

▪ The criteria for including beneficiaries in rural and urban areas differ. Rural inclusion adheres to SECC 2011’s general parameters such as literacy rates, median household income, occupation, housing type, and sanitation.

Beneficiaries in rural regions are identified based on seven deprivations outlined in the SECC database. In urban areas, eleven occupational criteria are employed to determine entitlement.

▪ Outlined below is a comprehensive breakdown of beneficiaries in both rural and urban sectors:

Rural Beneficiaries

▪ PMJAY extends coverage to rural families meeting at least one of six deprivation criteria (D1 to D5 and D7).

▪ Additionally, automatic inclusion applies to destitute or alms-dependent households, manual scavenger households, primitive tribal groups, and legally released bonded labor households.

D1 – Single room dwelling with kucha walls and roof
D2 – No adult member aged 16 to 59
D3 – Households lacking adult male members aged 16 to 59
D4 – Disabled members without able-bodied adult members
D5 – SC/ST households
D7 – Landless households primarily reliant on manual casual labor for income

Urban Beneficiaries

▪ The scheme encompasses urban populations engaged in 11 distinct occupational categories:

  1. Ragpicker
  2. Beggar
  3. Domestic worker
  4. Street vendor/cobbler/hawker/other service provider on streets
  5. Construction worker/plumber/mason/labor/painter/welder/security guard/coolie and other head-load workers
  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 establishments/helper/delivery assistant/attendant/waiter
  10. Electrician/mechanic/assembler/repair worker
  11. Washerman/chowkidar

▪ The SECC 2011 beneficiary list excludes government employees, individuals owning 5 acres or more of agricultural land, and those with two, three, or four-wheelers, a mechanized fishing boat, or Kisan cards with an Rs. 50,000 credit limit. Additionally, individuals earning more than Rs. 10,000 per month and possessing a refrigerator and landline connection are also excluded.

Key Features of Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Government-Funded Health Assurance: PM-JAY, the world’s largest government-backed health insurance/assurance initiative, offers comprehensive coverage.

Comprehensive Hospitalization Coverage: Families benefit from a substantial coverage of Rs. 5 lakhs per annum, catering to secondary and tertiary care needs across both public and private empanelled hospitals nationwide.

Inclusive Eligibility: Over 12 crore impoverished and vulnerable families (approximately 55 crore individuals) are entitled to these extensive healthcare advantages.

Convenient Cashless Access: PM-JAY ensures convenient access to healthcare services without the burden of immediate payment, allowing beneficiaries to receive care promptly.

Financial Security against Medical Costs: The scheme’s primary aim is to alleviate the burden of substantial medical expenses that often drive nearly 6 crore Indians into poverty annually.

Holistic Support: PM-JAY covers pre-hospitalization (up to 3 days) and post-hospitalization (up to 15 days) expenses, encompassing diagnostics and medication costs.

Inclusive Coverage: All families, irrespective of size, age, or gender, are eligible to benefit from PM-JAY.

Immediate Coverage for Pre-existing Conditions: The initiative provides coverage from the outset for all pre-existing medical conditions.

Nationwide Portability: Beneficiaries have the flexibility to access cashless treatment across the country, availing services from any empanelled public or private healthcare facility.

Extensive Service Range: PM-JAY encompasses a wide array of approximately 1,929 medical procedures, encompassing comprehensive treatment expenses such as medication, supplies, diagnostics, physician fees, room charges, and surgical and ICU expenses, among others.

Equitable Reimbursement: Public healthcare institutions are reimbursed at par with private hospitals, ensuring fair compensation for healthcare services rendered.

Benefit Cover Under PM-JAY for Enhanced Health Benefits

In India, the scope of benefits provided by various Government-backed health insurance initiatives has traditionally been limited by set upper limits, typically ranging from INR 30,000 to INR 3,00,000 per family annually across different states.

This approach has led to a fragmented system. However, PM-JAY introduces a transformative change by offering comprehensive coverage up to INR 5,00,000 per family per year for specified secondary and tertiary healthcare needs. This expansive coverage encompasses various aspects of medical treatment, including:

  1. Medical examinations, consultations, and treatments
  2. Pre-hospitalization care
  3. Medicines and medical supplies
  4. Non-intensive and intensive care services
  5. Diagnostic tests and laboratory investigations
  6. Necessary medical implants
  7. Accommodation during treatment
  8. Nutritious food services
  9. Management of treatment-related complications
  10. Post-hospitalization follow-up care for up to 15 days

The significant advantage of the INR 5,00,000 coverage is that it applies on a family floater basis, offering flexibility for utilization by any or all members of the family. Unlike the earlier RSBY scheme with a five-member family cap, PM-JAY has been meticulously crafted, taking insights from past programs, to ensure that there are no constraints on family size or the age of family members.

Furthermore, a noteworthy feature of PM-JAY is the inclusion of coverage for pre-existing medical conditions right from the enrollment date. This revolutionary aspect means that individuals with existing health issues can now receive treatment for those conditions under the scheme from the moment they join.

Pradhan Mantri Jan Arogya Yojana

Frequently Asked Questions

Q1. When was Ayushman Bharat Pradhan Mantri Jan Arogya Yojana launched?

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was launched on 25 September 2018 by Prime Minister Narendra Modi.

Q2. What is the second component of Ayushman Bharat and what is it commonly referred to as?

The second component of Ayushman Bharat is known as the Pradhan Mantri Jan Arogya Yojna, or PM-JAY for short.

Q3. Where was the PM-JAY scheme launched?

The PM-JAY scheme was launched in Ranchi, Jharkhand, India.

Q4. What is the main objective of PM-JAY?

The main objective of PM-JAY is to provide financial protection and access to quality healthcare services to vulnerable and economically disadvantaged families in India.

Q5. Who is eligible to benefit from PM-JAY?

Families that are identified as socioeconomically deprived based on the Socio-Economic Caste Census (SECC) 2011 data are eligible to benefit from PM-JAY.

Q6. How much financial coverage does PM-JAY offer?

PM-JAY offers cashless coverage of up to INR 5,00,000 per eligible family per year for specified healthcare treatments.

Q7. Is there any restriction on family size under PM-JAY?

Unlike previous schemes (Rashtriya Swasthya Bima Yojana (RSBY) , PM-JAY does not have a cap on family size. All eligible family members can benefit from the coverage.

Q8. Is the PM-JAY scheme available only in rural areas?

No, PM-JAY covers both rural and urban areas. Beneficiaries from various socioeconomic backgrounds in both settings can benefit from the scheme.

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