BENEFITS OF AYUSHMAN BHARAT YOJANA SCHEME

Around 13.44 crore families, accounting for 65 crore people, are potential beneficiaries of the Ayushman Bharat scheme. To date, 32.40 crore people have been issued health cards under this initiative.

Pradhan Mantri Jan Arogya Yojana (PMJAY), widely known as the Ayushman Bharat Yojana Scheme, is a flagship initiative by the Government of India. This health insurance scheme is designed to provide financial protection to the poor, vulnerable, and economically weaker sections of society in times of medical emergencies. 

As per the latest Indian government cabinet meeting held on Wednesday, 11th September, the new rule states that, according to Health Minister Ashwini Vaishnaw, under the Ayushman Bharat PM Jan Arogya Yojana, people above 70 years of age will also be eligible for free treatment with coverage up to ₹5 lakh.
Read this article to understand the benefits of PMJAY and its coverage, including its eligibility criteria, features, benefits, and the application process.

 

What is PMJAY (Ayushman Bharat Yojana Scheme)?

Ayushman Bharat Yojana is advised as one of the largest healthcare schemes in India. The PM-JAY scheme is aiming to cover over 50 crore Indian citizens, especially for those from economically weaker backgrounds. This Scheme launched in September 2018, the PMJAY scheme provides health insurance coverage of up to Rs. 5 lakh per eligible family annually.

The government’s health insurance scheme covers most medical treatment costs, including medicines, diagnostics, and pre-hospitalization expenses. It also offers cashless hospitalization services through the Ayushman Bharat Yojana e-card, which can be used at any empanelled hospital across the country. Beneficiaries can receive treatment simply by presenting their PMJAY e-card.

 

Eligibility Criteria for PMJAY (Rural and Urban)

The PMJAY scheme is designed to cover the bottom 40% of poor and economically weaker sections in India. The eligibility criteria are structured to ensure that only the underprivileged benefit from the scheme.

PMJAY Rural

• Families living in a single-room dwelling made from temporary materials like mud and thatch.
• Families without any adult members between the ages of 16 and 59.
• Families without any adult male members within the age range of 16 to 59 years.
• Families with disabled members and no able-bodied individuals.
• Families belonging to Scheduled Castes (SC) or Scheduled Tribes (ST).
• Landless families where the primary source of income is manual, casual labor.

PMJAY Urban

• Beggars
• Domestic workers
• Ragpickers
• Street vendors and service providers like cobblers and hawkers
• Plumbers, construction workers, masons, and other similar laborers
• Sweepers, gardeners, and sanitation workers
• Artisans, handicrafts workers, and tailors
• Drivers, transport workers, and rickshaw pullers
• Shop workers, peons, and delivery assistants
• Mechanics, electricians, and repair workers
• Security guards and washermen

 

Coverage Under Ayushman Bharat Yojana Scheme

• Medical examinations, consultations, and treatments.
• Pre-hospitalization expenses.
• Non-intensive and intensive care services.
• Medicines and medical consumables.
• Diagnostic and laboratory services.
• Accommodation during hospitalization.
• Medical implants where necessary.
• Food services during hospitalization.
• Complications arising during treatment.
• Post-hospitalization expenses for up to 15 days.
• COVID-19 treatment.

 

Key Features of Ayushman Bharat Yojana Scheme

• It is one of the world’s largest government-funded health insurance schemes.
• Provides coverage of up to Rs. 5 lakh per family per year.
• Covers approximately 50 crore beneficiaries, including over 10 crore poor and vulnerable families.
• Offers cashless hospitalization across empanelled public and private hospitals.
• Covers pre-hospitalization expenses for up to 3 days and post-hospitalization expenses for up to 15 days.
• No rule and conditions on family size, age, or gender.
• Allows beneficiaries to avail services across the country.
• Covers all pre-existing conditions from day one.
• Includes 1,393 medical procedures, covering diagnostics, drugs, room charges, and more.
• Reimbursed at par with private hospitals and public hospitals.

 

The PMJAY scheme offers several key benefits

1. Covers all hospitalization expenses with cashless transactions for beneficiaries.
2. Includes pre and post-hospitalization costs.
3. Covers any complications arising during treatment.
4. Applicable to all family members without restrictions on family size, age, or gender.
5. Pre-existing conditions are covered from day one of admission.

