West Bengal to Implement Ayushman Bharat PM-JAY

West Bengal will become the 36th State/Union Territory to implement the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). The move marks an important step towards achieving Universal Health Coverage in India and expanding access to affordable healthcare services.

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¨     The National Health Authority (NHA) and the Government of West Bengal will sign a Memorandum of Understanding (MoU) for the implementation of AB PM-JAY, bringing the State under the ambit of the world’s largest publicly funded health assurance scheme.

¨     With the signing of the MoU, West Bengal will become the 36th State/UT in the country to implement the scheme.

¨     The inclusion of West Bengal is expected to provide financial protection against catastrophic health expenditure to millions of eligible beneficiaries and ensure portability of healthcare benefits across India.

¨     The move will strengthen the State’s healthcare ecosystem by improving access to affordable and quality healthcare services through a network of empanelled public and private hospitals.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)

¨     AB PM-JAY is a Centrally Sponsored Scheme under the Ayushman Bharat Mission, anchored by the Ministry of Health and Family Welfare.

¨     The National Health Authority (NHA) is the apex body responsible for implementing the scheme.

¨     It was launched on 23 September 2018 at Ranchi, Jharkhand, by Prime Minister Narendra Modi.

¨     It is regarded as the world’s largest publicly funded health assurance scheme.

¨     The scheme supports about 15 crore poor and vulnerable families and around 55 crore beneficiaries.

Components of Ayushman Bharat

¨     Health and Wellness Centres (HWCs): Provide comprehensive primary healthcare services closer to people’s homes. Cover maternal and child health, communicable and non-communicable diseases, mental health, dental care, eye care and geriatric care.

¨     Pradhan Mantri Jan Arogya Yojana (PM-JAY): Provides health insurance coverage for secondary and tertiary care hospitalization.

Key Features:

¨     Provides health cover of ₹5 lakh per family per year for hospitalization.

¨     Covers pre-existing diseases from day one.

¨     Includes 3 days of pre-hospitalisation and 15 days of post-hospitalisationexpenses.

¨     Offers cashless and paperless treatment at empanelled hospitals.

¨     Benefits are portable across India.

¨     No cap on family size or age for eligible beneficiaries.

Funding Pattern:

¨     General States: Centre (60): State (40).

¨     North-Eastern and Himalayan States: Centre (90): State (10).

¨     Eligibility: Covers poor and vulnerable families identified through the SECC database.Includes rural and urban deprived occupational categories.

¨     Covers all ASHA, Anganwadi Workers (AWWs) and Anganwadi Helpers (AWHs) and their families.

¨     Senior Citizen Expansion (2024): All citizens aged 70 years and above receive coverage regardless of socio-economic status.Eligible senior citizens receive a distinct PM-JAY card.Senior citizens already covered under PM-JAY families get an additional top-up cover of ₹5 lakh annually, separate from the family’s existing cover.Beneficiaries under Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), and Ayushman Central Armed Police Force (CAPF) can choose either their existing scheme or PM-JAY.

Significance

¨     Strengthens Universal Health Coverage (UHC) by expanding access to affordable healthcare.

¨     Reduces catastrophic health expenditure and out-of-pocket medical costs.

¨     Improves healthcare accessibility through a nationwide network of empanelled hospitals.

¨     Provides nationwide portability, allowing treatment across States.

¨     Enhances financial security for senior citizens through expanded coverage.

¨     Contributes to SDG-3 (Good Health and Well-being) and the principle of “Leave No One Behind”.