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Pradhan Mantri Jan Arogya Yojana (PMJAY)

Pradhan Mantri Jan Arogya Yojana or PMJAY is a health insurance plan designed to financially secure the healthcare expenses of the economically weaker sections of India. Ayushman Bharat Yojana, aims to cover 50 crore citizens of India from both rural and urban regions of the country. Also known as the Ayushman Bharat Yojana, it provides a sum insured of ₹5 lakh, and covers diagnostic cost, medical treatment, hospitalisation, pre-existing illnesses and several critical ailments. 

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What is Ayushman Bharat Yojana or PMJAY Scheme?

The primary aim of the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme is to provide health insurance coverage to approximately 50 crore citizens of India. Due to the requirement for better healthcare services to battle medical contingencies, the government of India introduced this health insurance scheme to secure the economically weaker sections of the country.

Moreover, the Ayushman Bharat Yojana offers an average coverage amount of ₹5 lakh to beneficiaries. This covers a majority of diagnostics, pre-hospitalisation costs, medicines, and medical treatment expenses. In addition to this, the cashless, as well as paperless services, work in favour of the nominees at any given point of time in their lives.

 

Ayushman Bharat Yojana Eligibility Criteria for Rural and Urban People

As we know, over 10 crore families across the country will be provided basic health care under the PMJAY Scheme. Like any other health plan, the Ayushman Bharat Yojana, too, has certain pre-conditions. Depending on these pre-conditions, it decides who can avail the health coverage benefits. When it comes to rural areas, the eligibility criteria mainly depend on the individuals’ living conditions, income, and other deprivations. Whereas for the urban areas, it is based on each individual’s occupation.

 

PMJAY Eligibility Criteria: Rural

According to the 71st round of the National Sample Survey Organisation, over 85.9% of people in rural areas do not have access to basic healthcare plans. 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. Also, the families enrolled under the Rashtriya Swasthya Bima Yojana (RSBY) will be covered under the PMJAY scheme.

In the rural areas, this health facility is available to:

  • People belonging to scheduled caste and scheduled tribe families

  • Households with no male member between the age of 16 years and 59 years

  • Beggars and those surviving on alms

  • Families with no individual between the age of 16 years and 59 years

  • Households with no healthy adult individual and at least one physically challenged member

  • Landless families who make a living by working as casual manual labourers

  • Primitive tribal communities

  • Legally released bonded labourers

  • People living in one-room makeshift houses with no proper walls or roof

  • Manual scavenger families

PMJAY Eligibility Criteria: Urban

Much like the rural areas and as per the 71st round of the National Sample Survey Organisation, over 82% of urban families do not have access to adequate healthcare insurance. Furthermore, over 18% of the urban population avails health facilities by borrowing money in one form or another.

With the PMJAY scheme, these people can avail healthcare services, as the funding provided is ₹5 lakh per family. According to the Socio-Economic Caste Census 2011, the Ayushman Bharat Yojana in the urban areas is beneficial to workers’ families. Moreover, the families enrolled under the Rashtriya Swasthya Bima Yojana (RSBY) will be covered under the PMJAY scheme.

In the urban areas, the PMJAY scheme can be availed mainly by:

  • Washerman/ Chowkidars

  • Rag Pickers

  • Mechanics, electricians, and repair workers

  • Domestic help

  • Sanitation workers, gardeners, and sweepers

  • Home-based artisans and handicraft workers

  • Tailors

  • Cobblers, hawkers, and people providing services by working on streets or pavements

  • Plumbers, masons, construction workers, porters, welders, painters, and security guards

  • Transport workers such as drivers, conductors, helpers, cart, or rickshaw pullers

  • Assistants, peons of a small organisation, delivery men, shopkeepers and waiters

Who are Not Entitled to Health Coverage Under PMJAY Scheme?

People are not eligible for availing health services under the Ayushman Bharat Yojana if they:

 

  • Own a two, three, or four-wheeler or a motorised fishing boat

  • Have a mechanised farming equipment

  • Have a Kisan card with a credit limit of ₹50,000

  • Are employed by the government

  • Work in government-managed non-agricultural enterprises

  • Earn a monthly income above ₹10,000

  • Own refrigerators and landlines

  • Are with decently build houses

  • Own agricultural land of 5 acres or more

Inclusions & Exclusions Under the Ayushman Bharat Yojana

What’s Covered?

What’s Not Covered?

