PRADHAN MANTRI JAN AROGYA YOJANA આયુષ્માન ભારત યોજના PMJAY 2022

આયુષ્માન ભારત યોજના PMJAY 2022

PRADHAN MANTRI JAN AROGYA YOJANA પ્રધાનમંત્રી જન આરોગ્ય યોજના (PMJAY) અંતર્ગત સમગ્ર દેશમાં આયુષ્માન ભારત યોજના ચલાવવામાં આવી રહી છે. ભારત સરકારની આ યોજના હેઠળ દેશના 10 કરોડથી વધુ પરિવારોને લાભ મળશે. આ માટે તમારે આયુષ્માન ભારતનું કાર્ડ બનાવવું પડશે, જેના માટે કેટલીક જરૂરી લાયકાત નક્કી કરવામાં આવી છે. પાત્રતા ધરાવતા લોકો આ કાર્ડ બનાવી શકે છે અને હોસ્પિટલોમાં 5 લાખ સુધીની મફત સારવાર મેળવી શકે છે.

PRADHAN MANTRI JAN AROGYA YOJANA

Ayushman Bharat Yojana is being run across the country under Pradhan Mantri Jan Arogya Yojana (PMJAY). More than 100 million families in the country will benefit under this scheme of the Government of India. For this you have to create a card of Ayushman Bharat, for which some required qualifications have been determined. Eligible people can make this card and get free treatment up to Rs 5 lakh in hospitals.

જો તમે આયુષ્માન ભારત યોજનાનું કાર્ડ મેળવવા માંગતા હો તો આ માટે તમારે પહેલા તમારી પાત્રતા તપાસવી પડશે. આ કામ ખૂબ જ સરળ છે અને ઘરે બેસીને ઓનલાઈન કરી શકાય છે. તમારા મોબાઇલ નંબર સાથે લોગ ઇન કરીને, તમે જાણી શકો છો કે તમારા પરિવારને પ્રધાનમંત્રી જન આરોગ્ય યોજનામાં સમાવવામાં આવેલ છે કે નહીં. પ્રધાનમંત્રી જન આરોગ્ય યોજનાનો લાભ લેવા માટે તમારે કોઇ અરજી કરવાની જરૂર નથી.

If you want to get Ayushman Bharat Yojana card then you have to check your eligibility first. This work is very simple and can be done online from home. By logging in with your mobile number, you can know if your family is included in the Prime Minister’s Public Health Scheme. You do not need to apply to avail the benefits of Pradhan Mantri Jan Arogya Yojana.

PRADHAN MANTRI JAN AROGYA YOJANA

જો તમારા પરિવારને પ્રધાનમંત્રી જન આરોગ્ય યોજનાના લિસ્ટમાં સમાવવામાં આવેલ છે, તો પછી તમે તબીબી સારવાર માટે યોજના સાથે જોડાયેલી કોઈપણ હોસ્પિટલમાં દર વર્ષે 10 લાખ રૂપિયા સુધીનો લાભ મેળવી શકો છો.

આ 4 સરળ સ્ટેપથી જાણો

  1. સૌ પ્રથમ PM જન આરોગ્ય યોજનાની સત્તાવાર વેબસાઇટ mera.pmjay.gov.in પર જાઓ
  2. અહીં તમે ડાબી બાજુ LOGINની ટેબ જોઈ શકશો, અહી મોબાઈલ નંબરની માહિતી પૂછવામાં આવે છે. એન્ટર મોબાઇલ નંબર સાથે કોલમમાં તમારો મોબાઇલ નંબર દાખલ કરો. તેની નીચે તમને કેપ્ચા કોડ ભરવાનું કહેવામાં આવશે, તે દાખલ કરો. આ પછી તમારા મોબાઈલ પર OTP મળશે.
  3. ત્યારબાદ તમારા રાજ્ય અને જિલ્લા પર ક્લિક કરો.
  4. આ કર્યા પછી તમને ડોકયુમેન્ટ અથવા ID નંબર પસંદ કરવાનું કહેવામાં આવશે. આના પર ક્લિક કર્યા પછી સર્ચ પર ક્લિક કરો.

