Executive Summary:
The response addresses a parliamentary inquiry regarding the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY). It details the scheme's coverage, review mechanisms for expansion, grievance redressal, inclusion of high-cost treatments, and steps to enhance inclusivity and responsiveness. The scheme aims to provide financial health coverage to vulnerable populations.
Key Points / Main Content:
* **Scheme Overview:**
* ABPMJAY provides ₹5 lakh health coverage per eligible family per year for secondary and tertiary care hospitalizations.
* The Health Benefit Package (HBP) 2022 includes 1,961 procedures across 27 medical and surgical specialties.
* Detailed package information is available at https://pmjay.gov.in/hospital/hbp.
* **Coverage Review and Expansion:**
* ABPMJAY periodically reviews and revises HBPs to include treatments for diseases with significant population impact.
* **Grievance Redressal:**
* Empaneled hospitals cannot deny treatment to eligible beneficiaries.
* A three-tier grievance redressal system exists at District, State, and National levels.
* Beneficiaries can lodge grievances via web portal (Centralized Grievance Redressal Management System CGRMS), call centers (14555), email, or letter.
* Necessary action, including support for treatment, is taken based on the grievance nature.
* **High-Cost Treatments:**
* HBP 2022 covers high-cost treatments, including cancer care (medical, radiation, and surgical oncology) and renal and bone marrow transplants.
* **Inclusivity and Responsiveness:**
* In January 2022, the beneficiary base was revised to 12 crore families.
* In March 2024, eligibility expanded to include 37 lakh Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs), Anganwadi Helpers (AWHs), and their families.
* The scheme has been further extended to cover 6 crore senior citizens aged 70 years and above through Vay Vandana Card, irrespective of their socioeconomic status.
* The number of Health Benefit Packages have been increased from 1,393 to 1,961 procedures to expand coverage and address unmet healthcare needs.
Impact Analysis:
* **Eligible Families:**
* *Impact:* Access to secondary and tertiary healthcare services with financial coverage of ₹5 lakh per year.
* *Action Required:* Utilize the scheme for eligible treatments and follow grievance procedures if needed.
* **Empaneled Hospitals:**
* *Impact:* Obligation to provide treatment to eligible beneficiaries and adhere to scheme guidelines.
* *Action Required:* Stay updated on HBP revisions and ensure compliance with grievance redressal mechanisms.
* **Government (Ministry of Health and Family Welfare):**
* *Impact:* Responsible for the effective implementation, monitoring, and periodic review of the ABPMJAY scheme.
* *Action Required:* Continue to assess and expand the scheme's coverage, address grievances, and enhance inclusivity.
* **ASHAs, AWWs, AWHs and Senior Citizens:**
* *Impact:* Extends coverage to these previously excluded groups, increasing access to healthcare.
* *Action Required:* Enroll in the scheme and understand the benefits and procedures for availing healthcare services.
Key Entities Referenced
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana: A flagship scheme of the Government of India that provides health coverage of 5 lakh per eligible family per year for secondary and tertiary care hospitalizations.
Health Benefit Package 2022: A package master that includes 1,961 procedures across 27 medical and surgical specialties under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.
Accredited Social Health Activists: Included in the expanded eligibility criteria of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in March 2024.
Anganwadi Workers: Included in the expanded eligibility criteria of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in March 2024.
Centralized Grievance Redressal Management System: A web-based portal for beneficiaries to file grievances under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.
State Health Agencies: An agency which can receive grievance letters regarding Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.
Vay Vandana Card: A card through which senior citizens aged 70 years and above are covered under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.
Shri Prataprao Jadhav: The Minister of State in the Ministry of Health and Family Welfare.
GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH ANDFAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 1010
TOBE ANSWERED ON25TH JULY,2025
MEDICALTREATMENTSCOVERED UNDERAYUSHMANBHARAT
1010. SHRIG KUMAR NAIK:
Will the Ministerof HEALTHANDFAMILYWELFAREbe pleased tostate:
(a) the details of specific diseases and medical treatments currently included from coverage
underAyushman Bharat;
(b) whether there is a mechanism put in place for reviewing and potentially expanding the
coverage list to include treatments for diseases that significantly impact the population, if so, the
detailsthereof;
(c) whether the Government has data of the number of cases where patients are denied coverage
under Ayushman Bharat due to exclusions, along with an outline of alternative support measures
availablefor such affected patients, if so, the details thereof;
(d) whether the Government has any consideration of including high-cost treatments, such as
advanced cancer therapies or organ transplants, to ensure that financially vulnerable patients can
accesslife-saving care,if so,the detailsthereof; and
(e) the steps taken/proposed to be taken by the Government to make the scheme more
inclusive andresponsive toevolving healthcareneedsinthe country?
ANSWER
THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND
FAMILYWELFARE
(SHRIPRATAPRAOJADHAV)
(a): Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a flagship
scheme of the Government of India that provides health coverage of ₹5 lakh per eligible
family per year for secondary and tertiary care hospitalizations. Latest Health Benefit
Package, HBP 2022 Package Master includes 1,961 procedures across 27 medical and
surgical specialties, todelivercomprehensive secondary and tertiarylevelhealthcareservices.
The detailsof the packages currentlyincludedunderAB PM-JAYcanbe accessed from
https://pmjay.gov.in/hospital/hbc(b): AB-PMJAYreviews and revises the Health Benefit Packages (HBPs), from time to time,
toinclude treatments for diseases that significantly impactthe population.
(c): As per the terms and conditions of empanelment, hospitals cannot deny treatment to
eligible beneficiaries of the scheme. In instances other than treatment denial due to exclusion
bythe empaneledhospital, beneficiariescanlodge grievances.Under AB-PMJAY, a three-tier
grievanceredressal system at District, StateandNational levelhasbeencreatedtoresolve the
issues faced by beneficiaries in utilizing healthcare services. At each level, there is a
dedicatednodal officer andGrievance Redressal Committees toaddress the grievances.
Beneficiaries can file their grievances using different mediums including web-based portal
Centralized Grievance Redressal Management System (CGRMS), Central & State call
centers (14555), email, letter to State Health Agencies (SHAs) etc. Based on the nature of
grievance, necessary action including providing of support to the beneficiaries in availing
treatmentunderthe scheme, istaken.
(d): Under the AB-PMJAY, the Government provides financial protection for secondary and
tertiary care hospitalizations to eligible beneficiaries. Health Benefit Package (HBP) 2022
includes coverage for high-cost treatments such as cancer care (medical, radiation, and
surgical oncology),aswell asrenalandbone marrow transplants.
(e): In January 2022, Government of India revised the beneficiary base of the scheme from
10.74 crore to 12 crore families, covering the bottom 40% of India’s population. Further, in
March 2024, the eligibility criteria were expanded to include 37 lakh Accredited Social
Health Activists (ASHAs), Anganwadi Workers (AWWs), Anganwadi Helpers (AWHs), and
their families. Recently, the scheme hasbeen further extended tocover 6 crore senior citizens
aged 70 years and above, representing 4.5 crore families, through Vay Vandana Card,
irrespective of theirsocio-economic status.
Further, the number of Health Benefit Packages have been increased from 1,393 to 1,961
procedurestoexpandcoverage and address unmet healthcareneeds.
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