Lok Sabha Question No. 233 (UNSTARRED), answered on 2023-07-21
Subject: Implementation of AB-PMJAY
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Chandeshwar Prasad, Amol Ramsing Kolhe, Kuldeep Rai Sharma, Subhash Ramrao Bhamre, Ramesh Bidhuri, Supriya Sadanand Sule, Dhanush M Kumar, Ganesan Selvam, DNV Senthilkumar. S., C.N. Annadurai, Manjulata Mandal

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

LOK SABHA UNSTARRED QUESTION NO. 233 TO BE ANSWERED ON 21 ST JULY, 2023

## IMPLEMENTATION OF AB-PMJAY

## 233. SHRI CHANDESHWAR PRASAD:

SHRI RAMESH BIDHURI:

DR. AMOLRAMSING KOLHE:

SHRIMATI MANJULATAMANDAL:

SHRI C.N. ANNADURAI:

SHRI KULDEEPRAI SHARMA:

DR. SUBHASH RAMRAO BHAMRE:

SHRI DHANUSH M. KUMAR:

SHRIMATI SUPRIYA SULE:

SHRI SELVAM G.:

DR. DNV SENTHILKUMAR S.:

Will the Minister of HEALTHAND FAMILYWELFARE

be pleased to state:

- (a) whether the Government is implementing Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and if so, State/UT-wise details thereof;
- (b) the number of persons benefited under AB-PMJAY during each of the last three years along with the expenditure incurred on OPD treatment and hospital admission of the beneficiaries under the scheme, State/UT-wise;
- (c) the targets set and necessary steps taken for strengthening and expansion of the Yojana in the country along with the challenges faced by the Government while implementing the Scheme;
- (d) the details of the eligibility criteria and process fixed to provide medical facility related benefits to the patients under the said Scheme; and
- (e) whether many households from rural areas have not been enrolled under AB-PMJAY thereby being deprived of the benefits under the Yojana and if so, State/UT-wise details thereof and corrective steps taken by the Government in this regard?

## ANSWER THE MINISTER OFSTATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (PROF. S. P. SINGH BAGHEL)

- (a) to (e): Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is the largest publicly funded health protection scheme in the world which aims to provide health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization to 12 crore

families. Many States/UTs implementing AB-PMJAY have expanded the beneficiary base to approximately 15.5 crore families at their own cost. The scheme is implemented in 33 States/UTs except for Delhi, Odisha, and West Bengal. As of 16th July 2023, approximately 24.02 crore Ayushman Cards have been created and a total of 5.38 crore hospital admissions worth Rs. 66,039 crore have been authorized under the scheme. State/UT-wise details of scheme implementation are at Annexure-I.

State/UT-wise details of number of persons benefited under AB-PMJAY along with the expenditure incurred during each of the last three years are at Annexure-II. This includes hospitalization (IPD) services including expenditure on pre-hospitalization up to 3 days and posthospitalization up to 15 days.

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.

About 45,000 hospital admissions are authorized under the scheme every day. Aapke Dwar Ayushman, a door-to-door campaign, which has enlisted the services of grassroots functionaries such as frontline healthcare workers, Panchayati Raj personnel and village level agents, has been taken for beneficiary mobilization and card creation. Support of ASHA workers, frontline workers under Panchayati Raj, Self Help Groups under the National Rural Livelihood Mission (NRLM) for beneficiary mobilization and IEC related activities is sought. This has resulted in the verification of over 14.7 crore beneficiaries, of which, over 10 crore Ayushman cards have been created since April 2022. National Health Authority (NHA) has coordinated with various Central Government ministries implementing welfare schemes such as Pradhan Mantri Ujjwala Yojana to enrich the SECC beneficiary database. NHA has revamped the beneficiary identification platform (BIS 2.0) for easy card creation. A PM-JAY mobile application has been developed and deployed to ramp up the card creation activity.

Details of the eligibility criteria for beneficiary families identified from SECC database are at Annexure-III. Flexibility has been provided to States/UTs to use non-SECC beneficiary family database for tagging against the leftover (unauthenticated) SECC families. Accordingly, many States/UTs have shared database of poor and vulnerable families against unidentified SECC families and the expanded beneficiary base. These databases have been integrated with NHA ' s IT system for card creation. The process for availing treatment under the scheme is at Annexure-IV.

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 empaneled hospital (public or private) across the country to avail cashless treatment benefits. A comprehensive media and outreach strategy is followed to spread awareness and empower beneficiaries, particularly in rural areas, about their entitlements and rights under the scheme which includes traditional media, community radio, street plays, digital displays, and Doordarshan testimonials. State Health Agencies have also engaged frontline workers, ASHAs, Anganwadi Workers and Village Level Entrepreneurs who are pivotal in creating mass awareness at the grassroots level.

