Lok Sabha Question No. 3915 (UNSTARRED), answered on 2023-03-24
Subject: Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Ramcharan Bohra, Nihal Chand Chauhan, Hemant Tukaram Godse, Dipsinh Shankarsinh Rathod, Bhartruhari Mahtab, Sangeeta Azad, Dulal Chandra Goswami

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

## LOK SABHA UNSTARRED QUESTION NO. 3915 TO BE ANSWERED ON 24 TH MARCH, 2023

## AYUSHMAN BHARAT-PRADHAN MANTRI JAN AROGYA YOJANA

## 3915. SHRI RAMCHARAN BOHRA:

SHRI NIHAL CHAND:

SHRI HEMANT TUKARAM GODSE:

SHRI DIPSINH SHANKARSINH RATHOD:

SHRI BHARTRUHARI MAHTAB:

SHRIMATI SANGEETA AZAD:

SHRI DULAL CHANDRA GOSWAMI:

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

- (a)  the  salient  features  of  Ayushman  Bharat  -  Pradhan  Mantri  Jan  Arogya  Yojana  along  with number of beneficiaries enrolled under the Scheme so far, State/UT-wise;
- (b) the details of targets fixed and achievements made so far under the Scheme;
- (c) the funds allocated, released and utilized under the Scheme, State/UT-wise;
- (d) whether a large number of Ayushman Bharat Cards are yet to be distributed, if so, the details thereof along with the reasons therefor, State/UT-wise;
- (e)  whether  a  Government  proposes  to  cover  Freedom  Fighters,  Senior  Citizens,  disabled  and vulnerable persons under the Scheme and if so, the details thereof along with the time by which such persons are likely to be covered under the Scheme, State/UT-wise; and
- (f) whether diseases like leprosy, skin diseases and cancer etc. are covered under the Scheme and if so, the details thereof?

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

- (a) to (f): The salient features of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (ABPMJAY)  are  at  Annexure-I.  State/UT-wise  details  of  the  number  of  beneficiaries  verified/ Ayushman cards created under the scheme are at Annexure-II. AB-PMJAY is the largest publicly funded health protection scheme in the world which provides health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization to 60 crore beneficiaries. Many States/UTs implementing  AB-PMJAY  have  expanded  the  beneficiary  base  to  approximately  15.5  crore families at their own cost. Targets are not fixed for AB-PMJAY as the scheme operates on the basis  of  beneficiary  demand  for  healthcare  services.  All  the  eligible  beneficiaries  of  the implementing States/UTs are entitled for services under the scheme from day one of the launch of the scheme.

As of 20 th March 2023, a total of 23.3 crore beneficiaries have been verified under the scheme and over  4.49  crore  hospital  admissions  worth  Rs.  54,241  crore  have  been  authorized  through  a network of 26,434 empanelled health care providers including 11,500 private hospitals.

State/UT-wise details of Central share of funds released under the scheme are at Annexure-III. Funds are released to States/UTs only after utilization certificate is submitted by them.

Ayushman  Bharat-Pradhan  Mantri  Jan  Arogya  Yojana  (AB-PMJAY)  is  an  entitlement-based scheme. No enrolment or registration of beneficiary is required to avail benefits under the scheme. The beneficiary may directly visit any empanelled hospital (public or private) across the country to avail cashless treatment benefits. Eligible beneficiaries cannot be denied treatment in absence of Ayushman Card.

Out of approximately 45 crore individuals in 33 implementing States/UTs, Ayushman card has been created for 23.3 crore beneficiaries. Further, NHA has launched special drive to expedite the Ayushman card creation in the country.

Any individual including freedom fighters, senior citizens and disabled  persons who meet the eligibility criteria are eligible to avail benefits under the scheme. Flexibility has been provided to States/UTs  to  use  non-SECC  beneficiary  family  database  for  tagging  against  the  leftover (unauthenticated) SECC families.

AB-PMJAY provides treatment corresponding to a total of 1,949 procedures under 27 different specialties  including  diseases  such  as  Cancer,  Diabetes,  Heart  Disease,  and  other  diseases.  26 procedures related to skin diseases and 549 procedures related to cancer are covered under the scheme.

