Ayushman Bharat Yojana, also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY), is a flagship health insurance scheme by the Government of India to cater to economically vulnerable Indians who are in need of healthcare services. Rolled out by Prime Minister Narendra Modi in September 2018, the scheme aims to cover about 50 crore citizens in India and already has several success stories to its credit.
Here is an article that covers everything you need to know about the PMJAY, from features and benefits to the application process.
Contents
- What is Ayushman Bharat Yojana (PMJAY) Scheme?
- What is covered under the Ayushman Bharat Yojana Scheme?
- List of critical diseases covered under the Ayushman Bharat Yojana Scheme
- What is not covered under Ayushman Bharat Yojana Scheme?
- Features of Ayushman Bharat Yojana Scheme
- Benefits of Ayushman Bharat Yojana Scheme
- Ayushman Bharat Yojana Scheme eligibility criteria for the rural and urban population
- Who is not entitled to avail the PMJAY scheme?
- PMJAY enrollment process
- Documents required to apply for Ayushman Bharat Yojana Scheme
- Ayushman Bharat Yojana: PMJAY patient card generation
- How to check the name in the Ayushman Bharat Yojana list 2020?
- Medical packages under Ayushman Bharat Yojana Scheme
- Hospitalisation process in PMJAY
- How to check the PMJAY hospital list
- PMJAY toll-free number and address
- PMJAY scheme: COVID-19 coverage
- Frequently asked questions
What is Ayushman Bharat Yojana (PMJAY) Scheme?
Considered as one of the biggest healthcare schemes in the world, the PMJAY scheme aims to provide healthcare to 10 crore Indian families. The scheme is designed specifically for the economically weaker sections of India and provides health insurance coverage of a maximum sum insured amount of Rs. 5 lakh.
This government health insurance scheme includes around 1,400 treatments with all related costs like OT expenses. The coverage includes 3 days of pre-hospitalization and 15 days of post-hospitalization services and is totally free with the annual premiums being footed by the central and state governments in a 60: 40 ratio.
What is covered under the Ayushman Bharat Yojana Scheme?
As mentioned earlier, the Ayushman Bharat Yojana Scheme offers coverage of up to Rs. 5 lakh per family per year for secondary and tertiary hospitalisation care.
The health insurance under AB-PMJAY includes the following components:
- Medical examination, consultation and treatment.
- Pre-hospitalisation coverage of up to 3 days.
- Post-hospitalisation expenses for up to 15 days.
- Medicine and medical consumables.
- Diagnostic and laboratory services.
- Non-intensive and intensive care services.
- Complication arising during treatment.
- Accommodation.
- Food services.
- COVID-19 treatment.
List of critical diseases covered under the Ayushman Bharat Yojana Scheme
Here are some of the critical illnesses covered under the PMJAY:
- Prostate cancer
- Double valve replacement
- Coronary artery bypass grafting
- Anterior spine fixation
- Carotid angioplasty with stent
- Pulmonary valve replacement
- Skull base surgery
- Tissue expander for disfigurement following burns
- Laryngopharyngectomy with gastric pull-up
What is not covered under Ayushman Bharat Yojana Scheme?
Ayushman Bharat Yojana Scheme has a minimal list of exclusions, which include:
- Individual diagnostics
- Out-Patient Department (OPD) expenses
- Fertility treatments
- Drug rehabilitation
- Organ transplant
- Cosmetic surgeries
Features of Ayushman Bharat Yojana Scheme
Below are some of the key features of the PMJAY scheme:
- PMJAY is one of the world’s largest health insurance scheme financed by the Government of India.
- Coverage of up to Rs. 5 lakh per family per annum for secondary and tertiary hospitalisation care across public and private hospitals.
- The scheme covers over 10 crore poor and vulnerable families.
- PMJAY scheme facilitates cashless healthcare services to its beneficiary.
- No restriction on the family size, gender or age.
- The beneficiary can avail services across the country at any of the empanelled public and private hospitals.
- The scheme includes 1,393 medical procedures.
- PMJAY also covers some of the specific pre-existing diseases.
- Includes cost for physician fees, surgeon fees, diagnostic services, room charges, supplies, ICU and IOT services.
Benefits of Ayushman Bharat Yojana Scheme
- Healthcare cover of Rs. 5 lakh per family.
- The scheme includes secondary and tertiary care.
- All families listed in the Socio-Economic Caste Census (SECC) to be covered.
- Priority to the girl child, women and senior citizens.
- Covers all pre-existing diseases and complications arising during the treatment.
- Cashless and paperless registration and admiration.
- Private sector participation to help in the achievement of public health goals.
- No cap on family size, age or gender.
Ayushman Bharat Yojana Scheme eligibility criteria for the rural and urban population
The PMJAY scheme has been launched to cover 40% of poor and economically weaker section of India. This includes 8 crore families in rural areas and 2.33 crore families in urban areas. Broken into smaller units, the scheme aims to cater to 50 crore individual beneficiaries.
