PMJAY Card Eligibility Criteria Details
PMJAY registration - A simple and easy process to avail of quality healthcare services.
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.
Inclusions & Exclusions Under the Ayushman Bharat Yojana
Here’s a breakdown of the Ayushman card benefits and all that is not covered under the Ayushman Bharat Yojana.
What’s Not Covered?
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
Testing and treatment of COVID-19
Drug rehabilitation programme
Cosmetic related procedures
Fertility related procedures
Individual diagnostics (for evaluation purposes)
List of Critical Ailments Covered Under PMJAY Scheme
PMJAY scheme provides funding of ₹5 lakh per family annually. The Pradhan Mantri health insurance benefit can be utilised for daycare procedures and even for pre-existing illnesses. Some of the critical illnesses covered in the PMJAY insurance plan are as follows:
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, 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:
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