Lok Sabha Question No. 4986 (UNSTARRED), answered on 2022-04-01
Subject: Medical Treatment under AB-PMJAY
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Imtiaz Jaleel Syed

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

## LOK SABHA UNSTARRED QUESTION NO. 4986 TO BE ANSWERED ON 01 ST  APRIL, 2022

## MEDICAL TREATMENT UNDER AB-PMJAY

## 4986.  SHRI SYED IMTIAZ JALEEL:

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

- (a)  whether  the  Government  has  signed  Memorandum  of  Understanding  (MoU)  with  private insurance companies for processing of claims under Ayushman Bharat Yojana;
- (b)  if so, the details thereof;
- (c)  whether the said MoUs is accessible in the public domain and if so, the details thereof;
- (d)  if not, the time by which these are likely to be made available in public domain;
- (e)  the  number  of  beneficiaries  treated  for  COVID-19  and  non-COVID-19  diseases  across  the country under AB-PMJAY during FY 2019-20, 2020-21 and 2021-22, State/UT-wise; and
- (f)    the  amount  of  expenditure  incurred  for  the  treatment  of  COVID-19  patients  under  ABPMJAY for FY 2019-20, 2020-21 and 2021-22, State/UT-wise?

## THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND

## ANSWER FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

- (a)  to  (d):  Under  Ayushman  Bharat  -Pradhan  Mantri  Jan  Arogya  Yojana  (AB-PMJAY), States/UTs  have  the  flexibility  to  implement  the  scheme  in  insurance  mode  or  trust  mode  or mixed mode i.e. partly insurance mode and partly trust mode. Out of 33 States/UTs implementing the scheme, 10 States/UTs namely Dadra & Nagar Haveli and Daman & Diu, Gujarat, Jammu and Kashmir,  Lakshadweep,  Jharkhand,  Maharashtra,  Meghalaya,  Nagaland,  Rajasthan  and  Tamil Nadu are implementing it either in insurance mode or in mixed mode. States/UTs implementing the  scheme  in  insurance/mixed  mode  directly  enter  into  agreements  with  insurance  companies. These agreements are accessible from the respective State Health Agencies.
- (e)  &  (f):  State/UT-wise  details  of  authorized  hospital  admissions  for  COVID-19  and  nonCOVID-19 for FY 2019-20, FY 2020-21 and FY 2021-22 and the amount of claims for COVID19 treatment under the scheme for FY 2020-21 and FY 2021-22 are at Annexure.