As with other government schemes, the PMJAY scheme comes with pre-conditions so that only the underprivileged people of the society can benefit from it.
PMJAY Rural
According to the National Sample Survey Organization (71st round), over 86% of rural households don’t have access to any healthcare insurance or assurance. PM Jan Arogya Yojana’s aim is to help these households avail healthcare services by providing funding of up to 5 lakhs per family. Further, households enrolled under the Rashtriya Swasthya Bima Yojana (RSBY) will benefit from the PMJAY as well.
The PMJAY health cover in rural areas is available to:
- People living in scheduled caste and scheduled tribe households.
- Families with no male members aged between 16 and 59 years.
- Families with no adult member in the age group between 16 and 59 years.
- Disabled member and no able-bodied member in the household.
- Beggars and those surviving on alms.
- Legally released bonded labourers.
- Families living in one-room makeshift houses with no proper roof or walls.
- Landless households whose major source of income is manual casual labour.
PMJAY Urban
The 71st round of the National Sample Survey Organization reveals that over 82% of urban households don’t have access to any kind of healthcare insurance or assurance. PMJAY aims to help this sector avail healthcare services by providing yearly assistance of up to Rs. 5 per family, per year. Here too, any family enrolled under the Rashtriya Swasthya Bima Yojana (RSBY) will come under the ambit of PM Jan Arogya Yojana.
Those who can take advantage of this government-sponsored scheme in urban areas mainly consist of:
- Rag Pickers
- Domestic help
- Chowkidars/ Washerman
- Mechanics, electricians, repair workers
- Sanitation workers, gardeners, sweepers
- Home-based artisans or handicraft workers, tailors
- Transport workers like drivers, conductors, helpers, cart pullers
- Assistants, peons, delivery boys, shopkeepers and waiters
- Cobblers, hawkers and others providing services by working on the street
- Plumbers, masons, construction workers, porters, welders, painters and security guards
Who is not entitled to avail the PMJAY scheme?
- Those who own a two, three or four-wheeler vehicle.
- Those who have Kisan cards with a credit limit of Rs. 50,000.
- Government employees
- Those who are working in government-run non-agricultural enterprises.
- Those who own a motorized fishing boat.
- Those who have mechanized farming equipment.
- Those who are earning more than Rs. 10,000 per month.
- Those who own landline phones or refrigerators.
- Those who own more than 5 acres of agricultural land.
- Those who live in decently built houses.
PMJAY enrollment process
As the PMJAY scheme is specifically designed to cater to the poor and vulnerable sections of the society, there is no enrollment process. Beneficiaries are selected based on the SECC 2011 and who are part of the RSBY plan. Here is how you can check if you’re eligible to be a beneficiary of the PMJAY.
- Visit Ayushman Bharat Pradhan Mantri Jan Arogya Yojana official website (pmjay.gov.in) and click on “Am I Eligible” icon.
- Enter your mobile number and the CAPTCHA code and generate OTP.
- After this, choose your state and search either by your name/mobile number/ HHD number or ration card number.
- Based on the search results, you will know whether or not you’re eligible for the PMJAY scheme.
- Alternatively, you can reach out to any of the Empanelled Health Care Providers (EHCP) or contact the Ayushman Bharat Yojana customer care at 1800-111-565 or 14555.
Documents required to apply for Ayushman Bharat Yojana Scheme
Below is the list of documents to apply for the PMJAY scheme:
- Identity and Age Proof (PAN Card/Aadhar Card)
- Details of your mobile number, email address and residential address.
- Income certificate
- Caste certificate
- Other documents stating your current family status
Ayushman Bharat Yojana: PMJAY patient card generation
Once you know that you’re eligible to avail the PMJAY benefits, you can work towards getting an e-card, which contains all the required information of the patient. It is mandatory for all beneficiaries to present this card at the time of availing the treatment.
Below is a step-by-step guide to getting the PMJAY e-card:
Step 1: Visit the official PMJAY website (mera.pmjay.gov.in/search/login) and log in with your registered mobile number.
Step 2: Enter the ‘Captcha Code’ on the screen to generate the OTP.
Step 3: Opt for the HHD code.
Step 4: Provide the HHD code to the Common Service Centre (CSC), where the HHD code and other details will be checked.
Step 5: The CSC representatives, also known as Ayushman Mitra, will complete the rest of the process.
Step 6: Finally, you’ll need to pay Rs. 30 to get the Ayushman Bharat Card.
How to check the name in the Ayushman Bharat Yojana list 2020?
There are various methods to check if your name is in the PMJAY list 2020, which include:
Online: Visit the official PMJAY website (pmjay.gov.in) and check if you’re eligible for the scheme.
Helpline numbers: You can also contact 14555 or 1800-111-565 to get information about your eligibility for the scheme.
