PMJAY will also pay for pre-hospitalisation drugs and diagnostics for three days before a person is admitted and for two days after discharge
Pre-authorisation for hospitalisations under the Pradhan Mantri Jan Arogya Yojana (PMJAY) will take half an hour, health minister J P Nadda said on Monday. He also unveiled the logo for the Rs 5 lakh health insurance/assurance scheme for 10.74 crore families, set to be launched on September 25.
In a bid to keep a check on “moral hazard” procedures – procedures that are availed by people having health insurance despite their being non-essential just because the money will be reimbursed – there is a provision in the PMJAY guidelines for pre-authorisation. Prer-authorisation will be mandatory for 636 of the 1,350 packages – or 47 per cent of all treatments covered under PMJAY.
Immediately after launch, every eligible family will receive a letter informing them about the entitlements and with the names of all members of the family. The QR code in the letter will be used for verification
Nadda said: “It will take half an hour” in asnwer to a query about whether crucial time will be lost in a patient seeking pre-authorisaion. It is for the same purpose of keeping a check on needless procedures, emergency consultation for acute colic, high fever, cuts, stitches, soft tissue injury, single-bone fracture plaster, nebulization for asthmatic attack, moderate dehydration, hypoglycaemia in a diabetic, dengue without complication, and food poisoning will be covered in the scheme only if the treatment is availed in a government hospital.
The mission which is the tertiery care arm of the flagship NDA health programme Ayushman Bharat will also cover pre-hospitalisation drugs and diagnostics for three days before a person is admitted and for two days after that. Immediately after the September 25 launch, every eligible beneficiary family will receive a letter informing them about the entitlements and with the names of all members of the family. The QR code in the letter will be used for verification of the beneficiaries.
All government hospitals would be deemed to be empanelled and the process of empanelment of private hospitals is on, Nadda said. At a time when data privacy is making headlines regularly, the National health Agency has put together 94 controls to ensure privacy of the data gathered for PMJAY.
