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.
PMJAY scheme makes quality 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 offered by the healthcare scheme to every family in need:
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.
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)
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
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.
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.
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.
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.
The benefits of Ayushman Bharat Yojana schemes are provided to either over 10.74 vulnerable families or approximately 50 crore beneficiary families.
You can lodge a complaint or grievance online on the CGRMS portal of the PMJAY scheme
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.
The PMJAY scheme contact and mailing information is as follows:
14555 or 1800-111-565 (both toll-free)
National Health Authority of India
3rd, 7th and 9th Floor,
Jeevan Bharati Building,
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.
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!
Under the Ayushman Bharat Yojana Scheme, the following health care services are covered:
Pre and post hospitalisation expenses
Newborn expenses and services
Here is the process of availing the cashless benefit under the PMJAY Scheme:
Register at the helpdesk in a network hospital
Validate your health card at the help desk
Admit the patient after the registration
Obtain a pre-approval via emails or any other online medium. However, the pre-authorisation is processed after the patient is admitted.
HHD stands for Household Identification number. It is a 25 character long string variable that uniquely identifies households.
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.
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.
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.
The PMJAY Scheme was formulated by the Prime Minister of India, Narendra Modi on September 25, 2018.
Yes. All pre-existing medical issues are covered under the PMJAY scheme, and any empanelled hospital cannot deny you treatment for the same.
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.
Outpatient care, drug rehabilitation, cosmetic surgeries and treatments, organ transplant, and fertility treatment are not covered under the PMJAY scheme.
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.