## State/UT-wise details of authorized hospital admissions

| State / Union Territory   | FY 2019- 2020      | FY 2020-2021   | FY 2020-2021       | FY 2020-2021       | FY 2021-2022   | FY 2021-2022       | FY 2021-2022       |
|---------------------------|--------------------|----------------|--------------------|--------------------|----------------|--------------------|--------------------|
| State / Union Territory   | For non- COVID- 19 | For COVID-19   | For COVID-19       | For non- COVID- 19 | For COVID-19   | For COVID-19       | For non- COVID- 19 |
| State / Union Territory   | Count              | Count          | Amount (in Rupees) | Count              | Count          | Amount (in Rupees) | Count              |
| Andaman &Nicobar Islands  | 152                | 6              | 330                | 337                | 1              | 16,200             | 798                |
| Andhra Pradesh            | 6,07,077           | 96,583         | 3,19,44,03,143     | 4,29,695           | 1,19,176       | 4,22,45,71,540     | 9,68,985           |
| Arunachal Pradesh         | 1,353              | -              | -                  | 75                 | -              | -                  | 30                 |
| Assam                     | 90,207             | 505            | 99,96,700          | 93,145             | 596            | 1,26,31,030        | 1,70,195           |
| Bihar                     | 1,60,245           | 13             | 97,030             | 89,386             | 14             | 2,08,742           | 1,12,847           |
| Chandigarh                | 3,518              | 1              | 12,000             | 5,390              | 7              | 1,25,000           | 8,119              |
| Chhattisgarh              | 8,71,818           | 20,512         | 15,59,11,490       | 4,98,749           | 25,089         | 51,93,57,810       | 8,80,890           |
| DNH and DD                | 34,055             | 1              | 60                 | 18,927             | 5              | 92,530             | 20,081             |
| Goa                       | 52                 | -              | -                  | 139                | 1              | 3,500              | 160                |
| Gujarat                   | 11,43,143          | -              | -                  | 8,25,135           | -              | -                  | 5,46,731           |
| Haryana                   | 97,681             | 341            | 71,21,240          | 1,31,798           | 512            | 1,06,09,058        | 1,66,737           |
| Himachal Pradesh          | 48,296             | 13             | 2,28,000           | 29,418             | 49             | 15,25,936          | 46,147             |
| Jammu And Kashmir         | 66,912             | 1              | 7,920              | 68,589             | 883            | 1,66,05,270        | 2,41,873           |
| Jharkhand                 | 4,10,154           | 795            | 1,55,24,240        | 2,97,992           | 751            | 2,03,56,488        | 3,16,747           |
| Karnataka                 | 5,94,850           | 93,388         | 4,04,13,80,000     | 6,86,214           | 98,187         | 4,54,40,22,000     | 10,98,261          |
| Kerala                    | 9,78,807           | 25,810         | 66,44,17,365       | 10,20,447          | 1,19,244       | 3,73,64,88,998     | 15,45,829          |
| Ladakh                    | 561                | -              | -                  | 396                | -              | -                  | 1,632              |
| Lakshadweep               | 1                  | -              | -                  | -                  | -              | -                  | 64                 |
| Madhya Pradesh            | 2,78,786           | 4,766          | 3,47,28,566        | 3,89,895           | 14,725         | 36,42,07,050       | 6,76,513           |
| Maharashtra               | 2,13,750           | 74,626         | 1,88,63,38,444     | 1,36,198           | 1,06,200       | 2,73,03,75,593     | 86,453             |
| Manipur                   | 12,850             | 87             | 23,48,591          | 16,312             | 749            | 3,33,91,852        | 22,511             |
| Meghalaya                 | 1,24,989           | 568            | 1,22,81,500        | 1,19,955           | 4,048          | 12,50,47,800       | 1,32,437           |
| Mizoram                   | 27,754             | 8              | 3,05,505           | 17,004             | 890            | 1,58,95,935        | 12,652             |
| Nagaland                  | 10,249             | 1              | 34,200             | 7,352              | 12             | 2,26,140           | 5,441              |
| Puducherry                | 1,377              | 142            | 22,50,900          | 2,549              | 228            | 31,39,740          | 11,343             |
| Punjab                    | 1,97,440           | -              | -                  | 4,23,407           | -              | -                  | 5,26,922           |
| Rajasthan                 | 9,26,367           | 23,974         | 14,20,34,658       | 4,38,484           | 2,423          | 1,45,21,073        | 9,86,969           |
| Sikkim                    | 1,220              | 3              | 60,900             | 2,036              | 38             | 9,86,400           | 2,798              |
| Tamil Nadu                | 8,55,420           | 1,641          | 5,54,64,339        | 5,83,194           | 32,124         | 3,88,16,07,568     | 6,14,426           |
| Telangana                 | -                  | -              | -                  | -                  | -              | -                  | 2,81,535           |
| Tripura                   | 51,229             | 43             | 2,54,280           | 30,244             | 13             | 1,35,720           | 45,117             |
| Uttar Pradesh             | 2,89,540           | 944            | 62,42,840          | 3,18,478           | 1,535          | 85,21,192          | 4,83,100           |
| Uttarakhand               | 1,30,600           | 390            | 4,26,35,224        | 1,21,044           | 2,620          | 24,15,18,478       | 1,73,025           |

## Note :

1. Packages for treatment of COVID-19 under PMJAY were notified from April, 2020 onwards.
2. Telangana joined the scheme in May, 2021.