NHA- on PMJAY- ESIC Convergence

National Health Authority

Ministry of Health & Family Welfare

Government of India

ESIC beneficiaries of 113 districts across MP, Maharashtra, Chhattisgarh and Karnataka can now avail cashless treatment under Ayushman Bharat PM-JAY

Mumbai, 13^th January 2021: After successfully completing a pilot in Bidar (Karnataka) & Ahmednagar (Maharashtra), the Ayushman Bharat PM-JAY – Employees’ State Insurance Corporation (ESIC) converged scheme has been expanded to 113 districts across four states of Madhya Pradesh (except Indore district), Maharashtra (except South Mumbai area, Pune, and Kolhapur districts), and Chhattisgarh (except Raipur and Korba districts) and four districts of Karnataka – Bidar, Chikballapur, Chikmagalur and Kodagu districts. Starting today 28 lakh ESIC beneficiary families in these districts will be able to avail cashless treatment at any of hospitals empanelled under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana across the country.

Speaking about the expansion of the scheme, Dr. Indu Bhushan, Chief Executive Officer, National Health Authority (NHA) said, “The National Health Authority and ESIC have been working continuously with a common goal to provide social security benefits in the form of cashless healthcare to its insured beneficiaries. We have jointly decided to expand the inpatient services under Ayushman Bharat PM-JAY to all ESIC beneficiaries located in 113 districts across Madhya Pradesh, Maharashtra, Chhattisgarh and Karnataka at any empanelled hospital anywhere across the country. I am pleased to share with you that on the first day of its expanded operations, 10 beneficiaries have already been admitted and receiving treatment under Ayushman Bharat PM-JAY.”

To ensure seamless services to ESIC beneficiaries, NHA has made the necessary changes in the PM-JAY IT platform to enable seamless hospitalisation and claims payment. It has also sensitized the Empanelled Health Care Providers (EHCPs) and different stakeholders to ensure smooth implementation. As under the current process, all the payments for the treatments will be done by the National Health Authority to the hospitals against their claims. A dedicated call centre toll-free helpline 14588 has been setup by National Health Authority to take up all queries and grievances from the general public.

National Health Authority and Employees’ State Insurance Corporation had entered into an agreement to extend cashless treatment to ESIC beneficiaries through the PM-JAY network hospitals and provide increased accessibility to better quality healthcare services and larger choice. The project was launched in a pilot phase in two districts, Bidder (Karnataka) & Ahmednagar (Maharashtra). Under the scheme, 32 beneficiaries availed the inpatient treatment services at PM-JAY hospitals. Based on the learning and experience in the pilot phase, the PM-JAY - ESIC converged scheme has been expanded for beneficiaries residing across 113 districts of 4 states – Chhattisgarh, Madhya Pradesh, Maharashtra and Karnataka (four districts).

About Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is the flagship scheme of Government of India that provides a cover of up to Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crore poor and vulnerable families. PM-JAY provides cashless and paperless access to services for the beneficiary at the point of service. More than 12 crore e-cards have been issued across 32 States and UTs implementing the scheme. 

About National Health Authority (NHA)

The National Health Authority (NHA) is the apex agency of the Government of India responsible for the design, roll- out, implementation and management of Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) and the National Digital Health Mission across the country. NHA functions as an attached office of the Ministry of Health and Family welfare and is governed by a Governing Board chaired by the Union Minister of Health & Family Welfare and has 11 members. Inter-alia, its functions include formulation of PMJAY policies, development of operational guidelines, implementation mechanisms, coordination with State Governments, monitoring and oversight, among others.