Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana
The AYUSHMAN BHARAT - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a government funded health insurance scheme which provides free treatment of up to Rs. 5 (five) lakhs per family per year. The scheme provides cover to over 10 crore families in India, and 2.33 lakhs families in Nagaland, who are poor and deprived families. In Nagaland, there are 64 empanelled hospitals running the scheme, 60 government and 4 private hospitals. The beneficiary can go anywhere in the country with their ecard and get free treatment from any empanelled government or private hospital. The scheme covers around 1500 treatment packages which include majority of secondary and tertiary care. The beneficiary does not have to spend money at the point of service that is the hospital.
Status update of Nagaland as on December 9 2019: Percentage coverage of families is 36% of the total target (85174 families with at least 1 (one) ecard in the family, 2.4 lakhs number of individual ecard issued, 6622 number of hospital admissions, hospital admission amount - Rs. 9 crore, number of hospital admissions (patients from Nagaland who have availed benefit) from outside the State is 272 (Preauth amount - Rs. 52.4 lakhs).
Who are eligible? Eligible households are those whose names appear in the Socio Economic and Caste Census (SECC) 2011 deprived categories. Also those who possess RSBY (Rashtriya Swasthya Bima Yojana) 2016 or 2017 issued cards are eligible.
Target Group for Rural (SECC): Total deprived households targeted for AB PM-JAY who belong to one of the six deprivation criteria amongst D1, D2, D3, D4, D5 and D7:
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 (D4)
D5: SC/ST households (D5)
D7: Landless households deriving major part of their income from manual casual labour
Automatically included: Households without shelter, Destitute/living on alms, Manual scavenger families, Primitive tribal groups and legally released bonded labour.
Target Group for Urban (SECC): Occupational categories of workers - Rag picker, beggar, domestic workers, street vendor/cobbler/ hawker/other service provider working on streets, construction worker/plumber/mason/labour/ painter/ welder/ security guard/coolie and another head-load worker, sweeper/sanitation worker/mali, home-based worker/artisan/handicrafts worker/tailor, transport worker/driver/conductor/helper to drivers and conductors/card puller/rickshaw puller, shop worker/assistant/peon in small establishment/helper/delivery assistant/attendant/waiter, electrician/mechanic/assembler/repair worker, washer-man and chowkidar.
Exclusion criteria: As per the SECC 2011, the following beneficiaries are automatically excluded - households having motorised 2/3/4 wheeler/fishing boat, households having mechanised 3/4 wheeler agricultural equipment, households having Kisan Credit Card with credit limit above Rs. 50,000/-, household member is a government employee, households with non-agricultural enterprises registered with government, any member of household earning more than Rs. 10,000/- per month, households paying income tax, households paying professional tax, house with three or more rooms with pucca walls and roof, owns a refrigerator, owns a landline phone, owns more than 2.5 acres or more of irrigated land with one (1) irrigation equipment, owns 5 acres or more of irrigated land for two or more crop season, owning at least 7.5 acres of land or more with at least one irrigation equipment.
How to check eligibility?
· Empanelled Hospital PMJAY helpdesk – Each empanelled hospital has a helpdesk
· Common Service Centre – Village Level Entrepreneurs, IT Deptt.
· mera.pmjay.gov.in – Online search SECC category
· PMJAY mobile App – from Google Palystore
· NGO partners – District specific –
1. Clairvoyance : Kohima (State Manager, Lanusosang – 9366149822 and Clairvoyance Tech- Tali-9612499537), Dimapur and Mokokchung
2. Kalos/KK : Phek
3. ECS/KBBB/TASU : Mon. Tuensang and Longleng
· WhatsApp Eligibility Check Nagaland – 9089776177
If eligible, what documents are required to make PMJAY card?
· Personal ID – Aadhaar/Voter’s ID/Driving License/Govt issued photo ID and RSBY card if beneficiary
· Family ID – Ration card/Village or Ward chairman family proof format
· Each individual will get own card
· Cost of card – In government hospital : Free (Ordinary paper), CSC/NGO on outreach mode : Rs. 30/card, ordinary paper
· Members of the same household whose names are not there can be added on producing proof : Ration card, birth certificate, marriage certificate and adoption certificate
· Entitlement – based scheme, no new family can be enrolled
Where to get benefit?
· In Nagaland 64 Hospitals (60 Public, 4 Private)– All District Hospitals, CHCs and some PHCs, Faith, CIHSR/Referral, House of Hope (ECS) and Impur Christian Hospital
· National portability, all empanelled hospitals (Public +Private) – E.g. Ganga Ram, Apollo Hospital Guwahati, NEIGRIHMS, Shija, AIIMS, etc. (Go to pmjay.gov.in and check hospital list)
What are the benefits?
· IPD (at least 24 hours hospitalization) services including day care procedures
· 1534 treatment packages
· Cashless service
· Covers all the cost associated with the treatment including – medicines, diagnostics, consultations, implants, pre-hospitalisation and post hospitalisation cost
· Exclusions – out–patient care, individual diagnostics (for evaluation), drug rehabilitation programs, cosmetic related, fertility related, transplants involving organs etc.
List of Empanelled Hospital in Kohima District
· Naga Hospital Authority, State Mental Health Institute Kohima, CHC Viswema, CHC Chiephobozou, CHC Tseminyu, UPHC Seikhazou, PHC Sechu Zubza, PHC Botsa and PHC Chunlikha
Beneficiary Identified so far – 20,810 no. of e cards issued, 86% of Aadhar linked e cards and 10,581 no. of families reached with at least 1 (one) e card.