 

Pre-hospitalisation expenses

 

 

Post-hospitalisation expenses for up to 15 days

 

 

Medical examination, consultation and treatment

 

 

Intensive and non-intensive care services

 

 

Medical consumables and medicines

 

 

Diagnostic and laboratory investigations

 

 

Any complications arising during treatment

 

 

Medical implantation facility, only if required

 

 

Food services

 

 

Accommodation benefit

 

 

Testing and treatment of COVID-19

 

 

OPD

 

 

Drug rehabilitation programme

 

 

Cosmetic related procedures

 

 

Fertility related procedures

 

 

Organ transplant

 

 

Individual diagnostics (for evaluation purposes)

 

 

List of Critical Ailments Covered Under PMJAY Scheme

PMJAY scheme provides funding of ₹5 lakh per family annually. The benefit can be utilised for daycare procedures and even for pre-existing illnesses. Some of the critical illnesses covered in the 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

How to Register for PMJAY Scheme?

There is no specific process to register for the Ayushman Bharat Yojana. It applies to all beneficiaries as identified by the SECC 2011 and those who are already a part of the RSBY plan. In case you want to check whether you are eligible to be a beneficiary of the PMJAY scheme, follow the steps below:

Step 1: Visit the PMJAY government website (https://www.pmjay.gov.in/) and click on 'Am I Eligible’.

Step 2: Enter your contact information and click on 'Generate OTP’.

Step 3: Select your state and search by name/HHD number/ration card number/mobile number.

Step 4: Based on the results, you can verify whether your family is covered under the PMJAY scheme.

Moreover, to know about Ayushman Bharat Yojana eligibility, you can contact any Empanelled Health Care Provider (EHCP) or Ayushman Bharat Yojana call centre at 14555 or 1800-111-565.

Documents Required to Apply for the Ayushman Bharat Yojana Scheme

  • A certified document confirming your age and identification

  • Existing contact details of the buyer

  • Income certificate

  • Caste certificate

  • A document stating the current family status

Steps to Check Your Name in the PMJAY List

Checking your name in the AB-PMJAY list is quite easy. It includes three different methods:

  • Visit the Common Service Centre (CSC) of PMJAY:

You can visit the nearest located PMJAY CSC or any empanelled hospital to check whether you are eligible for the Ayushman Bharat Yojana scheme or not.

  • Contact the Helpline Number:

The Ayushman Bharat scheme allows you to check your eligibility by simply contacting the helpline number 14555 or 1800-111-565.

  • Visit PMJAY Website:

By visiting the official PMJAY website (www.pmjay.gov.in), you can check your eligibility for Ayushman Bharat Yojana.

Now that you know the steps to check your name in the PMJAY list via the official portal, helpline number and the PMJAY CSC, let’s move on to the next section.

How to Download the Ayushman Bharat Yojana Card Online

The PMJAY beneficiaries can avail cashless health care services at any of the empanelled hospitals by simply using the Ayushman card. The beneficiaries are issued an Ayushman card at the time of registration. This e-card card contains all your necessary information and is mandatory to provide it when availing the treatments under the scheme.

To get the Ayushman card, follow the below steps:

Step 1: Visit the official PMJAY website.

Step 2: Login with your registered contact number.

Step 3: Enter the captcha code and generate the OTP (One-Time-Password).

Step 4: Opt for the HHD code.

Step 5: Provide the correct HHD code to the Common Service Centre (CSC) of PMJAY.

Step 6: They will check and verify the details provided.

Step 7: The PMJAY CSC representative (also known as Ayushman Mitra) will complete the remaining process.

Step 8: You will have to pay ₹30 to get the Ayushman card.

Ayushman Bharat Yojana Scheme: Medical Packages and Hospitalisation Process

Individuals, as well as families, can utilise the health coverage of ₹5 lakh provided under the Pradhan Mantri Arogya Scheme. This sum is enough to cover surgical treatments and medical expenses in almost 25 specialities that include:

  • Cardiology

  • Neurology

  • Oncology

  • Paediatrics

  • Orthopaedics

However, you cannot reimburse medical and surgical expenses simultaneously. In the case of multiple surgeries, the surgery with the highest cost is paid in the first instance; then a 50% waiver is offered for the second surgery and a 25% discount on the third.

Additionally, unlike other health insurance plans , PMJAY has no waiting period for pre-existing illnesses. This service comes under a larger umbrella scheme of Ayushman Bharat Yojana. So, in case you or any of your loved ones need immediate medical assistance, you do not have to worry about the expenses incurred. However, make sure that the individual seeking treatment is admitted to a network government or private hospital.

Moreover, this scheme also provides cashless treatment and hospitalisation, primarily because of the 60:40 cost-sharing agreement between the Centre and States. Once you are recognised under the plan, you and your family members will be issued the Ayushman card by professionals identified as Ayushman Mitras. The PMJAY or Ayushman card is an e-card that allows you to avail the benefits of Pradhan Mantri Jan Arogya Yojana at any of the network hospitals.

