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Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a part of the Ayushman Bharat initiative. It provides health insurance to the economically weaker sections of India. Ayushman Bharat aims to cover 50 crore citizens of India from both rural and urban regions. The Ayushman Bharat Yojana will provide a sum insured of ₹5 Lakhs. This will cover the following expenses:

  • Diagnostic cost

  • Medical treatments

  • Hospitalisation

  • Pre-existing illnesses

  • Several critical ailments

Features of the Ayushman Bharat (PM-JAY) Scheme

PM-JAY scheme makes healthcare accessible to the poorest of poor families in India. Hence, the benefits offered by this health insurance plan are massive. Take a look at these features and benefits offREAD MOREered by the healthcare scheme to every family in need: READ LESS

Health Cover of ₹5 Lakhs.

Health Cover of ₹5 Lakhs.

PM-JAY offers a cover of ₹5 Lakhs for families & individuals living below the poverty line.

Priority to girl child, women, and senior citizens

Priority to girl child, women, and senior citizens

PM-JAY prioritises children (especially the girl child), women, and senior citizens.

Pre-Existing Diseases Covered

Pre-Existing Diseases Covered

This scheme covers pre-existing diseases in all empaneled hospitals across India.

Access to paperless & cashless health care

Access to paperless & cashless health care

PMJAY provides access to quality health care by paperless and cashless means.

Support and coordination by the Arogya Mitra

Support and coordination by the Arogya Mitra

All empaneled hospitals across India has a dedicated Aarogya Mitra to help patients.

Benefits available across India

Benefits available across India

A beneficiary can get treated at any empaneled hospital across India.

Families listed in SECC are covered

Families listed in SECC are covered

All eligible families listed in the SECC database are covered. There is no cap on family size or age of the members.

PMJAY Scheme - Features and Benefits

PMJAY Card Eligibility Criteria Details

Register for PM-JAY with this simple process to avail of quality healthcare services.

 

The National Sample Survey Organisation conducted their 71st round of survey. This survey reports that over 85.9% of people in rural areas do not have access to a basic healthcare plan. Moreover, 24% of the rural population seeks healthcare facilities by borrowing money.

 

This is where the Pradhan Mantri Jan Arogya Yojana scheme comes in handy. It helps these people avoid getting into a debt trap and avail health facilities. This scheme is economically beneficial to underprivileged households. Families who enrol for Rashtriya Swasthya Bima Yojana will be covered under PM-JAY.

Inclusions & Exclusions Under the Ayushman Bharat Yojana

Here is the list of benefits that are covered and all that is not covered under the Ayushman card:

 

What’s Covered?

What’s Not Covered?

1

Pre-hospitalisation expenses for up to 3 days

OPD

2

Post-hospitalisation expenses for up to 15 days

Drug rehabilitation programme

3

Medical examination, consultation, and treatment

Cosmetic related procedures

4

Intensive and non-intensive care services

Fertility related procedures

5

Medical consumables and medicines

Organ transplant

6

Intensive and non-intensive care services

Individual diagnostics (for evaluation purposes)

7

Medical consumables and medicines

 

8

Diagnostic and laboratory investigations

 

9

Any complications arising during treatment

 

10

Medical implantation facility, only if required

 

11

Food services

 

12

Accommodation benefit

 

13

Testing and treatment of COVID-19

 

List of Critical Ailments Covered Under PM-JAY Scheme

PM-JAY scheme provides funding of ₹5 lakh per family annually. The PM-JAY scheme can be used for day care procedures and even for pre-existing illnesses. Some of the critical illnesses covered in the PM-JAY insurance plan are as follows:

  • Prostate cancer

  • Coronary artery bypass grafting

  • Double valve replacement

  • Carotid angioplasty with stent

  • Pulmonary valve replacement

  • Skull base surgery

  • Laryngopharyngectomy with gastric pull-up

  • Anterior spine fixation

  • Tissue expander for disfigurement following burns

  • COVID-19 treatment and testing

Ayushman Bharat Yojana Scheme: Medical Packages and Hospitalisation Process

Individuals and families can utilise the health coverage of ₹5 lakh under this scheme. This can cover surgical and medical expenses of almost 25 specialties that include:

  • Cardiology

  • Neurology

  • Oncology

  • Paediatrics

  • Orthopaedics
     

However, you cannot reimburse medical and surgical expenses simultaneously. Here is the process for multiple surgeries:

  1. The surgery with the highest cost is paid in the first instance

  2. A 50% waiver is offered for the second surgery

  3. A 25% discount on the third
     

Additionally, PM-JAY has no waiting period for pre-existing illnesses. This service comes under a larger umbrella scheme of Ayushman Bharat Yojana. If you need urgent medical assistance, you do not have to worry about the expenses incurred. However, ensure that you seek treatment at a government or private hospital.
 

Moreover, this scheme provides cashless treatment and hospitalisation. This is possible because of the 60:40 cost-sharing ratio between the Centre and States. Upon enrolling you and your family members will receive an Ayushman card. This card is issued and verified by professionals known as Ayushman Mitras. The Ayushman card is an e-card that allows you to avail the benefits of PM-JAY at any of the network hospitals.

PMJAY Scheme: Key Things to Consider

  • Services

    Under the PM-JAY scheme, the private hospitals provide their services at large. Moreover, the beneficiaries can avail the services of primary, tertiary and secondary hospitals.

  • Paperless

    With the PM-JAY scheme, one can ensure paperless and scalable health insurance plans. This is possible because of the National Institution for Transforming India (NITI) Aayog.

  • Premium

    The State health agencies of India decide the premium, making it affordable. The affordable premiums ensure the continuation of this policy.

  • Families

    The benefits of the PM-JAY scheme is provided to over 10.74 families or 50 crore beneficiaries.

Pradhan Mantri Jan Arogya Yojana

How to File a Complaint or Grievance on the PMJAY Portal?

You can file a complaint or grievance on the CGRMS portal. Here is how you can file a complaint offline:

  • Contact the Ayushman Bharat scheme helpline operated by your State/NHA

  • Send a letter, email, or fax to the official SHA/NHA address

  • Meet the District Grievance Nodal Officer (DGNO). Your complaints will be formally processed here. The DGNO will enter your grievances via offline mode in the portal.

For technical support related to the PM-JAY, head to https://mera.pmjay.gov.in/search/login

 

To summarise, comprehensive health insurance is required to handle medical expenses. There are people who cannot afford health insurance plans. The PM-JAY scheme ensures that help is given to underprivileged families. Health is an essential aspect of our lives, and it should not be ignored at any cost. Register online for the Ayushman Bharat card to receive quality healthcare. Thus, every citizen of our country will be able to lead a healthy life.

Contact Information Regarding Ayushman Bharat Yojana

The PMJAY scheme contact and mailing information is as follows:

 

Contact Number:

14555 or 1800-111-565 (both toll-free)

Mailing Address:

National Health Authority of India

3rd, 7th and 9th Floor,

Tower-L,

Jeevan Bharati Building,

Connaught Palace,

New Delhi – 110001

 

You also get easy access to the information related to PM Jan Arogya Yojana with the Ayushman Bharat app. It is available on the Google Play Store for Android users only as of now. The app offers the facility to check your eligibility criteria for the scheme. You can even search for the empanelled hospitals around you.

To Conclude

PM-JAY is one of the world’s largest national health insurance schemes. Under this insurance scheme, the government has launched several healthcare initiatives such as:

  • National Health Protection Scheme (NHPS)

  • Rashtriya Swasthya Bima Yojana (RSBY)

  • Senior Citizen Health Insurance Scheme (SCHIS)

  • Central Government Health Scheme (CGHS)

  • Employees’ State Insurance Scheme (ESIS). 

  • Get exclusive insights for all healthcare programs under the PMJAY at bajajfinservmarkets.in

 

If you are not covered under PM-JAY, you can check out the pocket insurance plans on Bajaj Markets. Each plan focuses on specific healthcare needs and comes for a premium starting at ₹19!

Health Insurance Plans Available at Bajaj Markets

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