Common Service Centres (CSC): Visit your nearest CSC or any of the empanelled hospitals to check if you’re eligible for the healthcare scheme.
Medical packages under Ayushman Bharat Yojana Scheme
As a beneficiary of the scheme, individuals and families can avail nearly 25 specialities, including:
- Oncology
- Cardiology
- Orthopaedics
- Neurology
- Paediatrics
- COVID-19
It’s important to note that medical and surgical expenses cannot be reimbursed simultaneously. Also, if there are multiple surgeries, the surgery with the highest cost will be paid. For the second, you’ll receive 50%, and for the third, it will be 25%.
Hospitalisation process in PMJAY
All the PMJAY eligible families need not pay anything under the PMJAY scheme subject to being admitted in any of the empanelled public or private hospitals. The entire hospitalisation and treatment process is cashless and there is 60:40 cost-sharing between the state and the centre, respectively.
As a beneficiary, you’ll receive the Ayushman health card which will enable you to avail cashless treatment. With the card, you can avail the benefits of the scheme at any of the empanelled public and private hospitals.
How to check the PMJAY hospital list
Follow the below steps to find out the Ayushman Bharat hospital list:
Step 1: Visit the official website of PMJAY (https://hospitals.pmjay.gov.in/Search/empnlWorkFlow.htm?actionFlag=ViewRegisteredHosptlsNew)
Step 2: Select your state and district.
Step 3: Now, choose the type of hospital (public/ private and not for profit/ private-for-profit).
Step 4: Choose the medical speciality you’re looking for.
Step 5: Enter the “Captcha Code” and click on search.
From here, you’ll be redirected to the Ayushman Bharat Yojana hospitals along with their address, website and contact information.
PMJAY toll-free number and address
Below is the toll-free number and address of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana:
Toll-free number:
14555/1800-111-565
Address:
National Health Authority of India
3rd, 7th and 9th Floor,
Tower-L,
Jeevan Bharati Building
Connaught Place,
New Delhi – 110001
PMJAY scheme: COVID-19 coverage
In order to enable beneficiaries to avail the COVID-19 coverage, the Insurance Regulatory and Development Authority (IRDAI) has issued an advisory to all the health and general insurance companies to cover COVID-19 hospitalisation and treatment costs. Therefore, the PMJAY scheme covers COVID-19 treatment and hospitalisation.
COVID-19 patients can avail free treatment at empanelled hospitals through the PMJAY scheme. All you have to do is ensure that you’re a beneficiary of the government-funded scheme.
Frequently asked questions
Here are some of the FAQs of the Ayushman Bharat Yojana (PMJAY) scheme:
What services are offered under the Ayushman Bharat scheme?
Ayushman Bharat scheme covers the cost of hospitalisation, pre-hospitalisation, medication and post-hospitalisation expenses incurred during the treatment. Moreover, the scheme includes over 1,400 exorbitant treatments like knee replacements, skull surgery and the likewise.
Will an ID card be given to the beneficiaries of the PMJAY?
Under the PMJAY scheme, a dedicated ID card is given to the eligible family and a PMJAY ecard is provided to at the time of hospitalisation.
What is the HH ID number?
The HH ID or Household ID number is given to families who are identified under the SECC and contains 24 digits.
How can I get the Ayushman card?
In order to get the Ayushman card, you need to visit the official PMJAY site and log in with your registered mobile number. After completing the verification process, your HHD number will be generated and you’ll need to provide it to your nearest Common Service Centre (CSC). Then the CSC representative will complete the rest of the process.
Does PMJAY covers pre-existing diseases?
Yes, the scheme covers pre-existing diseases.
What services are not covered under the PMJAY scheme?
Healthcare services such as cosmetic surgeries, fertility treatment, organ transplant and drug rehabilitation are excluded from the PMJAY scheme.
Can I avail treatment for coronavirus through PMJAY scheme?
Under the scheme, you can avail both test and treatment for coronavirus or COVID-19 at an empanelled public or private hospital. All you need is your Ayushman Bharat Card and HHD number.
Is Ayushman Bharat Yojana applicable for farmers?
The scheme aims at providing free and accessible healthcare to vulnerable sections of society. You can refer to the above-mentioned details in this article to get detailed information about the eligibility criteria of the scheme.
Is there any death benefit for Ayushman card holders?
No, there is no death benefit for Ayushman card holders.
Whom should I contact at the time of hospitalisation?
Beneficiaries must contact CSC representatives (Ayushman Mitra) to avail cashless treatment at the empanelled hospital.
Does the scheme cover people above the age of 70 and 80?
Under the scheme, there is no cap of family size, age and gender. So, it does cover people above the age of 70 and 80.
How can I change my mobile number in PMJAY?
You need to contact your State Health Agency (SHA) to change your mobile number in PMJAY.
