Ayushman Bharat , also known as Pradhan Mantri Jan Arogya Yojana (PM-JAY), is a flagship healthcare scheme launched by the Government of India in September 2018. This ambitious healthcare program is aimed at providing financial protection and access to quality healthcare services to the vulnerable and economically disadvantaged sections of society in India. Ayushman Bharat has two main components: 1. Pradhan Mantri Jan Arogya Yojana (PM-JAY): Under this component, eligible families receive health insurance coverage for secondary and tertiary healthcare services. PM-JAY provides coverage of up to INR 5 lakh (approximately USD 6,700) per family per year for hospitalization expenses. It covers a wide range of medical treatments, surgeries, and procedures, including pre- and post-hospitalization expenses. 2. Health and Wellness Centers (HWCs): The second component of Ayushman Bharat aims to strengthen primary healthcare infrastructure in India. Under this initiative, the government is upg...
Standard Guidelines for Claim Processing (SGCP) under Ayushman CAFF Scheme. existing Standard Treatment Guidelines (STG) dated 06.03.2023/; 2. These guidelines will be effective from 15.06.2024 onwards. 3. NHA, CAPFs, O/o Pr. CCA (Home) & O/o ADG (Medical) are requested to widely disseminate these guidelines among hospitals, CAPF person net, CPDs/SAs/DMs/DDOs/PAOs. 4. The bills uploaded on NHA IT portal prior to 15.06.2024 will be processed as per the standard treatment guideline (STG) dated 06.03.2023. 5. NHA is requested to upload these guidelines on Ayushman CAPF Portal. STANDARD GUIDELINES FOR CLAIM PROCESSING UNDER AYUSHMAN CAPF SCHEME A. Each Unit/ Office will detail 02x Master trainers so that Jawans could upload their claims correctly with the help of the master trainers. B. For the persons, proceeding on superannuation/deputation a period of 06 months viewing rights to be allowed for view their claim status. C. FOR OPD CLAIMS (BILLS RAISED BY INDIVIDUAL/HOSPiTAU 1. Re...