Lok Sabha Question No. 2074 (UNSTARRED), answered on 2022-07-29
Subject: Implementation of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Kanakmal Katara, Keshari Devi Patel, Sunil Baburao Mendhe, Chandan Singh, Dileshwar Kamait, Locket Chatterjee, Khagen Murmu, Jyotirmay Singh Mahato, Jagannath Sarkar, Rama Devi, Kripanath Mallah, Geeta Kora, Vinayak Bhaurao Raut, Ramesh Bidhuri, Jaskaur Meena, Ramesh Chander Kaushik, Jugal Kishore Sharma, Riti Pathak, Sunil Kumar Soni, Mitesh Rameshbhai (Bakabhai) Patel, Shardaben Anilbhai Patel

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE

## DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 2074 TO BE ANSWERED ON 29 TH  JULY, 2022

## IMPLEMENTATION OF AYUSHMAN BHARAT - PRADHAN MANTRI JAN AROGYA YOJANA (AB-PMJAY)

## 2074.  SHRI KANAKMAL KATARA:

SHRI JUGAL KISHORE SHARMA:

MS. LOCKET CHATTERJEE:

SHRIMATI RITI PATHAK:

SHRI RAMESH BIDHURI:

SHRI KHAGEN MURMU:

SHRIMATI GEETA KORA:

SHRI JYOTIRMAY SINGH MAHATO:

SHRI SUNIL KUMAR SONI:

SHRIMATI KESHARI DEVI PATEL:

SHRI CHANDAN SINGH:

SHRIMATI JASKAUR MEENA:

SHRI JAGANNATH SARKAR:

SHRI DILESHWAR KAMAIT:

SHRI VINAYAK RAUT:

SHRI RAMESH CHANDER KAUSHIK:

SHRIMATI SHARDABEN ANILBHAI PATEL:

SHRI MITESH RAMESHBHAI PATEL (BAKABHAI):

SHRIMATI RAMA DEVI:

SHRI SUNIL BABURAO MENDHE:

SHRI KRIPANATH MALLAH:

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

- (a)  the salient features of AB-PMJAY along with the total number of beneficiaries in the country, State/UT-wise;
- (b)  the funds sanctioned, allocated and utilized and the number of hospitals empanelled under the Yojana, State/UT-wise during each of the last three years and the current year;
- (c)  the expenditure incurred on OPD treatment and hospital admission of the beneficiaries under the scheme during the last three years;
- (d)  the targets set and necessary steps taken for strengthening and expansion of the Yojana in the country;
- (e)  the details of State/UTs wherein the Yojana is being made implemented along with efforts being made to include all uncovered areas of the country;
- (f)    the  number  of  Ayushman Bharat Cards issued so far along with the number of application approved and rejected in the country, State/UT-wise; and
- (g) whether the Government proposes to conduct any survey to include and provide benefits of the  said  Yojana  to  the  left  out/deprived  stakeholders  in  the  country  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  (g):  The  salient  features  of  Ayushman  Bharat  -  Pradhan  Mantri  Jan  Arogya  Yojana (AB-PMJAY) are at Annexure-I. State/UT-wise details of the number of beneficiary families in the country are at Annexure-II. State/UT-wise and Financial Year wise details of Central share  of  funds  released  and  the  number  of  hospitals  empanelled  under  the  scheme  are  at Annexure-III. Funds are released to States/UTs only after utilization certificate is submitted by them.

The expenditure incurred on hospital admission of the beneficiaries under the scheme during the last three years is Rs. 35,016 crore. This includes expenditure on pre-hospitalization up to 3 days and post-hospitalization up to 15 days. Such transactions are not separately recorded on IT platform as these are part of treatment packages.

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.

33 States/UTs are implementing the scheme. State/UT of Odisha, West Bengal and Delhi are not implementing it. Government of India is pursuing with these States/UT to join the scheme so that eligible beneficiaries are not deprived of healthcare benefits provided thereunder.

AB-PMJAY  is  an  entitlement-based  scheme.  Eligible  beneficiaries  can  directly  visit  any empanelled public or private hospital to avail cashless treatment. Ayushman cards are issued to  the  beneficiaries  to  create  awareness  about  the  scheme.  As  of  27 th July  2022,  a  total  of 18.56 crore Ayushman Bharat cards are issued under the scheme. This includes 4.68 crore cards  issued  by  States/UTs  by  using  their  own  IT  platform.  State/UT-wise  details  of applications approved and applications rejected are at Annexure-IV.

PMJAY's beneficiary database is defined. 10.74 crore poor and vulnerable families (bottom 40 percent  population)  identified  on  the  basis  of  SECC  2011  data  are  entitled  to  receive  free treatment  under  the  scheme.  Further,  States/UTs  have  the  flexibility  to  run  their  own  health protection  schemes  in  alliance  with  AB-PMJAY  at  their  own  cost.  Accordingly,  States/UTs have expanded the scheme coverage to 14.75 crore beneficiary families at their own cost.