જો તમે આ યોજના માટે પાત્રતા ધરાવો છો તો તમને PM આરોગ્ય યોજના (PMJAY) દ્વારા આયુષ્માન કાર્ડ આપવામાં આવશે. આ કાર્ડ સાથે, તમારા પરિવારને એક વર્ષમાં યોજના સાથે જોડાયેલી કોઈપણ હોસ્પિટલમાં 10 લાખ સુધીની મફત સારવાર મળશે. PMJAY અંતર્ગત, સરકારે દેશભરમાં પસંદ કરેલી હોસ્પિટલોને સૂચિબદ્ધ કરી છે, જેની માહિતી પીએમ જન આરોગ્ય યોજનાની વેબસાઇટ પર ઉપલબ્ધ છે.
ઓફીસીયલ વેબસાઇટ પર જવા માટે અહી ક્લિક કરો.

also read this : vali dikri yojana

Ayushman Bharat

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.”

Ayushman Bharat is an attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service. This scheme aims to undertake path breaking interventions to holistically address the healthcare system (covering prevention, promotion and ambulatory care) at the primary, secondary and tertiary level. Ayushman Bharat adopts a continuum of care approach, comprising of two inter-related components, which are –

  • Health and Wellness Centres (HWCs)
  • Pradhan Mantri Jan Arogya Yojana (PM-JAY)
1. Health and Wellness Centers (HWCs)

 

In February 2018, the Government of India announced the creation of 1,50,000 Health and Wellness Centres (HWCs) by transforming the existing Sub Centres and Primary Health Centres. These centres are to deliver Comprehensive Primary Health Care (CPHC) bringing healthcare closer to the homes of people. They cover both, maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.

Health and Wellness Centers are envisaged to deliver an expanded range of services to address the primary health care needs of the entire population in their area, expanding access, universality and equity close to the community. The emphasis of health promotion and prevention is designed to bring focus on keeping people healthy by engaging and empowering individuals and communities to choose healthy behaviours and make changes that reduce the risk of developing chronic diseases and morbidities.(PRADHAN MANTRI JAN AROGYA YOJANA)

2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)

 

The second component under Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojna or PM-JAY as it is popularly known. This scheme was launched on 23rd September, 2018 in Ranchi, Jharkhand by the Hon’ble Prime Minister of India, Shri Narendra Modi.

Ayushman Bharat PM-JAY is the largest health assurance scheme in the world which aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crores poor and vulnerable families (approximately 50 crore beneficiaries) that form the bottom 40% of the Indian population. The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively. PM-JAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened. It subsumed the then existing Rashtriya Swasthya Bima Yojana (RSBY) which had been launched in 2008. The coverage mentioned under PM-JAY, therefore, also includes families that were covered in RSBY but are not present in the SECC 2011 database. PM-JAY is fully funded by the Government and cost of implementation is shared between the Central and State Governments.(PRADHAN MANTRI JAN AROGYA YOJANA)

Key Features of PM-JAY

 

  • PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government.
  • It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
  • Over 10.74 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
  • PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
  • PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.
  • It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
  • There is no restriction on the family size, age or gender.
  • All pre–existing conditions are covered from day one.
  • Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
  • Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
  • Public hospitals are reimbursed for the healthcare services at par with the private hospitals.

Benefit Cover Under PM-JAY

Benefit cover under various Government-funded health insurance schemes in India have always been structured on an upper ceiling limit ranging from an annual cover of INR30,000 to INR3,00,000 per family across various States which created a fragmented system. PM-JAY provides cashless cover of up to INR10,00,000 to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment.(PRADHAN MANTRI JAN AROGYA YOJANA)

  • Medical examination, treatment and consultation
  • Pre-hospitalization
  • Medicine and medical consumables
  • Non-intensive and intensive care services
  • Diagnostic and laboratory investigations
  • Medical implantation services (where necessary)
  • Accommodation benefits
  • Food services
  • Complications arising during treatment
  • Post-hospitalization follow-up care up to 15 days

The benefits of INR 10,00,000 are on a family floater basis which means that it can be used by one or all members of the family. The RSBY had a family cap of five members. However, based on learnings from those schemes, PM-JAY has been designed in such a way that there is no cap on family size or age of members. In addition, pre-existing diseases are covered from the very first day. This means that any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.(PRADHAN MANTRI JAN AROGYA YOJANA)

