Pradhan Mantri Jan Arogya Yojana: Everything you should know about

10 mins read
Pradhan Mantri Jan Arogya Yojana: Everything you should know about

Pradhan Mantri Jan Arogya Yojana(PMJAY), also known as Ayushman Bharat Yojana, is the scheme developed by the government to help economically weak citizens of India, who are in dire need of healthcare facilities.

This health insurance scheme was launched by the Prime Minister of India, Mr. Naredra Modi on 23rd of September 2018, to help the population 50 crore citizens across the country.

By September 2019, according to a report, 18,059 hospitals were empaneled, more than 4,406,461 lakh beneficiaries were admitted, and more than 10 crore e-cards were issued.

National Health Scheme – The Ayushman Bharat Yojana, aims to make tertiary and secondary healthcare entirely cashless. In this scheme, all the beneficiaries get an e-card to use at the empanelled hospital across the country. You can use this card to obtain cashless treatment at any of the empanelled hospitals.

The scheme covers 15 days of post-hospitalization and 3 days of pre-hospitalization expenses. Also, more than 1, 300 procedures with all costs associated with it, such as OT expenses is covered.

Pradhan Mantri Jan Arogya Yojana: Everything you should know about

PMJAY Eligibility Criteria for Rural & Urban People

The aim of this scheme is to provide healthcare to around 10 crore economically challenged families through providing healthcare cover of INR 5 Lakh per family.

Now the 10 crore families are divided into two parts. 8 crore families are from rural areas, and 2.33 crore families are from urban areas.

Pradhan Mantri Jan Arogya Yojana

However, the scheme has its own pre-conditions for who can avail of the healthcare benefits.

1. PMJAY Rural: 

The National Sample Survey Organization revealed that around 85.9 rural households don’t have access to any healthcare insurance or other healthcare privileges.

Moreover, more than 24% of rural families borrow money for accessing healthcare services. This scheme prevents rural families from falling into such debt traps and avail services by providing annual assistance of INR 5 Lakhs per family.

In the rural areas, the PMJAY health cover is available to:

  1. Primitive tribal communities
  2. Families living in one-room makeshift houses with no proper walls or roof
  3. Those living in scheduled caste and scheduled tribe households
  4. Beggars and those surviving on alms
  5. Families with no male member aged 16 to 59 years and Families with no individuals aged between 16 and 59 years
  6. Families having at least one physically challenged member and no able-bodied adult member
  7. Casual manual laborers with landless households
  8. Legally released bonded laborers
  9. Manual scavenger families

2. PMJAY Urban: 

Based on the National Sample Survey Organization’s report, around 82% of the healthcare cover/insurance or assurance. Moreover, 18% of urban families borrow money for accessing healthcare services. This scheme prevents rural families from falling into such debt traps and avail services by providing annual assistance of INR 5 Lakhs per family.

In the urban areas, the PMJAY health cover is available to:

  1. Sanitation workers, gardeners, sweepers
  2. Ragpickers/Domestic help
  3. Mechanics, electricians, repair workers, plumbers, masons, construction workers, porters, welders, painters and security guards
  4. Home-based artisans or handicraft workers, tailors
  5. Cobblers, hawkers and others providing services by working on streets or pavements
  6. Assistants, peons in small establishments, delivery boys, shopkeepers, and waiters
  7. Transport workers like drivers, conductors, helpers, cart or rickshaw pullers

Who is not entitled to the Health Cover under Pradhan Mantri Jan Arogya Yojana

  1. People with who owns a two, three or four-wheeler or a motorized fishing boat
  2. People who own mechanized farming equipment
  3. All those who have Kisan cards with INR 50000 or more credit limit.
  4. Government employees
  5. Those who work in government-managed non-agricultural enterprises
  6. People who are earning INR 10000 and above monthly
  7. People who own refrigerators and landlines
  8. People with decent, solidly built houses
  9. People with 5 acres or more of agricultural land on their name.

