## Report on ESIC Notification Regarding Ayushman Bharat PM-JAY
**1. Executive Summary:**
This report analyzes a notification issued by the Employees State Insurance Corporation (ESIC) regarding the integration of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (ABPMJAY) with ESIC/ESIS hospitals. The notification allows ABPMJAY beneficiaries to access medical services in underutilized ESIC/ESIS hospitals, subject to certain conditions. The core purpose is to improve the utilization of ESIC/ESIS hospitals and expand healthcare access for ABPMJAY beneficiaries. The key finding is the establishment of a framework for user charges and operational modalities, aligning with ABPMJAY package rates for inpatient care in designated hospitals.
**2. Introduction:**
This report provides a comprehensive analysis of the ESIC notification regarding the implementation of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (ABPMJAY) within the ESIC/ESIS framework, based solely on the information provided in the official notification text.
**3. Policy Overview:**
* This is a *New Policy* implementation announcement rather than an amendment.
* **Core Objective(s):** Based on the text, the core objectives are:
* To notify the rate of user charges for ABPMJAY beneficiaries accessing ESIC/ESIS hospitals.
* To facilitate the provision of medical services to ABPMJAY beneficiaries in underutilized ESIC/ESIS hospitals.
* To integrate ABPMJAY with the existing The Other Beneficiaries and Members of their Families Medical Facilities Scheme, 2010.
**4. Background and Rationale:**
This new policy addresses the issue of underutilization within ESIC/ESIS hospitals. The notification suggests that some ESIC/ESIS hospitals have low bed occupancy rates. By allowing ABPMJAY beneficiaries to access these facilities, the policy aims to increase hospital utilization and potentially improve the financial sustainability of these institutions, while expanding healthcare access to ABPMJAY beneficiaries.
**5. Key Provisions / Changes:**
As a new implementation policy, the main components are:
* **Eligibility:** ABPMJAY beneficiaries are eligible to receive medical services at underutilized ESIC/ESIS hospitals.
* **User Charges:** The rate of user charges will be as per the Memorandum of Understanding (MoU) between ESIC and the National Health Authority. The notification confirms that such rates are being formalized.
* **Inpatient Care:** Inpatient Department care charges will align with the extant Ayushman Bharat Pradhan Mantri Jan Arogya Yojna package rates.
* **Definition of Underutilization:** An underutilized hospital is defined as an ESIC/ESIS hospital where the bed occupancy rate is less than 60% during the last two financial years.
* **Operational Modalities:** The Director General of ESIC is responsible for specifying the names of ESIC/ESIS hospitals participating in ABPMJAY and defining the operational modalities through executive orders.
**6. Target Audience and Stakeholders:**
Based on the provided text, the target audience and stakeholders include:
* **Ayushman Bharat Pradhan Mantri Jan Arogya Yojna beneficiaries:** They gain access to a broader network of hospitals, specifically underutilized ESIC/ESIS facilities.
* **Employees State Insurance Corporation (ESIC):** The corporation is responsible for implementing the scheme and managing the integration of ABPMJAY.
* **ESIC/ESIS Hospitals:** Specifically, those hospitals with bed occupancy rates below 60% stand to benefit from increased patient volume.
* **National Health Authority:** The NHA, as a partner with ESIC, will be involved in the overall implementation and financial arrangements.
**7. Implementation Aspects (Inferred):**
* **Responsible Agency:** The Director General of the Employees State Insurance Corporation (ESIC) is responsible for specifying hospital names and operational modalities.
* **Procedures:** The text implies a procedure for identifying underutilized hospitals based on bed occupancy rates. It also suggests the development of executive orders to detail specific operational guidelines.
* **Timelines:** The notification references dates of previous publications related to the policy, implying that implementation is underway. However, specific timelines for full implementation are not explicitly detailed in this text.
**8. Expected Outcomes / Impact of Changes:**
The likely intended outcomes based on the policy's stated provisions in the text are:
* **Increased Utilization of ESIC/ESIS Hospitals:** The policy aims to improve the bed occupancy rates of underutilized hospitals.
* **Enhanced Healthcare Access for ABPMJAY Beneficiaries:** Expanding the network of hospitals accessible to ABPMJAY beneficiaries.
* **Improved Financial Sustainability of ESIC/ESIS Hospitals:** Potentially increasing revenue generation for hospitals with low occupancy rates.
* **Streamlined Healthcare Delivery:** The policy aims to integrate ABPMJAY into the existing ESIC/ESIS framework.
