Question : Implementation of AB-PMJAY

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) the salient features of Ayushman Bharat -Pradhan Mantri Jan AarogyaYojana (AB-PMJAY);

(b) whether the overall expenditure will be borne jointly by the Union and the State Governments, if so, the details thereof;

(c) the amount for which applications have been received under the said Yojana till date and the quantum of amount released to beneficiaries, State/UT-wise including Bihar;

(d) whether the Government proposes to include economically poor persons in addition to BPL Card holders under the said scheme and if so, the details thereof along with the State/UT-wise details of claims from beneficiaries received and settled so far; and

(e) the measures taken by the Government to add names of beneficiaries who have not been added so far along with the steps taken by the Government to include adequate number of private hospitals under the said scheme?

ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND
FAMILY WELFARE
(SHRI ASHWINI KUMAR CHOUBEY)
(a): The salient features of Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) are at Annexure-I.

Contd………

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(b): The ratio of contribution towards premium/cost of treatment of beneficiary between Centre and State is 60:40 in all States except North Eastern States and the 3 Himalayan States where the ratio is 90:10. In the case of Union Territories, the Central contribution of premium is proposed to be 100% for UTs without legislature, while it is in the ratio of 60:40 for those with legislature.
(c): The scheme provides for cashless treatment for the entitled beneficiaries at empanelled hospitals. No money is released to the beneficiary and payment is made directly to the hospitals by State Health Agency (SHA) in case of Trust mode, and by Insurance company in case of Insurance mode.
As on 18.06.2019, the total number of claims made are 23,26,520 and total claim amount submitted is Rs. 3077,51,38,624. State-wise details are at Annexure-II.
(d) & (e): AB-PMJAY covers deprived families in rural areas and families of workers of identified occupational categories in urban areas, as per the Socio-Economic Caste Census (SECC) - 2011 data. All such beneficiary families under RSBY that do not feature in the targeted groups as per SECC data, are also covered under PMJAY. At present, no proposal to extend the coverage of PMJAY is pending before the Government.

State-wise details of number of claims and claim amount are at Annexure-II.

State Governments through State Health Agencies empanel hospitals within their jurisdiction to provide care to identified beneficiary families. As far as inclusion of private hospitals under PMJAY is concerned, defined criteria and hospital empanelment guidelines have been adopted by the States.
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