Ayushman Bharat-PMJAY: Rates of 400 treatment procedures revised, new package on black fungus added


The National Health Authority (NHA) has revised the Health Benefit Package (HBP) Master under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB- PMJAY). In the revised version of Health Benefit Package (HBP 2.2), rates of some health packages have been increased by 20 percent to 400 per cent under PMJAY, NHA said in a statement.

The NHA further said that rates of around 400 procedure have been revised and one new additional medical management package related to black fungus have also been added.

Currently, Ayushman Bharat PMJAY has 1669 treatment procedures out of which 1080 are surgical, 588 medical and one unspecified package.

Ayushman Bharat PMJAY aims to achieve the target of Universal Health Coverage and provide access to free and affordable healthcare services to the citizens residing in the remotest of the areas. The scheme aims to provide free and cashless healthcare services up to Rs 5 lakhs per family per year to over 10.74 crore poor and vulnerable families (over 53 crore beneficiaries) as per Socio-Economic Caste Census (SECC)-2011 database.

What has changed

The rate revision has been done in the following categories:

(i) radiation oncology procedures

(ii) Medical Management procedures like procedure for dengue, acute febrile illness etc

(iii) surgical package treatment for black fungus

(iv) other procedures like Right/left heart catheterization, PDA closure, Arthrodesis, Cholecystectomy, appendicectomy etc.

Under medical management procedures, rates for ICU with ventilator has been revised by 100 percent, rates for ICU without ventilator by 136 percent, rates for HDU has been revised by 22 percent while prices for routine ward has been revised by 17 percent. The HBP 2.2 is expected to be rolled out from November, 2021.

Commenting on the revision of rates, Union Minister of Health and Family Welfare Mansukh Mandaviya said, “I am glad that the revised version of Health Benefit Packages (HBP 2.2) will strengthen the empanelled hospitals to provide better healthcare services to the beneficiaries under Ayushman Bharat PM-JAY. The revised packages for oncology will enhance cancer care for the beneficiaries in the country. Addition of new packages related to black fungus will be a huge relief to the beneficiaries. I am sure that the rationalised HBP will further improve the uptake of scheme in private hospitals leading to reduced Out-of-Pocket Expenditure for the beneficiaries.”

Dr RS Sharma, CEO, National Health Authority (NHA) said: “We constantly work on the feedback received from stakeholders for rationalization of health benefit package master. Since the inception of the AB PM-JAY scheme, new packages have been added to cover more disease conditions and regular rates of the packages are being revised to provide better healthcare services. These changes are necessitated to ensure effective implementation of the scheme and will be made in the Transaction Management System (TMS) to ensure that there are no challenges in portability. State Health Agencies (SHAs) currently implementing any of the previous versions of HBP can now accept and implement the latest version of HBP 2.2. NHA is doing continuous consultation with stakeholders and eminent professors of premier medical institutes.”

In 2018, Ayushman Bharat PMJAY was launched with the HBP 1.0 with a total of 1,393 packages. Since the inception of the scheme, over 2.2 crore eligible AB-PMJAY beneficiary have been provided with health coverage for secondary, tertiary and day care procedures for treatment of diseases and medical conditions through a vast network of 24,000 Empanelled Health Care Providers (EHCP).

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