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 13.44 crore families (65 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 details of the number of beneficiary families in the country

| State / UT        | Number of Eligible Families under AB-PMJAY   |
|-------------------|----------------------------------------------|
| A&N Islands       | 11,500                                       |
| Andhra Pradesh    | 54,67,524                                    |
| Arunachal Pradesh | 88,611                                       |
| Assam             | 26,96,996                                    |
| Bihar             | 1,08,11,015                                  |
| Chandigarh        | 30,074                                       |
| Chhattisgarh      | 36,50,364                                    |
| DNH&DD            | 26,342                                       |
| Goa               | 36,431                                       |
| Gujarat           | 43,83,948                                    |
| Haryana           | 15,45,936                                    |
| Himachal Pradesh  | 4,78,985                                     |
| Jammu And Kashmir | 5,97,801                                     |
| Jharkhand         | 28,05,753                                    |
| Karnataka         | 62,09,073                                    |
| Kerala            | 22,05,505                                    |
| Ladakh            | 10,904                                       |
| Lakshadweep       | 1,425                                        |
| Madhya Pradesh    | 83,57,257                                    |
| Maharashtra       | 83,63,664                                    |
| Manipur           | 2,73,250                                     |
| Meghalaya         | 3,47,013                                     |
| Mizoram           | 1,94,859                                     |
| Nagaland          | 2,33,328                                     |
| Puducherry        | 1,03,434                                     |
| Punjab            | 14,64,802                                    |
| Rajasthan*        | 58,95,363                                    |
| Sikkim            | 39,738                                       |
| Tamil Nadu        | 77,70,928                                    |
| Telangana         | 25,90,010                                    |
| Tripura           | 4,90,964                                     |
| Uttar Pradesh     | 1,16,84,453                                  |
| Uttarakhand       | 5,23,536                                     |

Note:  Above  list  does  not  include  eligible  beneficiary  family  count  of  SECC  2011  from  West  Bengal, Odisha and NCT of Delhi as they are not implementing AB-PMJAY.

## State/UT-wise details of fund released & hospitals empanelled under AB-PMJAY

| State/UT                  | FY 2019-20                         | FY 2019-20                  | FY 2020-21                         | FY 2020-21                  | FY 2021-22                         | FY 2021-22                  | FY 2022-23                         | FY 2022-23                  |
|---------------------------|------------------------------------|-----------------------------|------------------------------------|-----------------------------|------------------------------------|-----------------------------|------------------------------------|-----------------------------|
| State/UT                  | Fund released (in crore of Rupees) | No. of Hospitals empanelled | Fund released (in crore of Rupees) | No. of Hospitals empanelled | Fund released (in crore of Rupees) | No. of Hospitals empanelled | Fund released (in crore of Rupees) | No. of Hospitals empanelled |
| A and N Islands           | 0.41                               | -                           | 0.27                               | -                           | 0.76                               | -                           | -                                  | -                           |
| Andhra Pradesh            | 374.07                             | 818                         | 261.23                             | 70                          | 223.95                             | 576                         | 111.10                             | 10                          |
| Arunachal Pradesh         | -                                  | 17                          | 0.67                               | 16                          | 0.00                               | 18                          | -                                  | 7                           |
| Assam                     | 133.23                             | 151                         | 12.10                              | 49                          | 87.91                              | 16                          | -                                  | 14                          |
| Bihar                     | 82.49                              | 200                         | -                                  | 44                          | 59.77                              | 45                          | -                                  | 25                          |
| Chandigarh                | 3.82                               | 7                           | 1.84                               | 4                           | 2.49                               | 7                           | 1.11                               | 2                           |
| Chhattisgarh              | 280.37                             | 632                         | 112.62                             | 720                         | 66.00                              | 151                         | 66.32                              | 68                          |
| DNH and DD                | 2.02                               | 0                           | 4.24                               | 0                           | 1.76                               | 0                           | -                                  | 0                           |
| Delhi                     | -                                  | 35                          | -                                  | 20                          |                                    | 28                          | -                                  | 3                           |
| Goa                       | 0.06                               | 16                          | 0.49                               | 3                           | 0.60                               | 8                           | -                                  | -                           |
| Gujarat                   | 212.33                             | 105                         | 99.84                              | 104                         | 330.55                             | 168                         | -                                  | 51                          |
| Haryana                   | 58.69                              | 151                         | 71.92                              | 49                          | 89.95                              | 64                          | 12.11                              | 13                          |
| Himachal Pradesh          | 19.12                              | 22                          | 32.93                              | 13                          | 33.71                              | 35                          | -                                  | 15                          |
| Jammu and Kashmir         | 33.44                              | 82                          | 22.70                              | 2                           | 75.12                              | 39                          | -                                  | 21                          |
| Jharkhand                 | 126.50                             | 138                         | 100.32                             | 50                          | 7.98                               | 53                          | -                                  | 19                          |
| Karnataka                 | 254.13                             | 2356                        | 160.85                             | 241                         | 414.11                             | 102                         | -                                  | 28                          |
| Kerala                    | 97.56                              | 130                         | 145.61                             | 179                         | 138.90                             | 160                         | 69.45                              | 23                          |
| Ladakh                    | -                                  | 1                           | 1.62                               | -                           | 0.51                               | -                           | 0.10                               | -                           |
| Lakshadweep               | -                                  | -                           | -                                  | 5                           | 0.31                               | -                           | -                                  | -                           |
| Madhya Pradesh            | 118.46                             | 318                         | 164.80                             | 209                         | 355.25                             | 206                         | 207.22                             | 40                          |
| Maharashtra               | 241.88                             | 185                         | 376.65                             | 333                         | 324.75                             | 93                          | 164.88                             | 27                          |
| Manipur                   | 17.10                              | 42                          | 11.45                              | 8                           | 22.50                              | 15                          | 6.52                               | 6                           |
| Meghalaya                 | 18.07                              | 21                          | 49.52                              | 6                           | 22.28                              | 1                           | 5.32                               | -                           |
| Mizoram                   | 12.41                              | 16                          | 14.97                              | 4                           | 16.58                              | -                           | 1.98                               | 1                           |
| Nagaland                  | 10.89                              | 29                          | 12.27                              | 9                           | 14.09                              | 4                           | -                                  | 1                           |
| Odisha                    | -                                  | 24                          | -                                  | 2                           | -                                  | 1                           | -                                  | -                           |
| Puducherry                | -                                  | 19                          | 1.23                               | 2                           | 0.11                               | 6                           | -                                  | 1                           |
| Punjab                    | 55.55                              | 674                         | 46.85                              | 156                         | 80.50                              | 94                          | -                                  | 1                           |
| Rajasthan                 | 200.07                             | 974                         | 258.31                             | 21                          | 96.39                              | 12                          | -                                  | 6                           |
| Sikkim                    | 0.09                               | 5                           | 1.85                               | -                           | 1.04                               | 6                           | 0.53                               | -                           |
| Tamil Nadu                | 441.77                             | 88                          | 359.81                             | 44                          | 75.14                              | 623                         | 122.79                             | 53                          |
| Telangana                 | -                                  | 20                          | -                                  | 16                          | 150.26                             | 394                         | -                                  | 211                         |
| Tripura                   | 20.18                              | 15                          | 8.98                               | 36                          |                                    |                             | 1.50 -                             | 156                         |
|                           | 147.49                             | 961                         | 167.63                             | 18                          | 35.60                              | 2                           | 60.00                              | 1                           |
| Uttar Pradesh Uttarakhand | 30.73                              | 27                          | 40.52                              | 104                         | 157.56 54.23                       | 313 29                      |                                    | 19                          |
| West Bengal               | -                                  | 52                          | -                                  | 6                           | -                                  | 4                           | -                                  | 3                           |