**9. Conclusion:**
The ESIC notification represents a significant step toward integrating the Ayushman Bharat Pradhan Mantri Jan Arogya Yojna with the ESIC/ESIS healthcare system. By allowing ABPMJAY beneficiaries to access underutilized ESIC/ESIS hospitals, the policy aims to improve hospital utilization rates, expand healthcare access, and potentially enhance the financial stability of ESIC/ESIS facilities. The success of this initiative will depend on effective implementation, clear communication of operational modalities, and ongoing monitoring of hospital performance.
Key Entities Referenced
Employees State Insurance Corporation: A government organization responsible for providing social security and health insurance benefits to Indian employees.
National Health Authority: An organization that partners with ESIC for providing services under Ayushman Bharat Pradhan Mantri Jan Arogya Yojna.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojna: A national health insurance scheme in India, also referred to as ABPMJAY.
The Other Beneficiaries and Member of their Families Medical Facilities Scheme, 2010: A medical scheme by Employees State Insurance Corporation.
Employees State Insurance Act, 1948: An act that provides for health insurance of employees.
Employees State Insurance Scheme: A health insurance scheme operated by the Employees State Insurance Corporation
Central Government: The Union Government of India.
New Delhi: The capital of India.
S. BISWAS: Insurance Commissioner
रजिस्ट्री स.ं डी.एल.- 33004/99 REGD. No. D. L.-33004/99
सी.जी.-डी.एल.-अ.-13012021-224365
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असाधारण
EXTRAORDINARY
भाग III—खण् ड 4
PART III—Section 4
प्राजधकार स ेप्रकाजित
PUBLISHED BY AUTHORITY
स.ं 22] गई दिल्ली, ीिधवार, िगवरी 13, 2021/पौष 23, 1942
No. 22] NEW DELHI, WEDNESDAY, JANUARY 13, 2021/PAUSHA 23, 1942
कर्चम ारी राज्य ीीर्ा जगगर्
अजधसचू गा
गई दिल्ली, 22 दिसम् ीर, 2020
सख्ं या : य-ू 11/13/2/2019-जचदकत्स ा I.—िीदक कर्मचारी राज्य ीीर्ा जगगर् द्वारा “अन् य लाभा्थी रर नगके
पररवार के सिस्ट् यों के जलए जचदकत् सा सिजवधा यनिगा, 2010” के अगिसार आयिष्र्ाग भारत/प्रधागर्ंत्री िग आरनग्य यनिगा
(आ.भा./प्र.र्-ं ि.आ.यन) के अंतगमत सेवाएं प्रिाग करगे के जलए राष्ट्रीय स्ट्वास्ट््य प्राजधकरण, भारत सरकार के सा् दकए गए
सर्झौता ज्ञापग के अगिसार प्रयनक्त ा प्रभार कद िर कन आग े अजधसूजचत करग े हते ि र्सौिा अजधसूचगा त्ा इसके प्रकािग
कद जतज् से 30 दिगों कद अवजध कद सर्ाजि तक इससे प्रभाजवत हन सकगे वाले सभी व्यजियों से आपजि रर सिझाव
आर्ंजत्रत करगे के जलए दिगांक 19.10.2020 कन कर्मचारी राज्य ीीर्ा अजधजगयर् 1948 (1948 का 34) कद धारा 97
कद नप धारा (1) के अंतगमत य्ा अपेजित भारत का रािपत्र (असाधारण) के खडं -4 के भाग-III र्ें प्रकाजित कद गई ्ी ;
त्ा िीदक नि रािपत्र अजधसूचगा दिगांक 03.11.2020 कन सावमिजगक कद गई ्ी ;
त्ा प्रभाजवत हन सकग े वाल ेव्यजियों से कनई सिझाव प्राि गहीं हुए ।
अतः अी, िीएसआर 654(ई), दिगांक 04 अगस्ट् त, 2010 कन भारत का रािपत्र (असाधारण), भाग-II, खंड 3,
नप-खंड (i) र् ें अजधसूजचत कद गई “अन् य लाभा्थी रर नगके पररवार के सिस्ट् यों के जलए जचदकत् सा सिजवधा यनिगा,
2010” के अगिच्छेि 7 के सा् परित खंड 6 के नप खडं (1) द्वारा प्रिि िजियों का प्रयनग करते हुए र्हाजगिेिक, कर्मचारी
राज्य ीीर्ा जगगर् एतिद्व् ारा नक्त “अन् य लाभा्थी रर नगके परर वार के सिस्ट् यों के जलए जचदकत् सा सिजवधा यनिगा,
2010” के अतं गतम आयिष् र्ाग भारत/प्रधागर्ंत्री – िग आरनग् य यनिगा के लाभा््मयों कन अन् य लाभा््मयों के रूप र् ें
कर्मचारी राज्य ीीर्ा जगगर् (क.रा.ीी.जग.) या कर्मचारी राज्य ीीर्ा यनिगा (क.रा.ीी.यन.) के अल् प नपयनगी अस्ट् पतालों
178 GI/2021 (1)2 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4]