Coverage under PM-JAY

Including the poorest and most vulnerable population of any country in the health insurance programme is often the most challenging because they cannot pay any premium and are the hardest to reach. Many times they are also not literate and, therefore, require a very different approach for awareness generation. This is true for most Lower and Middle-Income Countries (LMIC) and India is not an exception.(PRADHAN MANTRI JAN AROGYA YOJANA)

 

Thus, PM-JAY has been rolled out for the bottom 40 per cent of poor and vulnerable population. In absolute numbers, this is close to 10.74 crore (100.74 million) households. The inclusion of households is based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas, respectively. This number also includes families that were covered in the RSBY but were not present in the SECC 2011 database.(PRADHAN MANTRI JAN AROGYA YOJANA)

The SECC involves ranking of the households based on their socio-economic status. It uses exclusion and inclusion criteria and accordingly decides on the automatically included and automatically excluded households. Rural households which are included (not excluded) are then ranked based on their status of seven deprivation criteria (D1 to D7). Urban households are categorised based on occupation categories.(PRADHAN MANTRI JAN AROGYA YOJANA)

In line with the approach of the Government to use the SECC database for social welfare schemes, PM-JAY also identifies targeted beneficiary families through this data.

Rural Beneficiaries (PRADHAN MANTRI JAN AROGYA YOJANA)

 

Out of the total seven deprivation criteria for rural areas, PM-JAY covered all such families who fall into at least one of the following six deprivation criteria (D1 to D5 and D7) and automatic inclusion(Destitute/ living on alms, manual scavenger households, primitive tribal group, legally released bonded labour) criteria:

  • D1- Only one room with kucha walls and kucha roof
  • D2- No adult member between ages 16 to 59
  • D3- Households with no adult male member between ages 16 to 59
  • D4- Disabled member and no able-bodied adult member
  • D5- SC/ST households
  • D7- Landless households deriving a major part of their income from manual casual labour

Urban Beneficiaries for PRADHAN MANTRI JAN AROGYA YOJANA


For urban areas, the following 11 occupational categories of workers are eligible for the scheme:

  • Ragpicker
  • Beggar
  • Domestic worker
  • Street vendor/ Cobbler/hawker / other service provider working on streets
  • Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and other head-load worker
  • Sweeper/ Sanitation worker/ Mali
  • Home-based worker/ Artisan/ Handicrafts worker/ Tailor
  • Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller
  • Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter
  • Electrician/ Mechanic/ Assembler/ Repair worker
  • Washer-man/ Chowkidar

Even though PM-JAY uses the SECC as the basis of eligibility of households, many States are already implementing their own health insurance schemes with a set of beneficiaries already identified. Thus, States have been provided the flexibility to use their own database for PM-JAY. However, they will need to ensure that all the families eligible based on the SECC database are also covered.

 

Expansion of coverage by States under PM-JAY and convergence

Various States have been implementing their own health insurance/assurance schemes over the past couple of decades. Most of these schemes provide cover for tertiary care conditions only. The benefit cover of these schemes is mostly available within the State boundaries except some smaller States have empanelled a few hospitals outside the State boundaries. Very few States had converged their schemes with the erstwhile RSBY scheme and many of them were operating independently. This was due to the lack of flexibility in the design of the RSBY, which although initially helped in quick scale-up but became a challenge over a period of time and offered limited flexibility to the States.

Even though these schemes were targeting the poor and vulnerable, there were large variations across States in terms of eligibility criteria and databases. Few States were using the food subsidy database while some others had created a separate database for their welfare schemes.

The primary objectives for launching PM-JAY were to ensure comprehensive coverage for catastrophic illnesses, reduce catastrophic out-of-pocket expenditure, improve access to hospitalisation care, reduce unmet needs, and to converge various health insurance schemes across the States. PM-JAY will also establish national standards for a health assurance system and is providing national portability of care. At the implementation level, the States are given the flexibility to use their own database if they were already implementing a health insurance/ assurance scheme and were covering more families than those eligible as per the SECC 2011 database. However, such States shall ensure that all families eligible as per the SECC data are covered and not denied benefits.