 

Critical Illnesses Covered Under Ayushman Bharat Yojana Scheme

The scheme covers over 1,300 medical packages, including critical illnesses such as:

• Prostate cancer
• Double valve replacement
• Coronary artery bypass graft
• COVID-19 treatment
• Pulmonary valve replacement
• Skull base surgery
• Anterior spine fixation
• Laryngopharyngectomy with gastric pull-up
• Tissue expander for burn-related disfigurement
• Carotid angioplasty with stent

 

How to apply ayushman bharat yojana ? / Enrollment Process for PMJAY 

The PMJAY scheme is an entitlement-based initiative, so there is no enrolment process. Beneficiaries are selected based on the SECC 2011 data and those included in the RSBY plan. To check your eligibility:

• Visit the official PMJAY website (https://pmjay.gov.in/) and click on the “Am I Eligible” icon.
• Enter your mobile number/contact number details to receive the generated OTP.
• Select your state.
• Search/find using your name, HHD number, Contact number or valid ration card number.
• The results will indicate whether you are eligible for the scheme.
• You can also contact the Ayushman Bharat Yojana customer care at 1800-111-565 or 14555, or reach out to any Empanelled Health Care Provider (EHCP).

 

Required Documents for Ayushman Bharat Yojana Scheme

1. Identity and age proof (Aadhaar Card/PAN Card)
2. Mobile number, email address, and residential address
3. Caste certificate
4. Income certificate
5. Documents showing your current family status

 

How to Download the Ayushman Bharat Yojana Card Online

To access cashless, paperless, and portable transactions through the PMJAY scheme, beneficiaries receive the Ayushman Bharat Yojana Golden Card. To get this card:

• Visit the official PMJAY website and log in using your registered mobile number.
• Enter the ‘Captcha Code’ to generate an OTP.
• Opt for the HHD code.
• Provide the HHD code to the Common Service Centre (CSC), where Ayushman Mitra representatives will assist you.
• Pay Rs. 30 to receive your Ayushman Bharat card.

Do you know The ABHA card provides Indian citizens with the facility to access all their health records through a digital platform from any location.

 

Medical Packages Under PMJAY

1. Cardiology
2. Oncology
3. Neurology
4. Pediatrics
5. Orthopedics
6. COVID-19 treatment
7. Pre-existing conditions are covered from the start, ensuring that beneficiaries receive comprehensive care.

 

Hospitalization Process Under PMJAY

If you or a family member needs hospitalization, you can access cashless treatment at any empanelled public or private hospital under the PMJAY scheme. The government shares the cost of hospitalization, with the center and state covering 60% and 40%, respectively. Beneficiaries receive the Ayushman health card, which enables them to access these benefits.

 

How to Find the PMJAY Hospital List

• Visit the official PMJAY website and go to the hospital list section.
• Select your state and district.
• Choose the type of hospital (public/private-for-profit/private and not for profit).
• Select the medical specialty you need.
• Enter the Captcha Code and click search.
• You will be redirected to a list of Ayushman Bharat Yojana hospitals, including their addresses, websites, and contact details.
• You can also check the ‘Suspended Hospital List’ on the same page.

 

Conclusion

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana or Ayushman Bharat Yojana, makes healthcare more accessible and affordable for millions of people in India. By covering medical costs for families in need, it helps ease the burden of unexpected hospital bills and ensures that everyone can get the treatment they need.

If you or your family could benefit from this scheme, check your eligibility and make sure you're covered. It's a simple step that can provide peace of mind and financial security during medical emergencies.

 

FAQs

Q1. Is the Ration Card mandatory for PMJAY card generation?

Ans: Yes, the Ration Card is typically required to verify the family unit.

Q2. What if I do not have a Ration Card?

Ans: If you do not have a Ration Card, you may need to provide other family proof documents like SECC-2011 ID or get assistance from local authorities to confirm your eligibility.

Q3. Can I use a digital copy of my Ration Card?

Ans: Yes, a digital copy of your Ration Card can be used for verification.

Q4. Where can I generate my PMJAY card?

Ans: You can generate your PMJAY card at a Common Service Center (CSC) or an empanelled hospital.

Q5. What types of treatments are covered under PMJAY?

Ans: PMJAY covers a wide range of treatments, including regular illnesses, surgeries, and critical diseases like cancer and heart conditions.

Q6. Is there a limit on the number of family members covered?

Ans: No, there is no cap on the number of family members covered under PMJAY.

Q7. Does PMJAY cover pre-existing conditions?

Ans: Yes, PMJAY covers all pre-existing diseases from the first day of enrollment.

Q8. What should I do if my PMJAY card is lost or damaged?

Ans: Visit a CSC or an empanelled hospital to get a replacement PMJAY card.

 

Last updated 19-09-2024