Table 1 Program design and implementation structure in the Pradhan Mantri Jan Arogya Yojana (PM-JAY)
PM-JAY Program Model | TPA Model | IC Model | Hybrid Model |
|---|---|---|---|
Implementation state | Uttar Pradesh | Chhattisgarh | Tamil Nadu |
Mode of implementation | Trust | Mixed mode | Mixed mode |
Name of state health agency (SHA) | State Agency for Comprehensive and Integrated Services | State Nodal Agency | Tamil Nadu Health Systems Project |
Implementation support agency: insurance company (IC) | None | 1 IC | 1 IC |
Implementation support agency: third-party administrator (TPA) | 4 TPAs | 1 internal TPA (only to support high-value claims) | 3 TPAs |
Previous or pre-existing scheme (including year of termination, if applicable) | RSBY, terminated in 2015 | RSBY, for below-poverty-line population, terminated immediately before PM-JAY launch; MSBY, continuing for all of the non-PM-JAY-eligible population | CMCHIS, continuing for some of the non-PM-JAY-eligible population |
Eligible households for PM-JAY and currently implemented state schemes (September–December 2021)* | 124 million | 27.8 million | 14.7 million |
Geographic location | Northern India | Central India | Southern India |