All you should know about Pradhan Mantri Jan Arogya Yojana Abhiyan (PMJAY)

Prime Minister Narendra Modi has been keen on offering better medical facilities for the common people. As medical treatments are rather costly, poor people, living in villages and cities cannot attain proper medical therapy.

With the implementation of Pradhan Mantri Jan Arogya Yojana or PMJAY, the central government offers financial assistance for common people. Under this scheme, poor individuals will receive medical insurance.

This will be offered in the form of cashless treatment for all beneficiaries.

Launch details

Key features of the scheme

1. Easy access to medical treatment – Each year thousands die in India due to lack of medical care. Most of these individuals were poor and could not afford high medical expenditure. With the implementation of this project, poor people will receive free medical treatment.
2. Medical insurance amount – Under this scheme, all applicants will be able to attain a medical insurance scheme that amounts to a whopping 5 lakhs. This amount is for one financial year.
3. Number of beneficiaries – This scheme offers this cashless treatment and medical insurance benefits to as many as 10.74 individuals. Only those people will be able to apply who have their names registered in the SECC-2011 Data list.
4. Implementation in all areas – The scheme will be implemented in all parts of the nation.
5. Flexibility of implementation – The central government has highlighted some implementation methods for easy of operations. Each state will be able to choose the implementation mode that suits its needs.
6. For both villages and cities – People, living in rural areas as well as cities will be able to enroll for this scheme as long as they fulfill other eligibility criteria. 85% and 60% beneficiaries have been identified from villages and urban settlements respectively.
7. Listed hospitals only – The cashless and paperless treatment will be available only if the patients get admission in empanelled hospitals.

Important dates related to the scheme

Modes of implementing the scheme

As per the scheme draft, the central government highlighted that states will be able to implement the Ayushman Bharat – Pradhan mantri Jan Arogya Yojana in three possible ways – Mixed mode, Insurance Mode and Trust Mode. The states have already made their selections. The list below highlights the preference of each state.

 Important information for beneficiaries

1. Eligible applicants will not have to enroll for this scheme to attain the medical benefits.
2. Applicants need not make any financial payments for attaining the benefits of this scheme.
3. In case any fake website or agent tries to fool the beneficiaries and amass wealth from them, then the agent or website owners will be booked under law.

Scheme related details

1. As the scheme will allow family members to attain medical facility, official family letters will be issued to each family.
2. Any interested individual or beneficiary can call on the toll free number 14555 to attain more information about the medical insurance scheme.
3. The central authority has clearly mentioned that on on 5^th September, the official launch of Pradhan Mantri Jan Arogya Yojana application and official portal will take place.
4. Apart from mass media, any individual who desires application related or other information can get it from over 10,000 empanelled hospitals and 3 lakh registered Common Service Centers.

How will a beneficiary attain perks of PMJAY?

1. Hospitalization – All patients, registered under this scheme will have to get admission in any of the hospitals, which feature in the empanelment list. Without hospitalization, they will not attain the benefits of cashless treatment.
2. Identification – The representatives at the hospital will check the ID papers to determine that the identification of the candidate.
3. Registration – Once the identification scrutiny is complete, the patient details will be registered for admission.
4. Approval of authorization request – It is the responsibility of the hospital authority to check the remaining balance in the medical insurance card of the patient. After this, the hospital will figure out under which package the person needs to be admitted and treated.
5. Treatment – Once the documentations are complete, the patient will be treated by the doctors.
6. Discharge from hospital – With proper treatment in the hospitals, the patients will regain health soon. Once the doctors feel that the patient is fit to go home, they will prepare the discharge papers.
7. Submission of claim application form – The hospital representatives will prepare discharge documents. Apart from this, they will also attach treatment and post treatment details. These papers will then be submitted to the respective government department, along with the insurance claim application form.
8. Claim settlement – Once the claim papers have been carefully scrutinized by the government specialists, the hospital will receive the money in its bank account via e-transfer of cash.

How will hospital representatives identify beneficiaries?

