Lok Sabha Question No. 1070 (UNSTARRED), answered on 2020-09-18
Subject: Pradhan Mantri Jan Arogya Yojana
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Supriya Sadanand Sule, DNV Senthilkumar. S., Subhash Ramrao Bhamre, Kuldeep Rai Sharma, Amol Ramsing Kolhe

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 1070 TO BE ANSWERED ON 18 TH SEPTEMBER, 2020

## PRADHAN MANTRI JAN A ROGYA YOJANA

1070. SHRIMATI SUPRIYA SUL E: DR.DNV SENTHILKUMAR S.: DR.SUBHASH RAMRAO BH AMRE: SHRI KULDEEP RAI SHA RMA: DR.AMOL RAMSING KOLH E:

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

- (a) whether the Government is implementing Pradhan Mantri Jan Arogya Yojana and if so, the details thereof;
- (b) the eligibility criteria fixed by the government to avail the benefits under the yojana;
- (c) whether the government has taken steps to create awareness about the yojana since it aims to extend better healthcare services for the lowest strata of society and if so, the details thereof;
- (d) whether only few people have availed or are now und rgoing treatment for COVID - 19 under Pradhan  Mantri Jan  Arogya  Yojana  and  if  so,  the  details  thereof  and  the reasons  therefor alongwith the corrective measures taken in this regard;
- (e) whether the government has reviewed the performance of this yojana; and
- (f) if so, the outcome thereof and the corrective steps taken on the shortcomings?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

(a) Yes.

The  Government  is  implementing  Ayushman  Bharat -Pradhan  Mantri  Jan  Arogya Yojana  from  23.09.2018  to  provide  health  cover  of    Rs.  5  Lakhs  per  family  p er  year,  for secondary and tertiary care hospitalizations to around 10.74 crore poor and vulnerable (approx.. 50 crore individuals).

As  on  14.09.2020  the  scheme  is  being  implemented  in  32  States/UTs.  The  States Telangana, Odisha, West Bengal and National Capital Territory of Delhi are not implementing the scheme. Further, over 12.55 crore beneficiaries have been verified under the scheme crore hospital admissions worth Rs. 15,733 Crore have been authorized through a networ 23,331 ho spitals empanelled under the scheme.

(b)AB - PMJAY  covers  deprived  families  in  rural  areas  and  families  of  workers  of  identi occupational categories in urban areas, as per the Socio - Economic Caste Census (SECC) - 2011 data. Further, all such beneficiary families under erstwhile Rashtriya Swasthya Bima Yojana that do  not  figure  in  the  targeted  groups  as  per  SECC  data  are  also  covered  under  AB - PMJAY. Details of entitlement criteria of the scheme are at the Annexure.

(c) Under AB - PMJAY, a comprehensive media and outreach strategy to spread awareness and empowering  the  beneficiaries  about  their  entitlements  and  rights  under  the  scheme  has followed. This includes the use of media vehicles such as outdoor media, digital display counters across var ious railway stations, announcements at major bus stations, passenger tr branding, national  and regional press  coverage,  op - eds  and  advertorials  in  print  media,  radio campaign, telecast of beneficiary testimonials via Doordarshan, mass messaging through SMS, traditional media etc.

Additionally, social media platforms are also being utilised to reach out to the se and  primary  audiences  including  the  intended  beneficiaries  and  other  stakeholders.  Out programme like school contact programs, act ivation programs at village level, van campaigns etc. are also being undertaken suitably in consultation with respective State Health Agenc

(d) As on 14.09.2020 under AB - PMJAY, over 4.03 Lakh hospitalizations have been authorized towards the treatment and testing of Covid - 19.

The institutional response towards COVID - 19  is  being  directed by the States/UTs and many  States/UTs  are  providing  free  treatment  to  COVID - 19  patients  through  designated hospitals in their respective jurisdictions irrespective of entitlement under any scheme.

Necessary  advisories  have  been  issued  to  State  Health  Agencies  to  ensure  that beneficiary is deprived of his/her entitlement to avail free treatment under the AB - PMJAY.

(e) & (f) The progress of AB - PMJAY is continuously ass essed and monitored on real time basis. A dashboard  with various key performance indicators (KPI) has been designed to consta monitor the scheme. The performance of the scheme is objectively evaluated in terms of e - cards issued, number of hospital admi ssions, quality of treatment provided, timely settlement of clai etc.

Additionally,  National  and  regional  review  meetings  are  conducted  with  all stakeholders, including State Health Agencies, on a periodic basis.

Based on the feedback received, var ious steps have been taken to ensure that the benefit reaches to the eligible beneficiary -

- Drives of e - cards generation have been undertaken in States/UTs in a mission mode.
- 'Open BIS policy'  has been devised which enables States to engage services of different public or private entities in addition to the network of Common Service Centres (

Village level Entrepreneur (VLEs) and Arogya Mitras (AMs) to facilitate the benefic identification process.

- Health Benefit Packages (HBPs) under the scheme have been rationalised as HBP 2.0
- States/UTs  have  been  requested  to  empanel  tertiary  care  hospitals  in  their  St addition to the existing network of empanelled hospital.
- Further,  all  the  Ministries  and  departments  have  been  directed  by  the  Government of India to empanel all public hospitals under AB - PMJAY.

## 1. For Rural Areas

- I. Automatically  included  households  (based  on  fulfilling  any  of  the  5  parameters inclusion):
- a. Households without shelter.
- b. Destitute, living on alms.
- c. Manual scavenger families.
- d. Primitive tribal groups.
- e. legally released bonded labour
- II. Household belonging to Standard Deprivation Parameter
- a. Only one room with kucha walls and kucha roof (D1)
- b. No adult member between age 16 to 59 (D2)
- c. Female  headed  households  with  no  adult  male  member  between  age  16  to  59 (D3)
- d. Disabled member and no able - bodied adult member(D4)
- e. SC/ST households (D5)
- f. Landless  households  deriving  major  part  of  their  income  from  manual  casua labour (D7)
2. For urban areas, 11 defined occupational categories are entitled :
- I. Rag picker
- II. Beggar
- III. Domestic worker
- IV. Street vendor/ Cobbler/hawker / Other service provider working on streets
- V. Construction worker/ Plumber/ Mason/ Labor/ Painter/ Welder/ Securi ty guard/ Coolie and other head - load worker
- VI. Sweeper/ Sanitation worker / Mali
- VII. Home - based worker/ Artisan/ Handicrafts worker / Tailor
- VIII. Transport  worker/  Driver/  Conductor/  Helper  to  drivers  and  conductors/  Ca puller/ Rickshaw puller
- IX. Shop worker/ Assistant/ Peon in small establishment/ Helper/ Delivery assista Attendant/ Waiter
- X. Electrician/ Mechanic/ Assembler/ Repair worker
- XI. Washer- man/ Chowkidar
3. Such families that were enrolled in the erstwhile Rashtriya Swasthya Bima Yojana but not feature in the targeted Socio -Economic Caste Census data.

## Entitlement Criteria under AB -PMJAY