Implementation of PMJAY

Pradhan Mantri Jan Arogya Yojana (PMJAY) is being implemented through the State Governments/UTs. The State Governments have been given flexibility to implement PMJAY either through insurance companies, or directly through trust/society, or in a mixed mode. The payments for treatmentis done on pre-defined package rate basis. Keeping in view the State specific requirements, States/UTs have the flexibility to modify these rates within a limited bandwidth.

National Health Agency (NHA), registered as a society, has been setup by the Government to implement PMJAY through State level Health Agencies. A robust IT system has been put in place for effective implementation of the Scheme. In addition, a Central Grievance Redressal Management System has been designed for receiving grievances. Grievances can be registered on the portal or through the National Call Centre 14555 or through mail, letter, fax etc., which are acknowledged, recorded, escalated & resolved as per well-defined process through a three tier grievance redressal structure.

Further, a multi-prong approach has been adopted by putting in place a fraud control mechanism.

State Governments, through State Health Agencies, empanel hospitals within their jurisdiction to provide care to beneficiary families. As far as private hospitals under PMJAY are concerned, defined criteria and hospital empanelment guidelines have been adopted. The guidelines are available on the website www.pmjay.gov.in.