Health Insurance and Ayushman Bharat
How PM-JAY Works: Packages, Claims and Hospitals
The scheme pays hospitals fixed package rates for procedures, and the National Health Authority manages claims through an IT platform.
Behind the card.
Packages
Each treatment has a fixed price, such as for hip replacement or dialysis.
Empanelment
Hospitals must apply and meet standards.
Claims
Hospitals submit claims online, and payments follow checks.
Tension
Low rates and delays lead some hospitals to refuse or limit patients.
A package rate
A hospital is paid a fixed sum for a knee replacement under the scheme.
Assuming all hospitals participate equally
Some avoid low-margin treatments.
Key takeaways
- Fixed package rates apply.
- Hospitals are empanelled.
- Claims are online.
- Rates can discourage participation.
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