Pradhan Mantri Jan Arogya Yojana Ayushman Bharat Program (Modicare Health Insurance Scheme)
The central government of India has launched a lot of health schemes for the weaker section of the society. The government launched yet another health scheme in the Union Budget of the country this year which will complement the schemes which were launched previously. The government has named this scheme Pradhan Mantri Jan Ayushman Bharat Scheme which will also be called as Modicare scheme.
|Scheme Name||Pradhan Mantri Jan Arogya Yojana Ayushman Bharat Program|
|Announced By||Arun Jaitley (Finance Minister)|
|Announcement Date||February 2018|
|Launching Date||Sep 2018|
|Scheme Type||Health Insurance [Bima] Yojana|
|Target Audience||BPL [SECC 2011 Data]|
|Insurance Coverage||5 Lakh|
|Toll Free Number||14555|
|Ayushman Bharat Website||abnhpm.gov.in|
|Beneficiaries List Name In Portal||mera.pmjay.gov.in|
Under the scheme, all the registered beneficiaries will be able to get a sum of 5 lakh INR. The insurance money will be provided to the beneficiaries on a yearly basis.
Already, 85% of rural people and 60% of urban people has been listed under the scheme that is eligible to avail the benefits.
Number of Family Members:
The Scheme will provide health care facilities to five members per family. This procedure will ensure that the maximum number of members of each family is able to receive health care facility.
The beneficiaries will have to register for the scheme and renew the health facilities for them and their family members each year. For this the beneficiaries will need to pay 1100-1200 INR on a yearly basis as a premium of the insurance.
The beneficiaries will have to pay a specific amount of money which will be counted as a premium amount of money every year to renew their schemes and avail the facilities of the scheme.
Ayushman Mitra :
There would be Arogya Mitras who would assist the people applying to avail the benefits of the scheme.
Golden Card :
A family card would be provided to the people and they need to carry to the health centers which are enlisted under the scheme.
Cashless Medical Facility:
Ayushman Bharat Scheme will ensure that the poor and needy people are able to get treatment and health care facilities without cash and thus the medical foundation of the will become stronger.
- Underprivileged Members: Only the underprivileged members of the society will be eligible for the Modicare Health Insurance Scheme. The individuals will have to ensure they don’t have any kind of medical insurance and they are weak financially to be eligible for this scheme.
- Number of Family Members: The government has stated that 5 members will be allowed per family but this policy was created to cover all the members of a family. So, it still remains to be seen what the committee finally decides.
- SECC 2011: Only the individuals, who are registered under the Socio-Economic Caste Census 2011 of India, will be eligible to avail the facilities of the Modicare Health Scheme.
SECC or Socio-Economic Caste Census is a special category of the government census. This category consists of the list of all the underprivileged people of India. This category is helpful for the government as they are able to use it in terms of welfare schemes and now the government will use it to properly implement the Ayushman Bharat Scheme.
The central government of India hasn’t provided the official list of documents which will have to be submitted by the applicants. But in below link we will provide the list of documents which may be necessary in this case.
How people would be cared under the scheme?
- Some of the steps have been mentioned in For the beneficiaries to avail the benefits of the National Health Protection scheme, it is not required to enroll for the same.
The following part of the article that would help the beneficiaries to obtain care under the scheme.
- Patient admission – First of all the patients should be admitted to the empanelled hospitals.
- Identification and registration – Following the admission, the patient would be identified eligible for the scheme with the help of the software. The identification of the candidate would be done with the help of Aadhaar card.
- Authorization and approval – The hospitals can check for the packages available for any particular candidate and would also check for the balance in the card. Following this, supporting evidence would be required to avail the treatment.
- After proper treatment, the patients would be discharged from the hospitals.
- The discharge summary and post-Treatment details should also be submitted to the hospital management. The hospitals would be paid by the government through banks and after the completion of the treatment procedure, the hospitals would ask for feedback from the patients.
Health Wellness Centers:
The government will select 1.5 lakh health care centers and hospitals for the successful implementation of the schemes and these centers will work as a wellness center. The government will allocate 1200 crore solely to develop and activate such centers.
How will the beneficiaries be identified at the empanelled hospitals?
The beneficiaries need to visit the hospitals where they would go through identification through the help of hospital officials. It would help to make sure whether they are eligible to avail the benefits of the scheme or not. For the same, Aadhaar card and other identification proof need to be provided to the hospital management. Also, a BIS or Beneficiary Identification System with the help of a letter along with family card would be required. From this, e-card would be generated which would be required during further process of treatment.
Timely payments of hospitals
Most of the hospitals enlisted under this scheme would get timely payments and would be following certain steps.
- Funds pertaining to the treatment would be transferred directly with the help of State Health Agency or SHA or National Health Agency or NHA.
- Each of these SHA would have an ESCROW account in which the amount would be transferred.
- Banks would take care of the payments made to the hospitals.
- The timely settlement of the hospital claims should be taken care of.
Mobile Number as identification –
It is obvious that the Beneficiaries will now be able to get make use of their registered mobile phone numbers as their ID number under the NHPM (National Health Protection Mission). So the moment beneficiaries need to get any family member admitted in the hospital, he or she will have to provide only with their registered mobile number to the hospital authorities.The officials have also mentioned that the users are in present time not able to alter their mobile phone numbers very often so this is one factor that they have considered to use them as ID under the scheme. Apart from this, he also stated that today most FMCG companies and cable service providers are also following a similar trend.
What are the anti-fraud guidelines for the scheme?
The guidelines for the methodology include detection, deterrence and prevention under the scheme. Pre-authorization and prevention would be required by the beneficiaries and provide required identification proof to the hospital management to ensure that they are suitable to avail the benefits of the scheme. This would also include data analysis and social monitoring o the candidates. In addition, deterrence includes anti-fraud cells, contract management and de-empanelment.
How to Find Impaneled Hospital List?
New Tax System
To manage the expenditure of the scheme, the taxpayers of the country have been levied a health tax which will be charged at 1%. This tax will be levied on the taxpayers from 2018 and the government expects it to generate as much as 11, 000 crore INR. The money generated from the tax will be used to manage the costing of Ayushman Bharat Scheme.
On the September 2018, the Pradhan Mantri Jan Arogya Yojana would be launched under the leadership of Prime Minister Narendra Modi. As per the benefits of the scheme, it would implement the process for the betterment of health related issues among the rural mass.On account of National Health Protection, the scheme has promised to provide Rs. 5 Lakh insurance for the hospitalization of the needy people. In addition, the scheme would cover almost 50 Crore people and ensure them cashless treatment in good hospitals.
State Involved Under the Scheme
|1||Ayushman Bharat ‘Niramayam’ Yojana Madhya Pradesh||ayushmanbharat.mp.gov.in/|
|2||Mukhyamantri Aam Aadmi Swasthya Bima Yojana In Delhi|
|3||Atal Ayushman Uttarakhand Yojana|
|4||Ayushman Bharat Arogya Karnataka Yojana|
|5||Ayushman Bharat Yojana Haryana||ayushmanbharatharyana.in|
|6||PM-JAY In Punjab|