Implementation Model-PRADHAN MANTRI JAN AROGYA YOJANA

Various States are using different models for implementing their own health insurance/ assurance schemes. Some of them are using the services of insurance companies while others are directly implementing the schemes in their States.

 

Considering the fact that States are at different levels of preparedness and have varying capacity to manage such schemes, PM-JAY provides the States with the flexibility to choose their implementation model. They can implement scheme through assurance/trust model, insurance model or mixed model.

A. Assurance Model/Trust Model

 

This is the most common implementation model adopted by most of the States. Under this model, the scheme is directly implemented by the SHA without the intermediation of the insurance company. The financial risk of implementing the scheme is borne by the Government in this model. SHA essentially reimburses health care providers directly. Even though no insurance company is involved, the SHA employ the services of an Implementation Support Agency (ISA) for claim management and related activities. As there is no insurance company in the picture, apart from day-to-day management and administration of the scheme, the SHA also has to carry out specialised tasks such as hospital empanelment, beneficiary identification, claims management and audits and other related tasks(PRADHAN MANTRI JAN AROGYA YOJANA)

B. Insurance Model

In the insurance model, the SHA competitively selects an insurance company through a tendering process to manage PM-JAY in the State. Based on market determined premium, SHA pays premium to the insurance company per eligible family for the policy period and insurance company, in turn, does the claims settlement and payments to the service provider. The financial risk for implementing the scheme is also borne by the insurance company in this model. However, to ensure that the insurance company does not make an unreasonable profit, the scheme provides for a mechanism where insurance companies can only get a limited percentage of the premium for their profit and administrative costs.(PRADHAN MANTRI JAN AROGYA YOJANA)

After adjusting a defined percentage for expenses of management (including all costs excluding only service tax and any cess, if applicable) and after settling all claims, if there is surplus then 100 per cent of leftover surplus should be refunded by the insurer to the SHA within 30 days. The percentage that will need to be refunded will be as per the following:

a. In Category A States (administrative cost cannot exceed 20%)

  • i. Administrative cost allowed 10% if claim ratio less than 60%.
  • ii. Administrative cost allowed 15% if claim ratio between 60 to less than 70%.
  • iii. Administrative cost allowed 20% if claim ratio between 70 to less than 80%.

b. In Category B States (administrative cost cannot exceed 15%)

  • i. Administrative cost allowed 10% if claim ratio less than 60%.
  • ii. Administrative cost allowed 12% if claim ratio between 60 to less than 70%.
  • iii. Administrative cost allowed 15% if claim ratio between 70 to less than 85%.

In case the claim settlement ratio exceeds 120% (115% in the case of Category B States) in any policy period, then the excess amount shall be initially shared in equal proportion between the insurance company and State Government / Union Territory. Thereupon, out of the excess burden amount, which the State Government / Union Territory has borne, the Central Government shall share the burden in line with the sharing pattern ratio. However, the total contribution of the Central Government along with the premium share and excess burden amount of claim shall not exceed the maximum ceiling amount of share of Central Government, applicable for that particular States / UTs, respectively. Any amount over and above the Central and State Government’s contribution amount shall have to be borne by the insurance company, respectively.

C. Mixed Model

Under this, the SHA engages both the assurance/ trust and insurance models mentioned above in various capacities with the aim of being more economic, efficient, providing flexibility and allowing convergence with the State scheme. This model is usually employed by brownfield States which had existing schemes covering a larger group of beneficiaries.

Financing of The Scheme-PRADHAN MANTRI JAN AROGYA YOJANA

PM-JAY is completely funded by the Government and costs are shared between Central and State Governments. The Government of India decides a national ceiling amount per family that is used to determine the maximum limit of the central share of the contribution. The actual premium discovered through open tendering process or the maximum ceiling of the estimated premium decided by Government of India for the implementation of PM-JAY, whichever is less, would be shared between Central Government and States/UTs in the ratio as per the extant directives issued by Ministry of Finance, from time to time. In addition, administrative cost for implementing the scheme at the State level is also provided under the scheme and shared between Centre and State in the same sharing pattern.