Hospitalization Process and Medical Packages in PMJAY

In general, the INR 5 Lakhs health insurance cover provided by the PMJAY scheme can be utilized by both individuals as well as families. The amount is sufficient enough to cover both surgical and medical treatments, such as cardiology, oncology, pediatrics, orthopedics, neurosurgery, etc.

If you are going to have multiple surgeries, the highest package cost is paid for in the first instance, followed by a waiver that you get for the second chance and then a 25% discount for the third. This insurance scheme is unlike any other scheme offered by government and private healthcare insurance providers.

If anyone in the family needs to be hospitalized, then they should not pay anything, but just make sure that you or your family member is admitted to any of the empanelled government/private hospitals.

The 60:40 cost-sharing agreement between the Centre and States makes this cashless treatment and hospitalization possible.

List of Critical Diseases covered under PMJAY scheme:

PMJAY provides coverage for over 1,350 medical packages at empanelled private and public hospitals.

A few critical illnesses that are covered in PMJAY:

  • Skull base surgery
  • Prostate cancer
  • Carotid angioplasty with stent
  • Double valve replacement
  • Anterior spine fixation
  • Pulmonary valve replacement
  • Coronary artery bypass grafting
  • Laryngopharyngectomy with gastric pull-up

Exclusions in PMJAY:

  • OPD
  • Drug rehabilitation program
  • Cosmetic related procedures
  • Fertility related procedures
  • Organ transplants
  • Individual diagnostics (for evaluation)

Also Read: How to Apply for MUDRA Loan in India (2020)

How to Apply for Ayushman Bharat Yojana?

There is no specific or special Ayushman Bharat Registration procedure as such.

PMJAY is applicable to all those who all are already a part of the RSBY scheme and beneficiaries identified by the SECC 2011. But if you want to know whether you are eligible for this scheme, then:

  • First, open the official website and then click on ‘Am I Eligible.’
  • After that, enter your mobile number and the CAPTCHA code.
  • Then click on ‘Generate OTP.’ and you will receive the OTP on your mobile number.
  • Enter the OTP and then click on ‘submit.’
  • After that, select your state and search by name/ mobile number/ ration card number/ HHD number/

The search results will help you can verify if you or your family are eligible for this scheme or not.

There is also another way to do so; you just have to go to any of the PMJAY Empanelled Healthcare Provider (EHCP) or contact on the Ayushman Bharat Yojna Call Centre number: 14555 or 1800-111-565

How to generate the PMJAY Patient Card?

After checking your eligibility for the PMJAY healthcare benefits, then you can work towards getting your e-card. You will need your Aadhaar or Ration card to get your identity verified at a PMJAY kiosk. In order to get your family verified, you will have to provide family identification proofs such as a government certified list of members, a PM letter, and an RSBY card. After the verification process is done, you will get your e-card with your unique AB-PMJAY ID on it.

The benefits of the PMJAY :

1. Healthcare cover of Rs.5 lakh per family: 

The health cover provides a sum of INR 5 Lakh for economically challenged families (Families that are below the poverty line).

The annual subscription is completely free of cost as the annual premium is being footed by the central and state governments in a 60:40 ratio.

2. Priority to the girl child, women, and senior citizens:

There is no cap on the family size and age as this health cover is for all. Also, this scheme holds women, children, and senior citizens over the age of 60 years in special regard.

4. Both secondary and tertiary care is covered:

Secondary and tertiary healthcare is covered under the benefits of this scheme. Specialists like cardiologists, urologists, and advance medical treatments such as cancer, surgery, cardiac surgery, etc.

5. All pre-existing diseases covered:

Not all insurance providers and schemes cover pre-existing diseases, but the PMJAY does, and it makes treatment in all public hospitals mandatory. It means that any individual seeking medical care cannot be turned down.

Sushma Singh

Sushma is a full-time blogger and financial expert. Join Sushma and 10,000 monthly readers here to learn how to save and invest your money wisely.