Lok Sabha Question No. 95 (STARRED), answered on 2021-12-03
Subject: Implementation of AB-PMJAY
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Badruddin Ajmal, Dharmendra Kumar Kashyap

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

## LOK SABHA STARRED QUESTION NO.95 TO BE ANSWERED ON THE 3 RD  DECEMBER, 2021 IMPLEMENTATION OF AB-PMJAY

## *95.   SHRI M. BADRUDDIN AJMAL: SHRI DHARMENDRA KASHYAP:

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

- (a)  the  details  and  salient  features  of  Ayushman  Bharat  -Pradhan  Mantri  Jan  Arogya Yojana (AB-PMJAY) along with the eligibility conditions and the procedures laid down for availing of medical facilities by the patients thereunder;
- (b)  the  number  of  patients  registered  and  those  who  have  availed  medical  facilities under the said Yojana so far during the last three years, State/UT-wise and year wise;
- (c)  the  budget  allocated  and  utilised  for  treatment  of  COVID-19  patients  and  NonCOVID-19 patients under the said Yojana, State/UT-wise, district-wise and year wise during the last three financial years;
- (d) whether the funds allocated under the scheme have been reduced drastically over the years  and  if  so,  the  details  thereof  including  its  impact  on  the  implementation  of  the scheme; and
- (e)  the  steps  taken/being  taken  by  the  Government  to  cover  each  and  every  eligible beneficiary under the scheme and promote/extend it to remotest parts of the country?

## ANSWER

## THE MINISTER OF HEALTH AND FAMILY WELFARE (DR. MANSUKH MANDAVIYA)

(a) to (e) A Statement is laid on the Table of the House.

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 95* FOR 3 RD  DECEMBER, 2021

The details, salient features along with the eligibility conditions and the rocedure laid down for availing of medical facilities by the patients under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) are at Annexure-I.

AB-PMJAY is an entitlement-based scheme, all the eligible beneficiary families are covered from day one of the implementation of the scheme in the State/UT.

AB-PMJAY  does  not  require  registration,  however,  beneficiary  verification process is being undertaken to verify the genuineness of the beneficiary. Ayushman cards are issued to all eligible beneficiaries as part of this process.

As  of  28 th November  2021,  a  total  of  17.2  Crore  Ayushman  cards  have  been issued to the scheme beneficiaries. Further, a total of 2.49 Crore hospital admissions worth  Rs.  28,863  Crore  have  been  authorized  through  a  network  of  approximately 24,000 empanelled public and private health care providers. The State/UT-wise and year-wise details are at Annexure-II.

The allocation of funds under AB-PMJAY is integrated both for COVID-19 and non-COVID-19 treatments. Funds are released as per the requirement of States/UTs. Details  of  release  of  Central  share  of  funds  State/UT-wise  and  year-wise  are  at Annexure-III.

District-wise  details  of  claims  paid  towards  authorized  hospital  admissions (COVID-19  and  Non-COVID-19  treatment)  are  available  at  the  following  URL: https://nhaindia- my.sharepoint.com/:f:/g/personal/statecoordination\_nhaindia\_in/EpwLN6UKCkZAor C33ZGzg7oBc\_rSRi4Vfc0uvUxDCmM69w?e=PbnB5t

State-wise  and  District-wise  details  of  claims  paid  for  authorized  hospital admissions for COVID-19 treatment are available at the following URL: https://nhaindia- my.sharepoint.com/:f:/g/personal/statecoordination\_nhaindia\_in/EpwLN6UKCkZAor C33ZGzg7oBc\_rSRi4Vfc0uvUxDCmM69w?e=PbnB5t

The funds allocated and utilized under AB-PMJAY are as follows: (In crore of Rupees)

| Fina ncial Year   | Budg et Estimate   | Revis ed Estimate   |   Total Expenditure* |
|-------------------|--------------------|---------------------|----------------------|
| 2018- 19          | 2400. 00           | 2160. 00            |              1965.25 |
| 2019- 20          | 6400. 00           | 3200. 00            |              3129.33 |
| 2020- 21          | 6400. 00           | 3130. 00            |              2651.08 |

*Includes expenditure on account of release of Grants-In-Aid to States/UTs for payment of premium as well as administrative expenses .