 

The existing sharing pattern is in the ratio of 60:40, for States (other than North-Eastern States & three Himalayan States) and Union Territories with legislature. For North-Eastern States and three Himalayan States (viz. Jammu and Kashmir, Himachal Pradesh and Uttarakhand), the ratio is 90:10. For Union Territories without legislatures, the Central Government may provide up to 100% on a case-to-case basis.

Payment of Central Share

  • Insurance model – A flat premium per family, irrespective of the number of members under PM-JAY in that family, is paid to the State Government which in turn pays this to the insurer based on the number of eligible families.
  • Assurance model – Central share of the contribution is paid based on the actual cost of claims or the ceiling whichever is lower. If the State is using an Implementation Support Agency, then cost of ISA, determined through tender, is also shared between Centre and State.

Expansion of Coverage By States Under PM-JAY, Convergence and Flexibility to The States

Various States have been implementing their own health insurance/assurance schemes over the past couple of decades. Most of these schemes provide cover for tertiary care conditions only. The benefit cover of these schemes is mostly available within the State boundaries except some smaller States who have empanelled a few hospitals outside the State boundaries. Very few States had converged their schemes with the erstwhile RSBY scheme and many of them were operating independently. This was due to the lack of flexibility in the design of the RSBY, which although initially helped in quick scale-up but became a challenge over a period of time and offered limited flexibility to the States.(PRADHAN MANTRI JAN AROGYA YOJANA)

Even though these schemes were targeting the poor and vulnerable, there were large variations across States in terms of eligibility criteria and databases. Few States were using the food subsidy database while some others had created a separate database for their welfare schemes.

The primary objectives for launching PM-JAY were to ensure comprehensive coverage for catastrophic illnesses, reduce catastrophic out-of-pocket expenditure, improve access to hospitalisation care, reduce unmet needs, and to converge various health insurance schemes across the States. PM-JAY will also establish national standards for a health assurance system and is providing national portability of care.

In the spirit of cooperative federalism and keeping in mind variations across the States, a lot of flexibility has been built in the PM-JAY design. Therefore, PM-JAY provides a lot of flexibility to States in terms of scheme design and implementation.

States have been provided the flexibility in terms of the following parameters:

  • Mode of implementation – States can choose the implementation model and can implement the scheme through Trust, Insurance company or Mixed model.
  • Usage of beneficiary data – PM-JAY uses SECC data for targeting the beneficiaries, however, States have been provided flexibility to decide on the dataset for this purpose, if they are covering more beneficiaries than SECC defined numbers. However, State will need to ensure that all beneficiaries eligible as per SECC data are also covered.
  • Co-branding – States can co-brand their existing health insurance/assurance schemes with PM-JAY as per co-branding guidelines of the scheme.
  • Expansion of cover to more people – States can cover more number of families than those defined as per SECC data. For these additional families, full cost will need to be borne by the States.
  • Increasing benefit cover to higher value – If the State want they can even expand the benefit cover beyond `5 lakh per family per year. However, in this case cost of additional cover will need to be completely borne by the State.
  • Revision in package numbers and pricing – PM-JAY provides cover of more than 1300 packages and their prices have been fixed by NHA. However, keeping in view the different disease profile and cost of services variations across the States, flexibility has been provided to the States to expand the number of packages and also within a limit State can also revise the package prices.
  • Reservation of packages for public hospitals – To ensure that such services that can be provided well by Government health facilities are not misused by private providers, NHA has defined a set of conditions that are reserved for only public health care facilities. States can revise list of such conditions that are reserved for public hospitals.
  • IT Systems – Before the launch of PM-JAY some of the States were implementing their own health insurance schemes and were using their own IT systems. PM-JAY provides flexibility that State can continue using their own IT system and share data with NHA on a real time basis in specified format.
  • Payment to public hospitals – States have also been provided flexibility to deduct a certain percentage of claims amount that is paid to public hospitals.

Hospital Empanelment

The supply of health care services under PM-JAY must be ensured through pre-selected, well equipped and well-prepared hospitals to deliver the benefits. Also, the hospitals must be distributed widely enough over the geography so as to ensure optimal accessibility to the eligible families.

