Lok Sabha Question No. 44 (UNSTARRED), answered on 2019-06-21
Subject: Implementation of AB-PMJAY
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Shrikant Eknath Shinde, Harish Dwivedi, Adoor Prakash, Pritam Gopinath Munde, Sushil Kumar Singh, Jagdambika Pal, Shrirang Appa Barne

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

LOK SABHA UNSTARRE D QUESTION NO. 44 TO BE ANSWERED ON 21 ST JUNE, 2019

## IMPLEMENTATION OF AB -PMJAY

## 44. DR. SHRIKANT EKNATH SHINDE:

SHRI HARISH DWIVEDI:

ADV. ADOOR PRAKASH:

DR. PRITAM GOPINATHRAO MUNDE:

SHRI SUSHIL KUMAR SINGH:

SHRI JAGDAMBIKA PAL:

SHRI SRIRANGA APPA BARNE:

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 Governments, if so, the details thereof;
- (c) the amount for which applications have been received under t he 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 Card holders under the said scheme and if so, the det ails 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 b added so far along with the steps taken by the Governm ent 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………

(b) : The  ratio  of  contribution  towards  premium/cost  of  treatment  of  beneficiary  betw Centre and State is 60:40 in all States except North Eastern States and the 3 Himalayan where the ratio is 90:10. In the case of Union Territories, the Central contr ibution of premium is proposed to be 100% for UTs without legislature, while it is in the ratio of 60:40 with legislature.

(c) : The scheme provides for cashless treatment for the entitled beneficiaries at empa hospitals. No  money  is  re leased  to  the  beneficiary  and  payment  is  made  directly  to  th hospitals by State Health Agency (SHA) in case of Trust mode, and by Insurance company case of Insurance mode.

As  on  18.06.2019,  the  total  number  of  claims  made  are  23,26,520  and  total  cl m 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  o identified  occupational  categories  in  urban  areas,  as  per  the  Socio - Economic  Caste  Ce nsus (SECC) - 2011  data.  All  such  beneficiary  families  under  RSBY  that  do  not  feature  in targeted groups as per SECC data, are also covered under PMJAY. At present, no proposa 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  thei jurisdiction to provide care to identified beneficiary families. As far as inclusion hospitals  under  PMJAY  is  concerned,  defined  criteria  and  hospital  empanelment  guideli have been adopted by the States.

……………..

## Salient Features of Pradhan Mantri Jan Arogya Yojana [PMJAY]

1. Government of India has launched Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY)  on  23.09.2018.  PMJAY  is  centrally  sponsored  scheme.  It  is  entirely  funded  b Government and the funding is shared between Centre and State governments as per prevail guidelines of Ministry of Finance.
2. PMJAY provides health coverage up to Rs. 5 lakh per family per year for secondary tertiary  hospitalization  to  around  10.74  crore  poor  and  vulnerable  families  (approx. beneficiaries).
3. PMJAY  is  an  entitlement  based  scheme.  This  scheme  cove rs  poor  and  vulnerable families based on deprivation and occupational criteria as per SECC database.
4. PMJAY provides cashless and paperless access to services for the beneficiary at the of service in any (both public and private) empanelled hospi tals across India. In other words, a beneficiary  from  one  State  can  avail  benefits  from  an  empanelled  Hospital  anywhere  in Country.
5. Under PMAJY, the States are free to choose the modalities for implementation. They implement  the  scheme  through insurance  company  or  directly  through  the  Trust/  Society  or mixed model.
6. There  is  no  restriction  on  family  size,  ensuring  all  members  of  designated  fa specifically girl child and senior citizens get coverage.
7. A well - defined Complaint and Publ ic Grievance Redressal Mechanism, has been put in place through which complaints/ grievances are registered, acknowledged, escalated for re action, resolved and monitored.
8. PMJAY  has  created  a  robust  IT  system  for  implementation  and  role  of  real time transaction data.
9. At National level, National Health Authority (NHA) has been set up as an attached o to Ministry of Health and Family Welfare to manage the implementation of the scheme.
10. The  details  of  package,  operational  guidelines  a nd  key  features  are  available  at www. pmjay.gov.in