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State/UT-wise details of scheme implementation

| State/UT                 | Ayushman cards   | Authorized Hospital Admissions   | Authorized Hospital Admissions   |
|--------------------------|------------------|----------------------------------|----------------------------------|
|                          | created          | Count                            | Amount                           |
| Andaman &Nicobar Islands | 40,847           | 2,277                            | ₹ 69,459,143                     |
| Andhra Pradesh           | 12,587,880       | 4,451,214                        | ₹ 115,731,498,523                |
| Arunachal Pradesh        | 93,019           | 3,503                            | ₹ 66,988,416                     |
| Assam                    | 15,917,052       | 736,611                          | ₹ 11,664,238,261                 |
| Bihar                    | 8,009,993        | 675,714                          | ₹ 7,029,303,633                  |
| Chandigarh               | 155,010          | 32,248                           | ₹ 257,026,281                    |
| Chhattisgarh             | 19,782,432       | 4,007,970                        | ₹ 43,745,723,942                 |
| Dadra And Nagar Haveli   | 301,967          | 81,918                           | ₹ 504,549,683                    |
| Daman And Diu            | 129,443          | 24,444                           | ₹ 184,845,584                    |
| Goa                      | 28,349           | 10,943                           | ₹ 344,570,780                    |
| Gujarat                  | 17,500,888       | 4,119,371                        | ₹ 85,193,588,523                 |
| Haryana                  | 8,502,991        | 853,216                          | ₹ 11,935,687,749                 |
| Himachal Pradesh         | 1,135,102        | 213,166                          | ₹ 2,643,986,840                  |
| Jammu And Kashmir        | 8,256,279        | 896,265                          | ₹ 15,022,219,920                 |
| Jharkhand                | 11,183,509       | 1,673,359                        | ₹ 18,997,311,518                 |
| Karnataka                | 14,082,463       | 5,462,667                        | ₹ 37,014,664,307                 |
| Kerala                   | 7,236,306        | 5,186,708                        | ₹ 51,248,805,329                 |
| Ladakh                   | 134,286          | 7,562                            | ₹ 117,823,795                    |
| Lakshadweep              | 26,157           | 634                              | ₹ 18,988,695                     |
| Madhya Pradesh           | 36,111,311       | 2,923,330                        | ₹ 45,679,642,342                 |
| Maharashtra              | 9,733,335        | 833,879                          | ₹ 21,647,976,820                 |
| Manipur                  | 488,801          | 103,744                          | ₹ 1,383,673,284                  |
| Meghalaya                | 1,812,935        | 636,385                          | ₹ 5,514,846,149                  |
| Mizoram                  | 437,808          | 97,650                           | ₹ 1,126,735,410                  |
| Nagaland                 | 589,112          | 43,758                           | ₹ 814,249,968                    |
| Puducherry               | 420,637          | 50,723                           | ₹ 392,090,792                    |
| Punjab                   | 7,839,044        | 1,599,735                        | ₹ 19,564,010,033                 |
| Rajasthan                | 10,910,534       | 5,741,363                        | ₹ 33,090,364,262                 |
| Sikkim                   | 54,676           | 13,007                           | ₹ 116,875,780                    |
| Tamil Nadu               | 4,046,027        | 9,049,081                        | ₹ 55,761,868,117                 |
| Telangana                | 6,456,575        | 890,317                          | ₹ 24,967,330,599                 |
| Tripura                  | 1,331,935        | 239,294                          | ₹ 2,082,095,979                  |
| Uttar Pradesh            | 29,762,516       | 2,336,507                        | ₹ 31,205,416,697                 |
| Uttarakhand              | 5,140,811        | 814,849                          | ₹ 15,259,619,178                 |

Note: States/UT of Odisha, West Bengal and Delhi are not implementing AB-PMJAY.

## State/UT-wise details of number of persons benefited under AB-PMJAY along with the expenditure incurred during each of the last three years