Reasons for sub-optimal utilization of funds under AB-PMJAY are at Annexure-IV.

NHA has  been  actively  collaborating  with  a  variety  of  stakeholders  including State  Health  Agencies  (SHAs),  Central  Government  Ministries  and  departments, technology solutions providers to fast-track the process of Ayushman card generation. The steps taken in this regard are at Annexure-V.

1. AB-PMJAY is the world's largest Government funded health assurance scheme.
2. AB-PMJAY provides health assurance of up to Rs.5 Lakh per family per year for secondary and tertiary healthcare hospitalizations.
3. AB-PMJAY is a completely cashless and paperless scheme.
4. The benefits under AB-PMJAY are portable across the country.
5. There is no cap on family size, or age or gender.
6. 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
7. 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).
8. AB-PMJAY is being implemented in all States and UTs barring West Bengal, NCT of Delhi and Odisha.
9.  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.
10. 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.
11.  The  States/UTs  have  been  provided  with  the  flexibility  to  implement  the  scheme  in  the operational model best suited to the local conditions. Thus, AB-PMJAY is being implemented in Insurance mode, Mixed mode and Trust mode.

## State/UT authorized hospital admissions in AB-PMJAY from FY 2018-19 to FY 2020-21

|                             | No. of authorized hospital admissions   | No. of authorized hospital admissions   | No. of authorized hospital admissions   | No. of authorized hospital admissions   |
|-----------------------------|-----------------------------------------|-----------------------------------------|-----------------------------------------|-----------------------------------------|
| State / UT                  | FY 2018- 19                             | FY 2019- 20                             | FY 2020- 21                             | FY 2021-22 (as on 28 th November, 2021) |
| Andaman and Nicobar Islands | 14                                      | 153                                     | 342                                     | 573                                     |
| Andhra Pradesh              | 1,33,432                                | 6,06,295                                | 4,45,122                                | 61113                                   |
| Arunachal Pradesh           | 378                                     | 1,354                                   | 77                                      | 24                                      |
| Assam                       | 32,713                                  | 90,194                                  | 93,355                                  | 102907                                  |
| Bihar                       | 19,733                                  | 1,60,114                                | 89,282                                  | 61103                                   |
| Chandigarh                  | 358                                     | 3,515                                   | 5,379                                   | 5300                                    |
| Chhattisgarh                | 2,31,267                                | 6,36,985                                | 4,98,774                                | 547827                                  |
| DNH and DD                  | 8,484                                   | 33,993                                  | 18,945                                  | 13579                                   |
| Delhi                       | -                                       | -                                       |                                         | 0                                       |
| Goa                         | 9,723                                   | 374                                     | 139                                     | 110                                     |
| Gujarat                     | 3,14,251                                | 11,40,664                               | 8,25,788                                | 346014                                  |
| Haryana                     | 11,226                                  | 97,511                                  | 1,38,814                                | 114225                                  |
| Himachal Pradesh            | 8,692                                   | 48,241                                  | 29,343                                  | 29274                                   |
| Jammu and Kashmir           | 6,317                                   | 66,797                                  | 67,926                                  | 144145                                  |
| Ladakh                      |                                         | 559                                     | 396                                     | 1246                                    |
| Jharkhand                   | 1,08,037                                | 4,09,749                                | 2,98,267                                | 182711                                  |
| Karnataka                   | 1,19,507                                | 5,94,257                                | 6,83,363                                | 651250                                  |
| Kerala                      | -                                       | 9,76,857                                | 10,44,635                               | 1101866                                 |
| Lakshadweep                 | -                                       | 1                                       |                                         | 12                                      |
| Madhya Pradesh              | 45,409                                  | 2,78,763                                | 4,30,474                                | 490443                                  |
| Maharashtra                 | 1,08,247                                | 2,14,922                                | 1,36,699                                | 78656.65                                |
| Manipur                     | 1,508                                   | 12,807                                  | 16,369                                  | 14803                                   |
| Meghalaya                   | 1,146                                   | 1,24,716                                | 1,23,737                                | 95414                                   |
| Mizoram                     | 7,097                                   | 27,726                                  | 16,991                                  | 9082                                    |
| Nagaland                    | 269                                     | 10,227                                  | 7,358                                   | 3475                                    |
| Odisha                      | -                                       | -                                       |                                         | 0                                       |
| Puducherry                  | -                                       | 1,370                                   | 2,587                                   | 6749                                    |
| Punjab                      | -                                       | 1,96,697                                | 4,22,884                                | 370366                                  |
| Rajasthan                   | -                                       | 9,25,684                                | 4,10,464                                | 0                                       |
| Sikkim                      | 9                                       | 1,215                                   | 2,027                                   | 1866                                    |
| Tamil Nadu                  | 4,00,235                                | 8,54,893                                | 15,68,343                               | 2626000                                 |
| Telangana                   | -                                       | -                                       |                                         | 13                                      |
| Tripura                     | 7,800                                   | 51,152                                  | 30,238                                  | 30442                                   |
| Uttar Pradesh               | 68,141                                  | 2,89,177                                | 3,19,600                                | 272564                                  |
| Uttarakhand                 | 20,594                                  | 1,30,291                                | 1,21,867                                | 109013                                  |
| West Bengal                 | 17,636                                  | -                                       |                                         | 0                                       |
| All India                   | 16,82,223                               | 79,87,253                               | 78,49,585                               | 74,72,166                               |

