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पीएमजेएवाई की फुल फॉर्म प्रधानमंत्री जन आरोग्य योजना है। आयुष्मान भारत योजना, जिसे प्रधानमंत्री जन आरोग्य योजना (PMJAY) के रूप में भी जाना जाता है।
इस योजना को सबसे बड़ी स्वास्थ्य योजनाओं में गिना जाता है। आयुष्मान भारत योजना का लक्ष्य 50 करोड़ से अधिक भारतीय नागरिकों को बीमा कवर देना है। यह गरीबों और आर्थिक रूप से कमजोर लोगों के लिए खासतौर से बनाई गई योजना है। PMJAY को सितंबर 2018 में लॉन्च किया गया था। ईसमें अधिकतम पांच लाख रुपये की बीमा राशि प्रदान की जाती है।
PMJAY अथवा आयुष्मान भारत योजना में दिया गया कवर
गरीबों के लिए आसान और सुलभ स्वास्थ्य सेवा प्रदान करने के इरादे से आयुष्मान भारत योजना हर साल माध्यमिक और तृतीयक अस्पताल में भर्ती देखभाल के लिए हर परिवार को पांच लाख रूपये तक की कवरेज प्रदान करती है।
इस स्वास्थ्य बीमा में लाभार्थियों की अस्पताल में भर्ती लागत और नीचे दी गई सुविधाए शामिल हैं।
1 चिकित्सा परीक्षण, परामर्श और चिकित्सा।
2 अस्पताल पूर्व खर्चे।
3 गहन और गैर गहन देखभाल सेवाएं।
4 चिकित्सा और चिकित्सा उपभोग्य।
5 डायग्नोस्टिक और प्रयोगशाला सेवाएं।
6 चिकित्सा प्रत्यारोपण सेवाएं और खाद्य सेवाएं।
7 इलाज के दौरान उत्पन्न होने वाली जटिलता।
8 पन्द्रह दिवस तक अस्पताल में भर्ती होने का खर्च।
9 COVID-19 (कोरोनावायरस) का उपचार।
योजना के अंतर्गत नहीं आने वाले घटक नीचे दिए गए हैं:
ओपीडी खर्च।
दवा पुनर्वास।
कॉस्मेटिक सर्जरी।
प्रजनन उपचार।
व्यक्तिगत निदान।
अंग प्रत्यारोपण।
नीचे PMJAY योजना की कुछ प्रमुख विशेषताएं हैं:
1:- दुनिया की सबसे बड़ी स्वास्थ्य बीमा योजनाओं में से एक है जो भारत सरकार द्वारा वित्तपोषित है।
2:- सरकारी और प्राइवेट अस्पतालों में माध्यमिक और तृतीयक देखभाल के लिए हर परिवार को प्रति वर्ष पांच लाख रुपये का बीमा कवर दिया जाता है।
3:- योजना के लिए लगभग पचास करोड़ लाभार्थी ( दस करोड़ से अधिक गरीब हकदार परिवार) पात्र हैं।
4:- निदान और दवाओं जैसे पूर्व-अस्पताल में भर्ती होने के 3 दिनों तक का खर्च।
5:- उपचार के लिए चिकित्सालय में भर्ती होने के पश्चात पन्द्रह दिनों तक का व्यय आता है जिसमें दवाएं और डायग्नोस्टिक्स शामिल हैं।
6:-परिवार के सदस्यों, लिंग या आयु पर कोई प्रतिबंध नहीं।
7:-किसी भी सरकारी और प्राइवेट अस्पतालों में किसी भी देश में सेवाओं का लाभ उठा सकते हैं।
8:-पहले से मौजूद सारी शर्तें एक दिन से शामिल हैं।
9:-इस योजना में 1,393 चिकित्सा प्रक्रियाएं शामिल हैं।
इसमें दवाओं, चिकित्सकों की फीस,सर्जन शुल्क, डायग्नोस्टिक सेवाओं, कमरे का शुल्क, आपूर्ति और आईसीयू के खर्चे शामिल हैं।
10:- प्राइवेट अस्पतालों के साथ सरकारी अस्पतालों की प्रतिपूर्ति की जाती है।
PMJAY के लाभ
1:-इसमें कैशलेस के साथ सभी सरकारी और प्राइवेट अस्पतालो में भर्ती खर्च मिलता है।
2:- हॉस्पिटल में भर्ती के दौरान आवास।
3:-पहले और बाद के अस्पताल के भर्ती खर्च।
4:-इलाज के दौरान उत्पन्न होने वाली कोई भी जटिलता।
5:-पूरे परिवार के सदस्यों द्वारा उपयोग किया जा सकता है।
6:-लाभार्थी के परिवार के सदस्यों की संख्या, आयु या लिंग पर कोई प्रतिबन्ध नहीं।