## Annexure II

| State - wise details for claim number & claim amount under AB - PMJAY (As on 18.06.2019)   | State - wise details for claim number & claim amount under AB - PMJAY (As on 18.06.2019)   | State - wise details for claim number & claim amount under AB - PMJAY (As on 18.06.2019)   | State - wise details for claim number & claim amount under AB - PMJAY (As on 18.06.2019)   |
|--------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------|
| Sl. No.                                                                                    | State                                                                                      | Claim Number                                                                               | Claim Amount                                                                               |
| 1                                                                                          | Chhattisgarh                                                                               | 5,07,707                                                                                   | 37924,31,567                                                                               |
| 2                                                                                          | Gujarat                                                                                    | 3,94,995                                                                                   | 64157,73,230                                                                               |
| 3                                                                                          | Kerala                                                                                     | 2,74,298                                                                                   | 15000,79,006                                                                               |
| 4                                                                                          | Tamil Nadu                                                                                 | 2,11,075                                                                                   | 39919,88,871                                                                               |
| 5                                                                                          | Jharkhand                                                                                  | 1,68,490                                                                                   | 16604,91,355                                                                               |
| 6                                                                                          | Karnataka                                                                                  | 1,41,238                                                                                   | 36389,05,339                                                                               |
| 7                                                                                          | Maharashtra                                                                                | 1,13,830                                                                                   | 28259,27,073                                                                               |
| 8                                                                                          | Uttar Pradesh                                                                              | 1,05,255                                                                                   | 11748,97,586                                                                               |
| 9                                                                                          | Andhra Pradesh                                                                             | 92,982                                                                                     | 25164,00,245                                                                               |
| 10                                                                                         | Madhya Pradesh                                                                             | 70,898                                                                                     | 7932,28,923                                                                                |
| 11                                                                                         | Bihar                                                                                      | 39,943                                                                                     | 3458,68,103                                                                                |
| 12                                                                                         | Uttarakhand                                                                                | 38,515                                                                                     | 3818,39,891                                                                                |
| 13                                                                                         | Assam                                                                                      | 36,577                                                                                     | 4777,70,292                                                                                |
| 14                                                                                         | Haryana                                                                                    | 23,588                                                                                     | 3302,30,981                                                                                |
| 15                                                                                         | Tripura                                                                                    | 16,607                                                                                     | 867,64,966                                                                                 |
| 16                                                                                         | Jammu And Kashmir                                                                          | 16,337                                                                                     | 1071,24,523                                                                                |
| 17                                                                                         | West Bengal                                                                                | 14,777                                                                                     | 1414,52,393                                                                                |
| 18                                                                                         | Himachal Pradesh                                                                           | 12,619                                                                                     | 1249,46,595                                                                                |
| 19                                                                                         | Meghalaya                                                                                  | 11,861                                                                                     | 867,35,930                                                                                 |
| 20                                                                                         | Mizoram                                                                                    | 11,630                                                                                     | 890,12,855                                                                                 |
| 21                                                                                         | Dadra And Nagar Haveli                                                                     | 11,140                                                                                     | 427,46,501                                                                                 |
| 22                                                                                         | Daman And Diu                                                                              | 3,234                                                                                      | 111,94,100                                                                                 |
| 23                                                                                         | NHCP                                                                                       | 3,082                                                                                      | 1308,99,614                                                                                |
| 24                                                                                         | Manipur                                                                                    | 2,361                                                                                      | 413,75,658                                                                                 |
| 25                                                                                         | Chandigarh                                                                                 | 1,450                                                                                      | 160,90,105                                                                                 |
| 26                                                                                         | Goa                                                                                        | 1,249                                                                                      | 407,02,384                                                                                 |
| 27                                                                                         | Nagaland                                                                                   |                                                                                            | 628 81,51,821                                                                              |
| 28                                                                                         | Sikkim                                                                                     |                                                                                            | 83 10,39,930                                                                               |
| 29                                                                                         | Arunachal Pradesh                                                                          |                                                                                            | 53 9,09,600                                                                                |
| 30                                                                                         | Andaman And Nicobar Islands14                                                              |                                                                                            | 58,200                                                                                     |
| 31                                                                                         | PSU                                                                                        | 4                                                                                          | 1,00,980                                                                                   |
| Total                                                                                      | Total                                                                                      | 23,26,520                                                                                  | 307751,38,624                                                                              |