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To register and avail the benefit: Registration
Members of DNT/NT communities are likely to have little or no access to medical facilities and other benefits available under the mainstream health policies. They are so poor that they cannot afford private medical care. It is, therefore, necessary that a separate target group is considered by the Government for assistance in health care for DNTs, NT and SNT communities under scheme like PMJAY Ayushman Bharat through State/UT Governments
The primary objective of the scheme is to provide financial assistance to National Health Authority (NHA) in association with State Health Agencies (SHAs) for undertaking providing a health cover of Rs. 5 lakhs per family per year to DNT, NT and SNT families as per norms of “Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.
The objective for supporting Health Care exclusively for DNT, NT and SNT families separately is to provide the benefits of PMJAY to those DNT/NT /SNT families which are living below poverty line and meet the eligibility criteria defined in this guideline.
Ayushman Bharat, a flagship scheme of Government of India, was launched to achieve the vision of Universal Health Coverage (UHC) with its underlining commitment, which is to "leave no one behind." Ayushman Bharat adopts a continuum of care approach, comprising of two inter-related components, which are-:
Government of India announced the creation of 1,50,000 Health and Wellness Centres (HWCs) by transforming the existing Sub Centres and Primary Health Centres. These centres are to deliver Comprehensive Primary Health Care (CPHC) bringing healthcare closer to the homes of people. Health and Wellness Centers are envisaged to deliver an expanded range of services to address the primary health care needs of the entire population in their area, expanding access, universality and equity close to the community.
India’s flagship public health insurance/ assurance scheme called “Ayushman Bharat Pradhan Mantri Jan Arogya Yojana aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to poor and vulnerable families 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. The coverage mentioned under PM-JAY, also includes families that were covered in RSBY but are not present in the SECC 2011 database.
National Health Authority (NHA) is the apex body responsible for implementing Ayushman Bharat PM-JAY. To implement the scheme at the State level, State Health Agencies (SHAs) have been set up by respective States. SHA is extending the coverage to beneficiaries. Functions of NHA involve set up systems and processes for convergence of PM-JAY with other health insurance/assurance schemes. It aims at following:
Coordination with State Governments for implementation of PM- JAY.
National Health Authority work closely with Insurance Regulatory and Development Authority on development and implementation of Health Insurance Regulations.
Effective implementation of PM-JAY across the country and its regular monitoring.
Carrying out awareness activities for informing beneficiaries and other stakeholders.
Through an insurance cover of Rs.5 lakh per family per annum offered totally free through premiums paid by both the central and state governments, the Pradhan Mantri Jan Arogya Yojana allow the poor to benefit from cashless secondary and tertiary healthcare. AB-PMJAY is an entitlement based scheme rolled out for the bottom 40 per cent of poor and vulnerable population. The inclusion of households is based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas, respectively. Rural households which are included (not excluded) are then ranked based on their status of seven deprivation criteria (D1 to D7). Urban households are categorized based on occupation categories.
Rural Beneficiaries: Out of the total seven deprivation criteria for rural areas, PM-JAY covered all such families who fall into at least one of the following six deprivation criteria (D1 to D5 and D7) and automatic inclusion (Destitute/ living on alms, manual scavenger households, and primitive tribal group, legally released bonded labour) criteria:
Urban Beneficiaries: For urban areas, the following 11 occupational categories of workers are eligible for the scheme:
Even though PM-JAY uses the SECC as the basis of eligibility of households, many States are already implementing their own health insurance schemes with a set of beneficiaries already identified. Thus, States have been provided the flexibility to use their own database for PM-JAY. Thus PM-JAY provides the States with the flexibility to choose their implementation model.
1. The marginalized population like DNT, NT, SNTs with higher need is utilizing the scheme less due to the factors that include eligibility rules, progress on beneficiary validation.
2. The Development and Welfare Board for De-Notified, Nomadic and Semi-Nomadic Communities (DWBDNC) will provide central assistance to the National Health Authority (NHA) for exclusively benefitting DNT communities under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) in partnership with State/UT Health Agencies (SHA). This will leverage the presence of an established NHA/ SHA network under PM-JAY via funds reimbursed under PMJAY.
3. The Ministry proposes to cover DNT, NT and SNT families through NHA/ SHA as follows:
The inclusion of beneficiaries in the scheme is proposed through registration of households of DNT, NT and SNT communities under SHA Assurance model wherein the States can use the flexibility to use the following of criteria for Rural households of DNT, NT and SNT communities as one of deprivation criteria for Rural households:
➢ D1- Houseless or only one room with kucha walls and kucha roof.
➢ D2- No adult member between ages 16 to 59.
➢ D3- Households with no adult male member between ages 16 to 59.
➢ D4- Disabled member and no able-bodied adult member.
➢ D7- Landless households deriving a major part of their income from manual casual labour
The inclusion of beneficiaries in the scheme is proposed through registration of households of DNT, NT and SNT communities under SHA Assurance model wherein the States can use the flexibility to use the following of criteria for urban households of DNT, NT and SNT communities as one of deprivation criteria for urban households:
➢ Ragpicker, Beggar, Street vendor/ Cobbler/hawker / other service provider working on streets
➢ Construction worker/Plumber/Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and other head-load worker
➢ Sweeper/ Sanitation worker/Mali
➢ Home-based worker/ Artisan/ Handicrafts worker/Tailor
➢ Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshawpuller
➢ Shop worker/ Assistant/ Peon in small establishment/ Helper/ Delivery assistant /Attendant/ Waiter
➢ Electrician/ Mechanic/ Assembler/ Repairworker
➢ Washer-man/ Chowkidar
The scheme component will be implemented through National Health Authority (NHA) in association with State/UT Health Agencies (SHA).If applicable, an MoU may be signed between MoSJE/DWBDNC with NHA for implementation of this component. NHA will ensure that SHA take help of the State Social Welfare Department to identify eligible DNT, NT and SNT families and provide the detail list of beneficiaries for PMJAY to State/UT Health Agencies (SHA).
Under the Pradhan Mantri Jan Arogya Yojana for poor to benefit from cashless secondary and tertiary healthcare, an insurance cover of maximum Rs.5 lakh per family per annum in a partnership with the National Health Authority (NHA) and State/UT Health Agencies (SHA) for exclusively benefitting eligible DNT, NT and SNT families will be offered totally free through premiums.
The premium as per the cost norms prescribed by NHA will be paid by the Development and Welfare Board for De-Notified, Nomadic and Semi- Nomadic Communities (DWBDNC) as central assistance to NHA for the annual insurance premium cover contribution in case of eligible DNT, NT and SNT families who shall in a partnership with the State/UT health agencies shall implement the scheme component. This will leverage the presence of an established NHA/ SHA network under PM-JAY via funds reimbursed under PMJAY.
The progress of implementation of the scheme will be reviewed by the DWBDNC through periodic reports from the implementing agencies.
The DWBDNC will conduct review meetings during which NHM would be required to make presentations on the progress.
The DWBDNC is free to make any modification in the aforesaid conditions in consultation with NHM whenever deemed necessary.