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Introduction and Salient Features of the AB-PMJAY

Salient features of the Ayushman Bharat- National Health Protection Mission to be launched in 2018-19 for families belonging to poor, vulnerable and disadvantage sections of populations are as below:

  • 1.  Cashless and paperless access to services for the beneficiary at the point of service in any (both public and private) empanelled hospitals across India.
  • 2.  The benefit coverage of AB-PMJAY will be Rs. 5,00,000/- covering over 10 Crore beneficiary families (identified through SECC database).
  • 3.  No restriction on family size, ensuring all members of designated families specifically girl child and senior citizens get coverage. It is suggested to preferably make woman as the head of family.
  • 4.  This Scheme is on entitlement basis. Every family figuring in defined SECC Database will be entitled to claim benefit under the scheme. The beneficiaries will be encouraged to bring Aadhaar for the purpose of identification. However, no person will be denied benefits under the scheme in the absence of Aadhaar.
  • 5.  Implementation Arrangement –States would have the option to use an existing Trust/ Society/ Not for Profit Company [SNA] or set up a new Trust/ Society/ Not for Profit Company [State Health Protection Mission Agency] to implement the scheme. With respect to implementation, the States will be free to choose the modalities for implementation. They can implement the scheme through insurance company or directly through the Trust/ Society or mixed model.
  • 6.  A well-defined Complaint and Public Grievance Redressal Mechanism, actively utilising electronic, mobile platform, internet as well as social media, will be put in place through which complaints/ grievances will be registered, acknowledged, escalated for relevant action, resolved and monitored.
  • 7.  While ensuring user convenience, AB-PMJAY would create robust safeguards to prevent misuse/ fraud/ abuse by providers and users. Pre-Authorisation will be made mandatory for all tertiary care and selected secondary care packages.