7:-पहले से मौजूद शर्तें पहले दिन से ही इसमें शामिल हैं।
गंभीर रोगों या बीमारियां जो आयुष्मान भारत योजना के तहत कवर किए जाते हैं।
प्रोस्टेट कैंसर।
डबल वाल्व प्रतिस्थापन
खोपड़ी आधार सर्जरी।
पूर्वकाल रीढ़ निर्धारण।
कोरोनरी रक्तवाहिनी बायपास ग्राफ़्ट।
COVID-19।
फुफ्फुसीय वाल्व प्रतिस्थापन।
गैस्ट्रिक पुल-अप के साथ लैरींगोफरींजेक्टोमी
जलने के बाद विघटन के लिए ऊतक विस्तारक।
स्टेंट के साथ कैरोटिड एंजियोप्लास्टी।
ग्रामीण और शहरी जनसंख्या के लिए आयुष्मान भारत योजना के पात्रता मानदंड
यह शहरी क्षेत्रों और ग्रामीण क्षेत्रों के लिए सामाजिक-आर्थिक जाति जनगणना 2011 के अभाव और व्यावसायिक मानदंडों पर आधारित था। आयुष्मान भारत योजना पात्रता पूर्व शर्तों के साथ डिज़ाइन की गई है ताकि समाज के केवल वंचित और गरीब लोगों को ही इसका का लाभ मिले।
PMJAY ग्रामीण क्षेत्रों में मिलने वाले लाभ
वे सभी लाभार्थी इस योजना में शामिल हैं जो कम से कम छह वंचित श्रेणियों में से एक के अंतर्गत आते हैं और स्वचालित रूप से निराश्रित, मैनुअल मेहतर परिवार, भीख मांग कर खाने वाले, आदिम जनजाति समूह, बंधुआ मजदूर शामिल हैं।
1:- घास फूस और मिट्टी की दीवारों और छत के साथ केवल एक कमरे वाले घर।
2:- लाभार्थी परिवार में 16 से 59 साल के बीच आयु वर्ग में कोई वयस्क सदस्य नहीं।
3:- लाभार्थी परिवार में 16 से 59 साल के बीच आयु वर्ग में कोई वयस्क पुरुष सदस्य नहीं।
4:- घर में कोई विकलांग सदस्य नहीं है।
5:- एससी और एसटी
6:- भूमिहीन परिवारों और आय के प्रमुख स्रोत मैन्युअल आकस्मिक श्रम के माध्यम से हैं।
PMJAY शहरी क्षेत्रों में मिलने वाले लाभ
इस योजना के अन्तर्गत शहरो के घरों को कब्जे के आधार पर बांटा जाता है। नीचे उन ग्यारह व्यावसायिक श्रेणियों को दिखाया गया है जो आयुष्मान भारत योजना के लिए पात्र हैं:
1- याचक
2- घरेलू कार्य करने वाला
3- कूड़ा उठाने वाला
4- कोब्बलर / स्ट्रीट विक्रेता / हॉकर / सड़क पर अन्य सेवा प्रदाता।
5- प्लंबर / कंस्ट्रक्शन वर्कर / मेसन / पेंटर / लेबर / वेल्डर / सिक्योरिटी गार्ड / कुली
6- स्वीपर / माली / स्वच्छता कार्यकर्ता
7- कारीगर / हस्तशिल्प कार्यकर्ता / दर्जी / गृह-आधारित कार्यकर्ता
8- ड्राइवर / परिवहन कार्यकर्ता / कंडक्टर / गाड़ी या रिक्शा चालक / चालक या कंडक्टर को हेल्पर
9- लघु प्रतिष्ठान / सहायक / सहायक / परिचर / वितरण सहायक / वेटर में दुकान कार्यकर्ता / चपरासी
10- मैकेनिक / इलेक्ट्रीशियन / रिपेयर वर्कर / असेंबलर
11- चौकीदार / वॉशर आदमी
जो इस योजना के तहत स्वास्थ्य सेवा प्राप्त करने के हकदार नहीं हैं वो निम्न प्रकार है:-
1: जो यंत्रीकृत कृषि उपकरण रखते हैं।
2: जो दो, तीन या चौपहिया रखते हैं।
3: जिनके पास किसान कार्ड हैं।
4: जो सरकारी कर्मचारी है।
5: जिनके पास एक मोटर चालित मछली पकड़ने की नाव हैं।
6: जो हर महीने 10,000 रुपये से ज्यादा कमाते हैं।
7: जो सरकार द्वारा संचालित गैर-कृषि उद्यमों में काम करते हैं।
8: जिनके पास 5 एकड़ से अधिक खेती के लिए जमीन है।
9: जो लैंडलाइन फोन या रेफ्रिजरेटर रखते हैं।
10:जिनके पास शालीनता से बने घर हैं।
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