This is a government-sponsored scheme with certain elements from the central sector. PMJAY provides a 5 lakh sum insured per family for both secondary and tertiary care (which does not involve the services of a super-specialist). This is a no-cost scheme for the recipients. It’s an entitlement-based programme that focuses on the people identified by the latest Socio-Economic Caste Census (SECC) data as beneficiaries. Individuals can go to any empanelled hospital that accepts cashless payments to make a payment. The beneficiary is considered insured once the database has recognised him or her. The expense of insurance is split around 60:40 between the centre and the state. Under the system, there are approximately 1,400 packaged prices for various medical treatments. These packed costs also include the typical number of days spent in the hospital for a medical procedure, as well as the supporting documentation required. Hospitals are not allowed to charge the beneficiary under any circumstances. A daily limit for medical management has also been established under the scheme. For the proper implementation of PMJAY in collaboration with state governments, the National Health Agency was established as an autonomous institution under the Society Registration Act, 1860.
News Source : The Hindu