## Note:

1. UTs of Jammu and Kashmir and Ladakh were established from erstwhile State of Jammu and Kashmir in FY 2019.

Therefore, bifurcated number of authorized hospital admissions for both UTs are shown from FY 2019 onwards.

2. AB-PMJAY was implemented in West Bengal till 10 th January 2019, following which the State government decided to withdraw from the implementation of the scheme.

## State/UT-wise details of Central funds released for AB-PMJAY from FY 2018-19 to FY 2020-21

Annexure - III (In crore of Rupees)

| Sl. No.     | State / UT                  | FY 2018- 19*   | FY 2019- 20*   | FY 2020- 21*   |
|-------------|-----------------------------|----------------|----------------|----------------|
| 1           | Andaman and Nicobar Islands | 0.15           | 0.41           | 0.27           |
| 2           | Andhra Pradesh              | 182.85         | 374.07         | 261.23         |
| 3           | Arunachal Pradesh           | 2.31           |                | 0.67           |
| 4           | Assam                       | 21.08          | 133.23         | 12.10          |
| 5           | Bihar                       | 88.27          | 82.49          |                |
| 6           | Chandigarh                  | 0.68           | 3.82           | 1.84           |
| 7           | Chhattisgarh                | 217.43         | 280.37         | 112.62         |
| 8           | Dadra & Nagar Haveli        | 3.25           | 2.02           | 3.17           |
| 9           | Daman and Diu               | 1.02           |                | 1.07           |
| 10          | Goa                         | 0.64           | 0.06           | 0.49           |
| 11          | Gujarat                     | 77.50          | 212.33         | 99.84          |
| 12          | Haryana                     | 26.81          | 58.69          | 71.92          |
| 13          | Himachal Pradesh            | 17.18          | 19.12          | 32.93          |
| 14          | Jammu and Kashmir           | 20.64          | 33.44          | 22.70          |
| 15          | Jharkhand                   | 170.17         | 126.50         | 100.32         |
| 16          | Karnataka                   | 159.31         | 254.13         | 160.85         |
| 17          | Kerala                      | 25.00          | 97.56          | 145.61         |
| 18          | Ladakh                      |                |                | 1.62           |
| 19          | Lakshadweep                 | 0.00           |                |                |
| 20          | Madhya Pradesh              | 72.57          | 118.46         | 164.80         |
| 21          | Maharashtra                 | 266.32         | 241.88         | 376.65         |
| 22          | Manipur                     | 7.18           | 17.10          | 11.45          |
| 23          | Meghalaya                   | 15.57          | 18.07          | 49.52          |
| 24          | Mizoram                     | 17.48          | 12.41          | 14.97          |
| 25          | Nagaland                    | 4.72           | 10.89          | 12.27          |
| 26          | Puducherry                  | 1.52           |                | 1.23           |
| 27          | Punjab                      | 2.24           | 55.55          | 46.85          |
| 28          | Rajasthan                   | 0.00           | 200.07         | 258.31         |
| 29          | Sikkim                      | 1.03           | 0.09           | 1.85           |
| 30          | Tamil Nadu                  | 304.98         | 441.77         | 359.81         |
| 31          | Tripura                     | 12.81          | 20.18          | 8.98           |
| 32          | Uttar Pradesh               | 85.01          | 147.49         | 167.63         |
| 33          | Uttarakhand                 | 12.54          | 30.73          | 40.52          |
| 34          | West Bengal                 | 31.28          |                |                |
| Grand Total | Grand Total                 | 1849.54        | 2992.93        | 2544.09        |