| State/UT                 | FY2020-2021   | FY2020-2021        | FY 2021-2022   | FY 2021-2022       | F2022-2023   | F2022-2023         |
|--------------------------|---------------|--------------------|----------------|--------------------|--------------|--------------------|
| State/UT                 | Count         | Amount (in Rupees) | Count          | Amount (in Rupees) | Count        | Amount (in Rupees) |
| Andaman& Nicobar Islands | 340           | 10,914,640         | 832            | 22,908,637         | 704          | 26,489,462         |
| Andhra Pradesh           | 692,243       | 22,090,601,465     | 1,106,905      | 26,229,454,261     | 1,418,409    | 34,227,987,210     |
| Arunachal Pradesh        | 84            | 2,241,506          | 187            | 3,701,320          | 1,011        | 18,775,843         |
| Assam                    | 92,699        | 1,416,097,471      | 175,803        | 2,685,468,199      | 240,388      | 3,923,814,247      |
| Bihar                    | 88,556        | 803,396,842        | 116,116        | 1,374,492,201      | 214,373      | 2,327,085,914      |
| Chandigarh               | 5,374         | 33,207,986         | 8,349          | 55,487,611         | 10,412       | 95,500,039         |
| Chhattisgarh             | 497,072       | 5,308,469,783      | 896,901        | 9,691,411,075      | 1,292,988    | 15,046,435,357     |
| Dadra And Nagar Haveli   | 14,820        | 89,951,801         | 16,113         | 105,476,316        | 16,380       | 114,122,502        |
| Daman And Diu            | 4,123         | 27,286,670         | 4,509          | 43,419,458         | 5,118        | 50,648,223         |
| Goa                      | 139           | 2,872,856          | 167            | 3,800,809          | 409          | 7,918,871          |
| Gujarat                  | 825,698       | 11,389,684,479     | 566,753        | 16,206,516,455     | 916,169      | 26,478,983,389     |
| Haryana                  | 138,773       | 1,582,411,868      | 185,239        | 2,422,825,064      | 284,160      | 4,258,702,276      |
| Himachal Pradesh         | 29,211        | 359,943,853        | 47,366         | 711,266,349        | 63,085       | 809,365,305        |
| Jammu And Kashmir        | 68,052        | 671,488,645        | 251,029        | 4,542,552,301      | 385,833      | 7,174,193,176      |
| Jharkhand                | 298,070       | 2,988,648,772      | 326,557        | 4,461,678,117      | 412,463      | 4,997,583,148      |
| Karnataka                | 670,460       | 5,838,145,498      | 1,127,554      | 7,534,757,850      | 2,101,312    | 10,407,352,331     |
| Kerala                   | 1,043,525     | 7,684,002,623      | 1,698,278      | 15,703,561,288     | 1,224,171    | 17,044,928,567     |
| Ladakh                   |               |                    | 509            | 6,818,858          | 5,184        | 84,565,458         |
| Lakshadweep              |               |                    | 66             | 2,040,520          | 424          | 13,161,345         |
| Madhya Pradesh           | 383,962       | 5,492,250,537      | 715,042        | 11,700,971,403     | 1,173,874    | 19,389,093,139     |
| Maharashtra              | 150,589       | 4,093,116,147      | 136,648        | 3,559,980,320      | 172,236      | 4,455,195,503      |
| Manipur                  | 16,360        | 166,041,429        | 24,062         | 309,642,581        | 38,930       | 539,675,029        |
| Meghalaya                | 123,734       | 955,785,201        | 145,303        | 1,176,178,157      | 185,407      | 1,810,382,164      |
| Mizoram                  | 16,983        | 210,535,641        | 13,860         | 176,995,078        | 23,319       | 314,522,378        |
| Nagaland                 | 7,357         | 107,694,700        | 5,653          | 112,486,224        | 12,483       | 269,303,640        |
| Puducherry               | 2,587         | 10,962,334         | 11,924         | 75,052,560         | 24,907       | 204,106,618        |
| Punjab                   | 422,814       | 4,734,170,676      | 535,475        | 6,689,976,806      | 300,023      | 3,821,386,440      |
| Rajasthan                | 410,463       | 2,420,966,577      | 1,226,774      | 8,270,329,226      | 3,178,441    | 17,010,164,586     |
| Sikkim                   | 2,022         | 16,278,553         | 2,872          | 19,211,267         | 4,833        | 43,903,918         |
| Tamil Nadu               | 1,894,990     | 8,642,942,295      | 4,494,358      | 16,296,759,506     | 1,289,881    | 13,490,439,160     |
| Telangana                |               |                    | 272,384        | 7,724,325,020      | 456,050      | 12,673,319,880     |
| Tripura                  | 30,099        | 241,114,560        | 46,049         | 406,506,314        | 76,574       | 792,188,668        |
| Uttar Pradesh            | 318,684       | 3,025,032,992      | 501,501        | 5,778,366,341      | 845,042      | 12,912,649,393     |
| Uttarakhand              | 121,595       | 1,737,181,478      | 181,965        | 4,009,854,962      | 261,167      | 5,954,550,646      |

## 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 kucha walls and kucha 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. Ragpicker
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

· A patient visits the dedicated PM-JAY kiosk at an empaneled hospital and presents their Ayushman card. In case they do not possess an Ayushman card, the Pradhan Mantri Arogya Mitra (PMAM) shall verify the patient ' s identity and eligibility using NHA ' s beneficiary identification system (BIS) and generate an Ayushman card for the patient.

- Based on the medical condition of the beneficiary, the empaneled hospital raises the request for pre-authorization.
- Once pre-authorization is approved, beneficiary undergoes the treatment as per the approved package.
- Once the treatment is completed, the beneficiary is discharged. At the time of discharge, the beneficiary is provided drugs for 15 days.
- The complete process is cashless and paperless.
- The detailed process flow may be found under:

https://www.pmjay.gov.in/sites/default/files/2018-09/PM-JAY%20Process%20Flow%20at%2 0Empanelled%20Hospitals.pdf

· Under PMJAY, treatments are provided by Empanelled Health Care Providers (EHCPs) to the beneficiaries on the basis of defined Health Benefit Packages (HBPs). A HBP consists of all the costs associated with the treatment, including pre- and post- hospitalization expenses. The detailed list of HBPs under PMJAY maybe found under:

https://pmjay.gov.in/sites/default/files/2022-04/HBP%202022%20..pdf

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