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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 to 60 crore beneficiaries.
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. Initially,  the  beneficiary families under Ayushman Bharat  - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) had 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
- 11) Washer-man/ Chowkidar
8. 33 States/UTs implementing AB-PMJAY have further expanded the coverage of the scheme to 15.5 crore families.
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 details of the number of beneficiaries verified/ Ayushman cards created under the scheme

| State/UT                              | Number of beneficiaries verified /Ayushman cards created   |
|---------------------------------------|------------------------------------------------------------|
| Andaman And Nicobar Islands           | 40,616                                                     |
| Andhra Pradesh                        | 11,709,939                                                 |
| Arunachal Pradesh                     | 82,607                                                     |
| Assam                                 | 7,502,411                                                  |
| Bihar                                 | 7,768,696                                                  |
| Chandigarh                            | 141,662                                                    |
| Chhattisgarh                          | 17,041,356                                                 |
| Dadra and Nagar Haveli &Daman and Diu | 430,863                                                    |
| Goa                                   | 27,076                                                     |
| Gujarat                               | 17,743,275                                                 |
| Haryana                               | 8,137,302                                                  |
| Himachal Pradesh                      | 1,131,516                                                  |
| Jammu And Kashmir                     | 8,142,855                                                  |
| Jharkhand                             | 10,582,316                                                 |
| Karnataka                             | 13,697,728                                                 |
| Kerala                                | 7,146,371                                                  |
| Ladakh                                | 130,420                                                    |
| Lakshadweep                           | 26,031                                                     |
| Madhya Pradesh                        | 35,534,316                                                 |
| Maharashtra                           | 9,161,278                                                  |
| Manipur                               | 482,457                                                    |
| Meghalaya                             | 1,779,340                                                  |
| Mizoram                               | 434,506                                                    |
| Nagaland                              | 435,497                                                    |
| Puducherry                            | 409,804                                                    |
| Punjab                                | 7,990,610                                                  |
| Rajasthan                             | 10,091,251                                                 |
| Sikkim                                | 52,614                                                     |
| Tamil Nadu                            | 18,550,814                                                 |
| Telangana                             | 4,198,258                                                  |
| Tripura                               | 1,313,815                                                  |
| Uttar Pradesh                         | 26,156,403                                                 |
| Uttarakhand                           | 5,017,750                                                  |

Note: Above list does not include eligible beneficiary family count from West Bengal, Odisha and NCT of Delhi as they are not implementing AB-PMJAY.

## State/UT-wise details of Central share of funds released under AB-PMJAY

| State/UT                |   Funds released (in crore of Rupees) |
|-------------------------|---------------------------------------|
| Andaman Nicobar Islands |                                  2.59 |
| Andhra Pradesh          |                               1527.52 |
| Arunachal Pradesh       |                                  4.75 |
| Assam                   |                                446.45 |
| Bihar                   |                                346.29 |
| Chandigarh              |                                 15.24 |
| Chhattisgarh            |                               1029.36 |
| DNH&DD                  |                                 18.26 |
| Goa                     |                                  2.32 |
| Gujarat                 |                               1380.37 |
| Haryana                 |                                390.87 |
| Himachal Pradesh        |                                133.13 |
| Jammu and Kashmir       |                                212.52 |
| Jharkhand               |                                404.97 |
| Karnataka               |                               1638.88 |
| Kerala                  |                                558.4  |
| Ladakh                  |                                  4.05 |
| Lakshadweep             |                                  0.46 |
| Madhya Pradesh          |                               1376.81 |
| Maharashtra             |                               1597.63 |
| Manipur                 |                                 91.21 |
| Meghalaya               |                                139.3  |
| Mizoram                 |                                 85.68 |
| Nagaland                |                                 62.18 |
| Puducherry              |                                 10.84 |
| Punjab                  |                                261.83 |
| Rajasthan               |                                923.61 |
| Sikkim                  |                                  6.31 |
| Tamil Nadu              |                               1694.37 |
| Telangana               |                                236.45 |
| Tripura                 |                                122.7  |
| Uttar Pradesh           |                                946.87 |
| Uttarakhand             |                                191.27 |

Note: Above list does not include eligible beneficiary family count from West Bengal, Odisha and NCT of Delhi as they are not implementing AB-PMJAY.

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