Lok Sabha Question No. 3320 (UNSTARRED), answered on 2022-08-05
Subject: Ayushman Bharat Yojana
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Sanjay Haribhau Jadhav, Shiromani Ram, Vinayak Bhaurao Raut, Bhavana Gawali (Patil), Omprakash Bhupalsinh alias Pawan Rajenimbalkar, Krupal Balaji Tumane

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

## LOK SABHA UNSTARRED QUESTION NO. 3320 TO BE ANSWERED ON 05 TH  AUGUST, 2022

## AYUSHMAN BHARAT YOJANA

## 3320.  SHRI SANJAY JADHAV:

SHRI RAMSHIROMANI VERMA:

SHRI VINAYAK RAUT:

SHRIMATI BHAVANA PUNDALIKRAO

GAWALI:

SHRI OMPRAKASH BHUPALSINH alias

PAWAN RAJENIMBALKAR:

SHRI KRUPAL BALAJI TUMANE:

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

- (a)  the  details  of  eligibility  criteria  and  procedure  prescribed  to  provide  benefits  of  medical facilities to the patients under AB-PMJAY;
- (b)  whether the Government has empanelled sufficient number of hospitals under the Yojana and if so, the details thereof, State/UT-wise;
- (c)  the criteria for empanelment of more Government/ private hospitals under the Yojana along with the details of hospitals proposed to be empanelled, State/UT-wise including Maharashtra;
- (d)  the steps taken by the Government for effective implementation, creating awareness and to make the Yojana user friendly;
- (e)  the appropriate steps taken by the Government to make the said Yojana more welfare oriented and people friendly; and
- (f)  whether the Government has received any suggestion/complaint from general public or State Governments regarding the said Yojana and if so, corrective measures taken/proposed to be taken by the Government in this regard, State/UT-wise?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

(a)  to  (f):  Ayushman  Bharat  Pradhan  Mantri  Jan  Arogya  Yojana  (AB-PMJAY)  is  an entitlement-based scheme. Eligible beneficiaries can directly visit any empanelled public or private  hospital  to  avail  cashless  treatment.  The  details  of  eligibility  criteria  for  availing medical  facilities  by  the  beneficiaries  under  the  scheme  are  at  Annexure-I.  State/UT-wise details of empanelled hospitals are at Annexure-II. All Government hospitals of and above the  level  of  Community  Health  Centre  (CHC)  are  deemed  empanelled  under  the  scheme. Details of criteria for empanelment of private hospitals are as under:

-  General criteria - For hospitals that provide non-specialised general medical and surgical care with or without ICU and emergency services.
-  Special criteria (for clinical specialties)  - For each specialty, a specific set of criteria is identified. A hospital is not allowed to apply for selected specialties and must agree to offer all specialties to scheme beneficiaries. In order to offer a specialised clinical service, the hospital must have necessary infrastructure and HR in place.

Empanelment of private hospitals is voluntary on their part. Intending private hospitals apply for empanelment and get empanelled subject to fulfilment of laid down criteria.

Details  of  steps  taken  for  effective  implementation,  creating  awareness  and  to  make  the Yojana  user-friendly  are  at  Annexure-III.  Feedback  received  from  various  stakeholders  is duly incorporated in the steps taken to improve implementation of the scheme.

*****

1. Ayushman Bharat, a flagship scheme of Government of India, was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC). This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to "leave no one behind."
2. AB-PMJAY is the world's largest Government funded health assurance scheme.
3. AB-PMJAY provides health assurance of up to Rs.5 Lakh per family per year for secondary and tertiary healthcare hospitalizations.
4. AB-PMJAY is a completely cashless and paperless scheme.
5. The benefits under AB-PMJAY are portable across the country.
6. There is no cap on family size, or age or gender.
7. The  beneficiary  families  under  Ayushman  Bharat  -  Pradhan  Mantri  Jan  Arogya  Yojana  (ABPMJAY) have been identified  from  the  Socio-Economic  Caste  Census  (SECC)  of  2011  on  the basis  of  select  deprivation  and  occupational  criteria  across  rural  and  urban  areas.  Details  are  as below:

## Detailed list of criteria for eligibility under AB-PMJAY as per SECC 2011

Automatically included:

1. Households without shelter
2. Destitute/ living on alms
3. Manual scavenger families
4. Primitive tribal groups
5. Legally released bonded labour

Deprivation criteria in rural area:

- D1: Only one room with kutcha walls and kutcha roof
- D2: No adult member between age 16 to 59
- D3: Female headed households with no adult male member between age 16 to 59
- D4: Disabled member and no able-bodied adult member
- D5: SC/ST households
- D7: Landless households deriving major part of their income from manual casual labour

Occupational criteria in urban area:

- 1) Rag picker
- 2) Beggar
- 3) Domestic worker
- 4) Street vendor/ Cobbler/hawker / Other service provider working on streets
- 5) Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and other head-load worker
- 6) Sweeper/ Sanitation worker / Mali
- 7) Home-based worker/ Artisan/ Handicrafts worker / Tailor
- 8) Transport  worker/  Driver/ Conductor/  Helper  to  drivers  and conductors/  Cart puller/ Rickshaw puller
- 9) Shop worker/ Assistant/ Peon in small establishment/ Helper/ Delivery assistant / Attendant/ Waiter
- 10) Electrician/ Mechanic/ Assembler/ Repair worker/Washer-man/ Chowkidar
8. The  number  of  eligible  beneficiaries  under  SECC  2011  is  10.74  crore  (50  crore  people).  33 States/UTs  implementing  AB-PMJAY  have  further  expanded  the  coverage  of  the  scheme  to include 14.75 crore families (72 crore people).
9. AB-PMJAY is implemented in all States and UTs barring West Bengal, NCT of Delhi and Odisha.
10. The  scheme  is  implemented  across  the  country  through  a  three-tier  model.  National  Health Authority, an attached office of the Ministry of Health and Family Welfare with full functional autonomy,  is  the  apex  body  implementing  AB-PMJAY  across  the  country.  For  effective implementation  of  AB-PMJAY  at  States/UTs  level,  State  Health  Agencies  (SHAs)  have  been established.  District  Implementation  Units  (DIUs)  have  been  set  up  for  ensuring  on-ground coordination between scheme stakeholders and for smooth implementation.
11. AB-PMJAY is completely funded by the Government and costs are shared between Central and State Governments in the ratio as per the extant directives issued by Ministry of Finance.

State/UT-wise hospitals empanelled under AB-PMJAY

| State/UT                 | Government   | Private   |
|--------------------------|--------------|-----------|
| Andaman &Nicobar Islands | 3            | -         |
| Andhra Pradesh           | 1,250        | 723       |
| Arunachal Pradesh        | 58           | 2         |
| Assam                    | 215          | 183       |
| Bihar                    | 606          | 340       |
| Chandigarh               | 7            | 26        |
| Chhattisgarh             | 1,040        | 533       |
| DNH and DD               | 7            | -         |
| Delhi                    | 34           | 74        |
| Goa                      | 22           | 14        |
| Gujarat                  | 1,912        | 834       |
| Haryana                  | 176          | 480       |
| Himachal Pradesh         | 147          | 115       |
| Jammu And Kashmir        | 194          | 84        |
| Jharkhand                | 278          | 573       |
| Karnataka                | 2,924        | 580       |
| Kerala                   | 199          | 534       |
| Ladakh                   | 10           | -         |
| Lakshadweep              | 6            | -         |
| Madhya Pradesh           | 475          | 508       |
| Maharashtra              | 312          | 757       |
| Manipur                  | 69           | 17        |
| Meghalaya                | 165          | 18        |
| Mizoram                  | 90           | 13        |
| Nagaland                 | 87           | 14        |
| Odisha                   | 26           | 2         |
| Puducherry               | 12           | 19        |
| Punjab                   | 245          | 682       |
| Rajasthan                | 892          | 206       |
| Sikkim                   | 16           | 1         |
| Tamil Nadu               | 796          | 937       |
| Telangana                | 399          | 337       |
| Tripura                  | 141          | 3         |
| Uttar Pradesh            | 1,108        | 1,985     |
| Uttarakhand              | 123          | 126       |
| West Bengal              | 60           | 10        |

## Note:

Hospitals are empanelled in non-implementing States/UT of Delhi, Odisha & West Bengal to facilitate beneficiaries avail treatment under the portability feature of the scheme.