## Reasons for sub-optimal utilization of funds under AB-PMJAY:

-  Three States and UTs viz. West Bengal, Odisha and NCT of Delhi which account for nearly 17% of the eligible beneficiary population are not implementing AB-PMJAY. Telangana only started implementing the scheme from 18 th May 2021.
-  Three large States Bihar, Madhya Pradesh, Uttar Pradesh which account for over 30% of the beneficiary  population  are  implementing  the  scheme  for  the  first  time.  The  demand  for healthcare services under AB-PMJAY is still picking up in these States.
-  Issues  related  to  quality  of  decade  old  SECC  data  has  posed  serious  challenges  in beneficiary  identification  as  some  of  the  deprived  poor  families  are  not  covered  under  the scheme and approx. 30% eligible beneficiary families are not traceable.
-  The average per beneficiary family premium is lesser than the upper ceiling of Rs. 1052 as was estimated during inception of AB-PMJAY.
-  Further,  utilization  of  AB-PMJAY  was  adversely  impacted  with  the  onset  of  the  COVID-19 pandemic. There was a pronounced decline in the demand for services under AB-PMJAY due  to  mobility  restrictions,  designation  of  empaneled  healthcare  providers  (EHCPs)  as dedicated  COVID-19  treatment  centers  and  reluctance  of  PMJAY  beneficiaries  to  avail services at EHCPs due to the fear of infection.

## Steps taken to fast-track the process of Ayushman Card generation:

-  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. States/UTs were encouraged to adopt such MoUs for non-SECC beneficiaries in their States.
-  'Aapke  Dwar  Ayushman'  (ADA)  is  a  key  initiative  of  NHA  that  is  being  implemented  in mission mode across various States/UTs, including focus States such as Bihar, Chhattisgarh, Madhya  Pradesh,  and  Uttar  Pradesh.  The  campaign  leveraged  a  grassroots  network  of healthcare  workers  (HCWs),  frontline  workers  (FLWs),  Panchayati  Raj  institutions  (PRIs), village  level  entrepreneurs  (VLEs)  /  agents  from  CSC  and  UTIITSL  to  mobilize  and  verify nearly 4 Crore beneficiaries.
-  NHA has reached out to Central Government Ministries implementing welfare schemes using SECC 2011 database. This was done with the intention of leveraging the updated databases of such welfare schemes for better targeting of PMJAY beneficiaries. Efforts are being made to reach out to eligible individuals from this list to issue Ayushman cards to them.
-  NHA has taken steps to increase avenues for Ayushman card generation:
- o Four additional agencies have been onboarded, along the lines of CSC and UTIITSL for the generation of Ayushman cards across the country.
- o Eight  additional  agencies  have  been  onboarded  to  ensure  near  real-time  approval  of Ayushman card requests.
-  NHA  has  undertaken  changes  to  the  technology  of  the  PMJAY  beneficiary  identification platform (BIS) to liberalize and democratize Ayushman card generation:
- o An enhanced location hierarchy based search option is enabled in SECC database. Village level  beneficiary  data  has  thus  become  accessible.  This  will  enable  local  Government officials, frontline workers and public representatives in identifying and mobilizing beneficiaries.
- o A revamped 'Self BIS' system has been launched for self / assisted verification.
- o Crowd sourced approval functionality has been enabled for beneficiary record approval.
-  Ayushman Pakhwara was conducted from 15 th to  30 th September 2021, in the backdrop of the completion of three years of AB-PMJAY to spread the message about AB-PMJAY.
-  NHA is planning integrated IEC campaigns of Ayushman Bharat -PMJAY with other national flagship schemes.