Jt AB PM-JAY-ESIC scheme expanded to 113 districts across 4 states

MP, Maharashtra, Chhattisgarh and Karnataka can now avail cashless treatment under Ayushman Bharat PM-JAY

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.

As per a statement from the National Health Authority (NHA), Ministry of Health & Family Welfare 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, CEO, 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 sensitised 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 NHA to the hospitals against their claims. A dedicated call centre toll-free helpline 14588 has been set up by NHA to take up all queries and grievances from the public.

NHA and ESIC 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) and 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).