## Details  of  steps  taken  for  effective  implementation,  creating  awareness  and  to  make  ABPMJAY user-friendly:

## Demand Side Interventions

- i. NHA  signed  Memorandums  of  Understanding  (MoUs)  with  leading  solutions providers  such  as  CSC  E-Governance  Services  India  Limited  (CSC)  and  UTI Infrastructure Technology and Services Limited (UTIITSL) to issue Ayushman cards free  of  cost  to  SECC  2011  beneficiary  undergoing  verification  for  the  first  time. State/UTs were encouraged to adopt such MoUs for non-SECC beneficiaries in their States.
- ii. 'Aapke Dwar Ayushman' (ADA) is a key initiative of NHA that is implemented in mission mode across 10 State/UTs, including focus States such as Bihar, Chhattisgarh,  Madhya  Pradesh,  and  Uttar  Pradesh.  The  campaign  leveraged  a grassroots network of healthcare workers, frontline workers, Panchayati Raj institutions, village level agents from CSC and UTIITSL to mobilize and verify nearly 4.2 crore beneficiaries.
- iii. NHA  has  reached  out  to  Central  Government  ministries  implementing  welfare schemes (Ujjwala Yojana, Awas Yojana) using SECC 2011 database. This was done to use the updated databases of such welfare schemes for better targeting of potential AB-PMJAY beneficiaries.
- iv. NHA  has  taken  steps  to  increase  avenues  for  Ayushman  card  generation  by onboarding additional agencies for card generation and card approval.
- v. Integration of pan-India Information, Education and Communication (IEC) campaigns of AB-PMJAY with other national flagship schemes.
- vi. NHA  has  launched  the  concept  of  Ayushman  Mitra  -  a  rewards  and  recognition program  to  transform  PMJAY  into  a  Jan  Andolan  by  creating  avenues  for  societal stakeholders to come forward and assist the scheme beneficiaries.
- vii. The beneficiary in the case of medical emergency may use the following channels to check his/her eligibility under PMJAY:
- 1) NHA has a 24x7 call centre 14555, which has widely been published.
- 2) Beneficiary  can  reach  out  to  any  government  hospital  (CHC  and  above)  for beneficiary verification. After verification at the Government hospital the beneficiary can be provided necessary treatment or can be directed to nearby other public or empanelled private hospital.
- 3) Beneficiaries can check his/her eligibility and also search for the nearest empanelled hospital through PMJAY Mobile App.
- 4) The beneficiary can visit mera.PMJAY.gov.in to check his/her eligibility under ABPMJAY.
- 5) All empanelled hospital (Public Hospital - deemed empanelled & Private hospitals) have  Pradhan  Mantri  Arogya  Mitra  who  facilitate  the  beneficiary  with  all  the necessary steps required to avail medical benefits.

## Supply Side Interventions

- i. NHA has developed the concept of a beneficiary  facilitation agency to increase the participation of empanelled public hospitals.
- ii. A  dedicated  'Hospital  Operations'  unit  has  been  formed  at  NHA  to  engage  with healthcare providers and increase their participation under the scheme.
- iii. A focused approach is followed for empanelling majority of 100-bedded hospitals and top corporate hospitals under AB-PMJAY.
- iv. Settlement  of  claims  is  one  of  the  key  drivers  to encourage  participation  of empanelled  hospitals  and  thereby  improve  service  delivery  to  beneficiaries.  In  this regard, NHA has taken several measures to expedite claims adjudication.