र्ें जचदकत् सा सिजवधाएं प्रा त करगे के जलए कें्र सरकार द्वारा य्ा अगिर्नदि त प्रयनक्त ा प्रभार िल्ि क त्ा अन् य जववरणों कन
जगम्ग जलजखत ितामधीग अजधसूजचत करत े ह,ैं गार्त :-
i. अंतरंग रनगी जवभाग िेखभाल कद िरें आयिष् र्ाग भारत/प्रधागर्ंत्री-िग आरनग् य यनिगा पककेि िरों कद र्ौिूिा िरों
के अगिसार हनगी;
ii. इस अजधसूचगा के प्रयनिग के जलए क.रा.ीी.जगगर् अ्वा क.रा.ीी.यनिगा के अल् प नपयनगी अस्ट् पताल होंग,े
िहां जपछल ेिन जविीय वषों र् ेंजीस्ट् तर अजधभनग 60 स ेकर् रहा ह;क
iii. आयिष् र्ाग भारत/प्रधागर्ंत्री-िग आरनग् य यनिगा के संींध र्ें क.रा.ीी.जगगर्/क.रा.ीी.यनिगा अल् प नपयनगी
अस्ट् पतालों के गार् रर नगकद पररचालग कायम-रीजतयााँ र्हाजगिेिक, क.रा.ीी.जगगर् द्वारा सर्य-सर्य पर
अजधिासी आििे ों के र्ाध् यर् स े जवजगर्िष्म ट कद िाएंगी ।
एस. जीस्ट्वास, ीीर्ा आयिि
[जवज्ञापग III/4/असा./458/2020-21]
EMPLOYEES’ STATE INSURANCE CORPORATION
NOTIFICATION
New Delhi, the 22nd December, 2020
No U-11/13/2/2019.-Medical I.—whereas draft notification further to notify the rate of user charges as per
Memorandum of Understanding entered by ESIC with National Health Authority, Government of India for providing
services under Ayushman Bharat/ Pradhan Mantri – Jan Arogya Yojna (AB/PM-JAY) by Employees’ State Insurance
Corporation in accordance with “The Other Beneficiaries and Member of their Families Medical Facilities Scheme,
2010” and was published as required under sub-section (1) of section 97 of the Employee’s State Insurance Act, 1948
(34 of 1948) in the Gazette of India (Extraordinary) Part III Section 4 dated 19.10.2020 for inviting objections and
suggestions from all persons likely to be affected thereby, till the expiry of period of thirty days on which the
notification was published;
And whereas, the said gazette notification was made available to the public on 03.11.2020;
And no suggestions were received from the persons likely to be affected;
Now, Therefore, in exercise of the powers conferred by sub-clause (1) of clause 6 of “The Other
Beneficiaries and Members of their Families Medical Facilities Scheme, 2010” notified vide G.S.R 654(E), dated
04th August, 2010 published in the Gazette of India (Extraordinary), part II Section 3, Sub-section (1) read with
paragraph 7 thereof, the Director General, Employees’ State Insurance Corporation, hereby notifies the rate of user
charges and other details, as the Central Government has approved for availing the medical services in the
underutilised Employees’ State Insurance Corporation (ESIC) or Employees’ State Insurance Scheme (ESIS) hospitals
by Ayushman Bharat/Pradhan Mantri – Jan Arogya Yojna beneficiaries, as other beneficiaries, under the said “The
Other Beneficiaries and Members of their Families Medical Facilities Scheme, 2010”, subject to the following
conditions, namely:-
• Inpatient Department care shall be as per the extant rates of Ayushman Bharat/Pradhan Mantri – Jan
Arogya Yojna package rates;
• An underutilised hospital for the purpose of this notification shall be the Employees’ State Insurance
Corporation Hospital or Employees’ State Insurance Scheme Hospital where the bed occupancy is less
than 60% during the last two financial years;
• Name of the ESIC/ESIS underutilised hospitals and their operational modalities regarding Ayushman
Bharat/ Pradhan Mantri – Jan Arogya Yojna shall be as specified by the Director General, Employees’
State Insurance Corporation, from time to time, through executive orders.
S. BISWAS, Insurance Commissioner
[ADVT. III/4/Exty./458/2020-21]
Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064
and Published by the Controller of Publications, Delhi-110054.