Bhubaneswar: Around 3.5 crore individuals will be benefitted from a merger of the Centre’s flagship health insurance scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), and state’s Gopabandhu Jan Arogya Yojana (G-JAY), said the state Health Minister, Mukesh Mahaling, on Friday.
He added that ‘one card’ will be issued to the beneficiaries.
When asked about the deadline for the integrated scheme’s roll-out in the state, the minister said he was hopeful of doing the same by the end of the current financial year.
But, does the total number of beneficiaries for the integrated scheme also include the existing numbers of the state-run insurance scheme? To this, the minister said that the process was on to prepare a comprehensive database of the beneficiaries. A clear picture will be assessed after completion of e-KYC verification of ration cards in the state, he added.
According to reports, under the integrated scheme, male beneficiaries will receive health insurance coverage up to Rs 5 lakh, while female beneficiaries will be covered up to Rs 10 lakh. The initiative also includes special provisions for senior citizens, who are above 70 years of age.
The minister said that 27,000 hospitals would be empanelled under the integrated scheme. Earlier, only 900 hospitals were empanelled under the state-run health scheme, he claimed.
What is Gopabandhu Jan Arogya Yojana (G-JAY)?
The Mohan Majhi-led BJP government had renamed the Biju Swasthya Kalyana Yojana (BSKY)—introduced by the previous BJD government— as Gopabandhu Jan Arogya Yojana during the presentation of the state budget for the financial year 2024-25.
The BSKY has two components. The state government bears full cost of all health services delivered to all patients, irrespective of income, status or residence, in all state-run health care facilities, starting from sub centre-level to district head quarter and government medical college hospital and blood banks.
Under BSKY, the state government also bears the cost of healthcare provided in empanelled private hospitals for over 96.5 lakh economically vulnerable families in the state, amounting to annual health coverage of Rs. 5 lakh per family and additional Rs. 5lakh for the women members of the family after exhaust of the initial limit.
What is Ayushman Bharat scheme?
Under Ayushman Bharat, one of the components is the Pradhan Mantri Jan Arogya Yojana or PM-JAY. This scheme was launched on September 23, 2018 in Ranchi, Jharkhand by Prime Minister Narendra Modi.
Ayushman Bharat PM-JAY aims at providing a health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization to over 12 crore poor and vulnerable families (approximately 55 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.
New facility for senior citizens under Ayushman Bharat
The Ayushman Bharat (AB) Pradhan Mantri Jan Arogya Yojana (PM-JAY) will also extend health insurance coverage of up to Rs 5 lakh annually to all senior citizens aged 70 and above, irrespective of their income status.
Senior citizens who are part of a family already enrolled in PM-JAY will receive an additional top-up of Rs 5 lakh, exclusive to them. The scheme has over 29,000 empanelled hospitals across India.
Senior citizens, who are already covered under public health insurance schemes like the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), or Ayushman CAPF, will have the option to either continue with their existing scheme or opt for AB PM-JAY.
Those under private health insurance policies or the Employees’ State Insurance scheme will also be eligible to avail the benefits of AB PM-JAY.
