Hybrid model Current Affairs - 2019

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Implementation of PMJAY

Pradhan Mantri – Jan Arogya Yojana (PM JAY) is a scheme of the government under Ayushman Bharat to reduce the financial burden on poor and vulnerable groups arising out of catastrophic hospital episodes and ensure their access to quality health services.

Implementation of PM JAY

The following steps have been undertaken for the effective implementation of the PM JAY:

  • The State Governments have been given the flexibility to implement PM JAY either through insurance companies, or directly through trust/society, or in a mixed mode. 
  • National Health Agency (NHA) has been set up by the Government to implement PM JAY through State level Health Agencies.
  • A robust IT system has been put in place for effective implementation of the Scheme.
  • Central Grievance Redressal Management System has been set up for receiving grievances. A system has been put in place to acknowledge, record, escalate & resolve grievances as per well-defined process through a three-tier grievance redressal structure.
  • A multi-prong approach has been adopted by putting in place a fraud control mechanism.

PM-JAY scheme would provide poor, deprived rural families and identified occupational categories of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data (approx. 50 crore beneficiaries) with health benefit cover of Rs Five Lakhs per family per year at free of cost. The health benefits under the scheme include more than 1,350 medical packages covering surgery, medical and daycare treatments, cost of medicines and diagnostics.

Implementation Models under the Pradhan Mantri Jan Arogya Yojana

The Pradhan Mantri Jan Arogya Yojana (PM JAY)  proposes three models through which the states can implement the scheme. They are

Insurance Model

Under this Model, the premiums are paid to the insurance company, which administers and pays the claim.

Trust-based model

Under this Model, each State forms its own trust to manage the scheme and claims will be disbursed from a corpus created from central and State government contributions.

Hybrid model

Under this Model, a part of the claim comes under the insurance model while the balance gets processed under the trust.

Pradhan Mantri Jan Arogya Yojana (PM JAY)

Pradhan Mantri – Jan Arogya Yojana (PM JAY) is a scheme of the government under Ayushman Bharat which aims to reduce the financial burden on poor and vulnerable groups arising out of catastrophic hospital episodes and ensure their access to quality health services was conceived.

Under the PM-JAY scheme about 10.74 crore poor, deprived rural families and identified occupational categories of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data (approx. 50 crore beneficiaries) will have health benefit cover of Rs Five Lakhs per family per year at free of cost. The health benefit cover includes more than 1,350 medical packages covering surgery, medical and daycare treatments, cost of medicines and diagnostics.

PM-JAY seeks to accelerate India’s progress towards the achievement of Universal Health Coverage (UHC) and Sustainable Development Goal 3 which calls for ensuring healthy lives and promote well-being for all at all ages.