Check Here: Difference Between Network & Non-Network Hospitals in Health Insurance

PMJAY Scheme: Key Things to Consider

  • Services

    Under the Pradhan Mantri Jan Arogya Yojana 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 PMJAY scheme, one can ensure paperless and scalable health insurance plans. The paperless transaction is possible under the leadership of the National Institution for Transforming India (NITI) Aayog.

  • Premium

    The health insurance premiums are a significant aspect for the continuance of the policy in the long run. Since the State health agencies of India fix the premium, it is affordable.

  • Families

    The benefits of Ayushman Bharat Yojana schemes are provided to either over 10.74 vulnerable families or approximately 50 crore beneficiary families.

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

You can lodge a complaint or grievance online on the CGRMS portal of the PMJAY scheme: www.cgrms.pmjay.gov.in

In case you want to lodge a complaint offline, you can do so by:

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

  • Sending a letter, email, or fax to the official addresses of the SHA/NHA

  • Directly meeting the District Grievance Nodal Officer (DGNO) of your district where the complaints are formally processed. The DGNO will enter the contents of grievances received via offline mode in the portal.

For additional technical support related to the PM Jan Arogya Yojana, you can head to https://mera.pmjay.gov.in/search/login.

To sum up, the exorbitant medical expenses have made having comprehensive health insurance the need of the hour. However, certain people cannot afford the Health Insurance Plans. The PM Jan Arogya Yojana programme is a measure to help underprivileged families tackle medical emergencies. In the end, health is an essential aspect of our lives. Hence, it should not be ignored, at any cost. Ayushman Bharat online registration can be done in order to get access to quality healthcare under this programme. Thus eventually, every citizen of our country will be able to lead a worry-free 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 also offers the facility to check your eligibility for the scheme and search the empanelled hospitals around you.

To Conclude

Pradhan Mantri Jan Arogya Yojana is one of the world’s largest national health insurance schemes. Under this medical insurance scheme, the government has launched several healthcare initiatives like National Health Protection Scheme (NHPS), Rashtriya Swasthya Bima Yojana (RSBY), Senior Citizen Health Insurance Scheme (SCHIS), Central Government Health Scheme (CGHS) and Employees’ State Insurance Scheme (ESIS). Get exclusive insights and details related to all healthcare programs under the AB-PMJAY scheme at Bajaj Markets.

Moreover, since the PM Jan Arogya Yojana scheme was launched recently, a majority of people are unaware of this government initiative. Hence, you can go through these top frequently asked questions (FAQs) about the Ayushman Bharat Yojana Scheme mentioned below.

In case you are not covered under the PMJAY scheme, you can also check out pocket insurance plans available on Bajaj Markets. Each plan focuses on specific healthcare needs and comes for a premium starting at ₹19!

Latest News around the AB-PMJAY Scheme

Ayushman Bharat PMJAY hospital admissions hit the 3-crore mark

The Ayushman Bharat PMJAY (Pradhan Mantri Jan Arogya Yojana) has successfully crossed 3 crore hospital admissions. As admissions tick 3.23 crore till date, ₹36,500 crore have been disbursed as claim amount with over 18 crore cards generated. Since its launch, AB PMJAY has helped over 3 crore beneficiaries. This scheme has thus far administered treatments worth ₹21,584 crore. Furthermore, over 26,000 hospitals have been established to ensure people from both rural and urban areas receive the right medical care. The Ayushman Bharat PMJAY scheme crossed its first milestone with 1 crore hospital admissions on May 20, 2020 and the second milestone with the 2-crore mark on August, 18, 2021.

- April 29, 2022

J&K: NHA CEO reviews implementation progress of PMJAY & ABDM

On April 20, 2022, the National Health Authority (NHA) CEO Dr. R S Sharma reviewed the implementation progress of PMJAY and Ayushman Bharat Digital Mission (ABDM) in Jammu and Kashmir. The NHA CEO appreciated the implementation efforts of the State Health Agency of both programmes in J&K and requested other Union Territories to follow this example. He further mentioned that the Aadhaar seeding of PMJAY cards in J&K stands at 97%, which is higher than the national average. Moreover, Dr. Sharma announced a registration fee waiver at the PMJAY Common Service Centre (CSC) which shall be covered by the NHA.

- April 20, 2022

NHA launches new Health Package Benefit 2022 with 365 new procedures

On April 7, 2022, the National Health Authority launched the new Health Package Benefit 2022, adding 365 new procedures under the PMJAY scheme. The new package was announced at a two-day event in Tamil Nadu, where the total number of procedures available under the plan is 1,949. The new Health Package Benefit 2022 will also introduce differential pricing depending on the level of care and type of city. Furthermore, an initiative of a patient classification system shall be rolled out soon under the PMJAY scheme.