 

In order to cater to the increased demands under PM-JAY and also to ensure quality care to the beneficiaries, it is imperative to maintain and grow a network of hospitals that also conform to the quality standards and criteria. This leads to the need of empanelment of hospitals on a pre-emptive basis so that beneficiaries are certain of their rights being honoured in the most convenient, cashless and quality manner.

Empanelment Criteria

Considering the supply side characteristics (nearly 71 per cent of the hospitals are running as proprietorship businesses with less than 25 beds capacity and offering non-specialised general clinical care), two types of empanelment criteria have been evolved. These criteria have been evolved based on the experience of the prevalent practice in other Government-funded health insurance schemes, State-specific regulations related to the quality of care and Clinical Establishment Act 2011.

The detailed criteria for empanelment are available on www.pmjay.gov.in

  • General criteria – For hospitals that provide non-specialised general medical and surgical care with or without ICU and emergency services.
  • Special Criteria (for clinical specialties) – For each specialty, a specific set of criteria has been identified. Under PM-JAY, a hospital is not allowed to select the risk, which means it cannot apply for selected specialties and must agree to offer all specialties to PM-JAY beneficiaries that are offered by it. However, in order to offer a specialised clinical service, the hospital must have necessary specific infrastructure and HR in place as mentioned in the special criteria developed under PM-JAY for the same.
  • Process of hospital empanelment in PM-JAY

    PM-JAY prescribes a two-tier approach to the empanelment of hospitals which is online, transparent and efficient and is completely free for all steps of the process. States are in the stewardship position of the entire process of hospital empanelment and they have the final decision-making power in this regard. At the State level, a State Empanelment Committee (SEC) has been set up under the State Health Agency. At the district level, a District Empanelment Committee (DEC) has been set up.

    Process of hospital empanelment image

    Each empanelled hospital needs to set up a dedicated help desk for the beneficiaries, which is manned by a dedicated staff appointed by the Empanelled Health Care Provider (EHCP). These help desk staff are called Pradhan Mantri Arogya Mitras (PMAMs) and their role is to facilitate treatment of beneficiaries at the hospitals. Every empanelled hospital receives a unique ID also.PRADHAN MANTRI JAN AROGYA YOJANA

    • Hospitals are required to apply online which is free of cost. The progress of the application can also be tracked online.
    • The online applications are scrutinised by the DEC and physical verification of the hospitals is carried out.
    • Following this verification, the DEC submits a recommendation to approve or reject the hospital to the SEC. The final decision regarding empanelment rests with the SEC.
    • Continuous quality improvement and other incentives to empanelled hospitals

      PM-JAY(PRADHAN MANTRI JAN AROGYA YOJANA) incentivises the empanelled hospitals to continuously strive for the attainment of higher quality standards. These incentives are certainly a motivation for the hospitals to attain the said quality standards. The following incentives are being provided under PM-JAY to the hospitals over and above the package rates

    • At the time of empanelment a hospital need not be NABH accredited but if during the course of association with PM-JAY a hospital attains entry level NABH accreditation, it is paid 10 per cent higher package rates. Similarly, the hospital attaining a full accreditation is paid 15 percent higher.
    • Hospitals attached to teaching institutions (medical, PG and DNB courses) are entitled for 10 per cent higher packages.
    • Also, to promote the hospitals to reach out to the beneficiaries in underserved areas, PM-JAY has come up with 10% higher package rates for hospitals which are situated in aspirational districts.

    National Health Care Providers (NHCP)


    Although States are in charge of the empanelment of hospitals, there are eminent tertiary care hospitals and specialised care hospitals that operate as autonomous institutes of excellence directly under the Ministry of Health and Family Welfare (MoHFW) or some other department. Most popular examples of such hospitals are AIIMS, Safdarjang Hospital, JIPMER, PGI Chandigarh, etc. The National Health Authority (NHA) has empanelled these hospitals directly by signing an MoU with each of the facility. Also, all NABH accredited private hospitals in the National Capital Region (NCR) are directly empanelled by NHA to widen the network of service providers. Empanelment of Government hospitals other than those managed by MoHFW is also a major step towards widening the network of hospitals.(PRADHAN MANTRI JAN AROGYA YOJANA)

Leave a Reply