1. Any applicant will have to go to any of the empaneled hospitals to attain cashless treatment.
2. Once the patient steps in the hospital, he/she needs to reach out to the help desk, especially created for PMJAY beneficiaries.
3. Here, the representatives will take the Aadhar card of the patient and feed in the patient details in the software.
4. If the details on the Aadhar card match with the database, then the representative will check whether the patient can get the treatment perks.
5. If the details match and the patient is eligible, then the representative at the help desk will hand over an electronic card to the patient.
6. The patient needs to give this e-card to the doctors who will begin treatment as soon as possible.

Fund transfer under the scheme

1. The central government has ensured that all empaneled hospitals will receive prompt payment. It will allow and encourage these hospitals to treat more patients.
2. Once the hospital submits the claim documents, they will be checked by the government departments. If all is in order, then either National Health Agency or State Health Agency will do the task of transferring funds.
3. An ESCROW account must be opened by the State Health Agency.
4. The central government has also kept provision for penalty in case the state or central agencies don’t dispatch payment in time.
5. The banks will get notifications, which will inform them about dispatching a certain payment in the account of a hospital.
6. Key Performance Indicators are also present. These will allow the central agency to check whether timely payments are made or not.

Guidelines to prevent fraudulent practicesDue to the elaborate process of this scheme, it is easy for tricksters to find loopholes and swindle people of their money. The central government has taken several steps to ensure to eliminate corrupt and malpractices. These guidelines will detect, prevent and deter such fraudulent activities. Patients will receive separate identification passes.

Apart from provider empanelment, the issuance of pre-authorization documents is a must. For proper detection of fraudulent practices, central government will put stress on data analysis, audits and social monitoring. Several penalties have been highlighted; along with contract management will help in keeping frauds at bay.

At the end of it all, if central government finds out that any hospital is not sticking by the guidelines, then it will be de-empaneled. The formation of the anti-fraud cell will keep an eye on all proceedings and strain out abnormalities.

Data Privacy and Security Policy of NHA

The NHA will take all necessary measures to ensure that the confidentiality of the patients’ data is maintained. It will consider Indian as well as international standards and regulations in mind for this. As the scheme deals with sensitive information, the central will implement 94 controls. Necessary precautions will be taken to collect, record, maintain and store confidential data.

Information about PMJAY packages

To ensure better medical facilities, the central government has made provisions for around 1300 treatment packages. These packages have been crafted in a format that they cover more than 20 specialty therapies. Among these packages, patient need pre-authorization for 50% treatments. The NITI Aayog, in consultation with other bodies has come with these packages and their rates. Hospitals will attain 10% and 15% incentives for NABH Entry Hospitals and NABH Full Accrediation respectively. Another 10% incentive will be offered to aspirational regions.

Training for PMJAY Jan Arogya Mitras

The central government will need help from trained people to carry out this elaborate scheme successfully. Such people are known as Pradhan Mantri Jan Arogya Mitras. These people will get training from the central government’s Skill Development department.

They will attain theoretical and practical training for manning separate sections. The training centers have been established in 15 states and union territories.

PMJAY pilot project

A scheme as elaborate as this will require several IT tools. For PMJAY, the central government has highlighted three such tools, which will come in handy in future. The National Health Agency has kept the provision for simple registration for all interested hospitals for empanelment under this scheme.

To ensure that only the rightful beneficiaries are getting the benefits, the scheme will make use of modern Demographic & Bio-metric identification methods. Lastly, all empaneled hospitals have been instructed to offer speedy treatment to patients. Central government will help these hospitals by dispatching payment on real-time basis.

Conclusion

The Pradhan Mantri Jan Arogya Yojana is one of the most ambitious projects of PM Modi. A lot depends on the successful implementation of this scheme. With proper operation, this project will be able to offer adorable treatment for poor people. It will also assist the central government to create a sound platform for future medical developments. It will also develop the infrastructure of the hospitals.

People with money always run to the private medical facilities for better treatment. With the implementation of this scheme, PM wants to bring back the glory of public hospitals again. With proper infrastructure, trained staff and modern equipment, public medical organizations can perform as well as the private agencies.