-  April 8, 2022

NHA proposes differential prices for PMJAY medical packages & services

The National Health Authority (NHA) has proposed a new pricing policy for the AB-PMJAY scheme which allows hospitals to charge differential prices depending on the services offered. The new rates will soon be announced in April 2022 where private sector tertiary hospitals and medical colleges are predicted to be the biggest gainers. Some of the new changes proposed include rates of surgical packages in hospitals of tier 1 and 2 cities to be hiked by 25% and 17% than the rate in tier 3 city hospitals. Various costing studies conducted last year suggest that these changes are the highest rise in the prices of treatment packages provided under the plan.

-  March 29, 2022

Delhiites to receive e-health card by 2023: Govt

Chief Minister Arvind Kejriwal on Friday, March 25, 2022 instructed his government officials to distribute e-health cards to the citizens of Delhi by 2023 under the Health Information Management System (HIMS). The e-health card will have all the information regarding the cardholder's medical history, and he/she will be able to seek treatment at any hospital that is linked to the HIMS system. As per officials of the Delhi Government, any person with this e-card will not be required to carry his/her medical reports and documents separately. Kejriwal has instructed the concerned departments to distribute these e-health cards at least 3 months before the implementation of the HIMS system, which is expected to begin in March 2023.

 

- Mar 25, 2022

Central Govt: Hospital admissions worth ₹37,185 crore authorised under AB-PMJAY since its inception

On March 25, 2022, the Minister of State for Health Bharati Pravin Pawar said that from September 2018 to March 21, 2022, hospital admissions worth ₹37,185 crore have been authorised under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). She added that if the beneficiaries availed these healthcare services on their own, it would have led to an out-of-pocket expenditure of up to 1.5-2 times of that incurred under the AB-PMJAY. In a written reply to a question, Bharati Pravin Pawar said that the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana has been successful in curtailing the country’s out-of-pocket expenditure.

- Mar 25, 2022

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FAQs on Pradhan Mantri Jan Arogya Yojana Scheme

✔️What services can be availed under the Ayushman Bharat Yojana Scheme?

Under the Ayushman Bharat Yojana Scheme, the following health care services are covered:

  1. Follow-ups

  2. Daycare surgeries

  3. Pre and post hospitalisation expenses

  4. Newborn expenses and services

✔️How to avail the cashless facility?

Here is the process of availing the cashless benefit under the PMJAY Scheme:

  1. Register at the helpdesk in a network hospital

  2. Validate your health card at the help desk

  3. Admit the patient after the registration

  4. Obtain a pre-approval via emails or any other online medium. However, the pre-authorisation is processed after the patient is admitted.

✔️What is the HHD number in PMJAY?

HHD stands for Household Identification number. It is a 25 character long string variable that uniquely identifies households.

✔️What is the Ayushman card?

The Ayushman card consists of a dedicated number for family identification. AB-NHPM is provided to every eligible family in India. Moreover, a family can obtain an e-card at the time of hospitalisation. However, the beneficiaries do not receive the Ayushman card.

✔️Is the beneficiary charged with any fee?

The beneficiaries need not pay any fee since the services are free of cost. In case of any doubts, they can contact the helpline number.

✔️Is there any cap on the family size or the age of the family members?

There is no restriction on the age limit or the size of the family under the Ayushman Bharat Yojana Scheme. The PM Jan Arogya Yojana is open to all the vulnerable families of India.

✔️When was the PMJAY Scheme launched?

The PMJAY Scheme was formulated by the Prime Minister of India, Narendra Modi on September 25, 2018.

✔️Are pre-existing diseases covered in PM Jan Arogya Yojana?

Yes. All pre-existing medical issues are covered under the PMJAY scheme, and any empanelled hospital cannot deny you treatment for the same.

✔️Is the post-hospitalisation expense covered in Ayushman Bharat Scheme?

Post-hospitalisation expenses are a part of the PMJAY scheme amount offered for the treatment. You have to endure no additional expenditure post discharge. However, make sure you take a follow-up date for the treatment from the hospital before the discharge.

✔️What services are excluded under PM Jan Arogya Yojana?

Outpatient care, drug rehabilitation, cosmetic surgeries and treatments, organ transplant, and fertility treatment are not covered under the PMJAY scheme.

✔️Under Ayushman Bharat insurance, who shall the beneficiary approach for support in empanelled hospitals?

You (the beneficiaries) should approach Ayushman Mitra (an insurance coordinator) who is available at the empanelled hospitals to help people avail the cashless treatment under the PMJAY insurance.