Note: State/UT of Odisha, West Bengal and Delhi are not implementing AB-PMJAY. Hospitals are empanelled in these States/UT to facilitate beneficiaries of implementing States/UTs to avail treatment under the portability feature of the scheme.

## State/UT-wise details of Ayushman card applications approved and rejected

| State/UT                         |   Applications approved |   Applications rejected |
|----------------------------------|-------------------------|-------------------------|
| Andaman &Nicobar Islands         |                   40043 |                       0 |
| Andhra Pradesh                   |                      88 |                       0 |
| Arunachal Pradesh                |                   62772 |                     513 |
| Assam                            |                  539226 |                   53090 |
| Bihar                            |                 7646955 |                      42 |
| Chandigarh                       |                   71725 |                     112 |
| Chhattisgarh                     |                15693571 |                      75 |
| DNH&DD                           |                  297092 |                       0 |
| Goa                              |                   24950 |                       0 |
| Gujarat                          |                14501281 |                   24207 |
| Haryana                          |                 2868042 |                     232 |
| Himachal Pradesh                 |                 1121417 |                       0 |
| Jammu and Kashmir (incl. Ladakh) |                 7329563 |                    1262 |
| Jharkhand                        |                 9469838 |                      55 |
| Karnataka                        |                     929 |                       2 |
| Kerala                           |                 6942739 |                       3 |
| Lakshadweep                      |                   19801 |                     460 |
| Madhya Pradesh                   |                27991916 |                   18835 |
| Maharashtra                      |                 7530113 |                    1088 |
| Manipur                          |                  439728 |                      42 |
| Meghalaya                        |                 1729919 |                       7 |
| Mizoram                          |                  389143 |                       8 |
| Nagaland                         |                  285954 |                      18 |
| Puducherry                       |                  391009 |                       0 |
| Punjab                           |                 7914511 |                      52 |
| Sikkim                           |                   49307 |                       0 |
| Tamil Nadu                       |                     941 |                      98 |
| Telangana                        |                       0 |                       0 |
| Tripura                          |                 1285727 |                       3 |
| Uttar Pradesh                    |                19444887 |                   70471 |
| Uttarakhand                      |                 4752936 |                       8 |

Note: In Rajasthan, AB-PMJAY is implemented in convergence with the States' health insurance scheme. To avail  benefits  under  the  converged  scheme,  eligible  beneficiary  families  can  use  their  existing  Jan  Aadhaar cards.