pmjay ayushman bharat yojana

PMJAY: Ayushman Bharat Yojana Scheme, Benefits, How to Apply

Health Insurance Insurance

Pradhan Mantri Jan Arogya Yojana (PMJAY) which is also referred to as Ayushman Bharat Yojana, is a health insurance scheme that intends to offer financial protection to economically weaker Indian population who are in need of health care facilities. Launched on 23rd September 2018 by Prime Minister Narendra Modi, PMJAY aims to offer coverage of up to Rs 5 lakh per family each year for secondary and tertiary care hospitalization. Apart from this, PMJAY beneficiaries get an e-card via which they can avail cashless hospitalization services at any empanelled private/public hospitals in the country.

Let’s understand this scheme in a detailed manner below.

Features of PMJAY or Ayushman Bharat Yojana Scheme

Some of the significant features of Ayushman Bharat Yojana (PMJAY) scheme are stated below:

  • Ayushman Bharat Yojana offers coverage of up to Rs 5 lakh per family every year for secondary and tertiary care across public/private empanelled hospitals in India
  • PM-ABJAY is one of the largest health insurance schemes of the world and around 10.74 crore poor families (50 crore beneficiaries) of our nation are eligible for AB-PMJAY scheme
  • PMJAY scheme covers three days of pre-hospitalization and fifteen days of post-hospitalization expenses like medicines and diagnostics
  • The scheme offers cashless access to health care services for the beneficiary at any empanelled public or private hospitals in the country
  • AB-PMJAY plan covers the treatment for some of the pre-existing diseases
  • Ayushman Bharat scheme includes 1,393 medical procedures such as diagnostic services, doctor’s fees, room charges, OT and ICU charges, etc
  • Apart from covering all the medical expenses related to the treatment of the beneficiary, PMJAY scheme also covers their day-care expenses
  • No restrictions are put irrespective of family size, age, or gender
  • Pradhan Mantri Jan Arogya Yojana (PMJAY) also reimburses the transportation cost incurred by the beneficiary in any public/private empanelled hospitals of the nation

What all are Covered by Ayushman Bharat Yojana/PMJAY Scheme?

Ayushman Bharat Yojana/PMJAY Scheme intends to provide healthcare facilities to the poor and needy. It covers the following components during the treatment of the beneficiary(s):

  • Medical examination, consultation, and treatment
  • Pre-hospitalization expenses
  • Post-hospitalization expenses are covered for fifteen days
  • Cost of medicine and medical consumables
  • Non-intensive and intensive care services
  • Expenses on diagnostic and laboratory services
  • Medical implantation services whenever required
  • Expenses incurred on complications arising during the treatment
  • Hospital accommodation charges
  • Food services
  • Covid-19 treatment

What is Not Covered Under Ayushman Bharat Yojana/PMJAY Scheme?

AB-PMJAY does not cover treatment expenses incurred on:

  • Cosmetic surgeries
  • Out-Patient Department (OPD) expenses
  • Drug rehabilitation
  • Fertility treatments
  • Organ transplantation
  • Individual diagnostics

Benefits of Ayushman Bharat Yojana Scheme

The benefits of Ayushman Bharat Yojana (PMJAY) scheme are stated below:

  • Under PMJAY scheme, treatment and health care facilities are available at free of cost across India
  • It covers all the uncovered hospital expenses with cashless transactions to beneficiaries
  • The scheme also makes provisions for the follow-up treatments to make sure that the patient is completely recovered
  • AB-PMJAY covers the treatment expenses of oncology with chemotherapy for fifty different types of cancer
  • It covers the pre-existing illnesses of the beneficiary that are included under this scheme

List of Critical Illnesses Covered Under PMJAY/Ayushman Bharat Yojana Scheme

Some of the critical illnesses covered by Ayushman Bharat Yojana are stated below:

  • Prostate cancer
  • Carotid angioplasty with stent
  • Double valve replacement surgery
  • Pulmonary valve replacement surgery
  • Skull base surgery
  • Anterior spine fixation
  • Tissue expander for disfigurement following burns
  • Coronary artery bypass grafting
  • Laryngopharyngectomy with gastric pull-up

PMJAY Eligibility Criteria for Rural and Urban Population

The Ayushman Bharat Yojana has been specifically designed for the poor and economically vulnerable people of the society can benefit from this scheme. To avail the benefits of this scheme it is important that all the check their names in the Socio-Economic Census 2011 data. This will ascertain if their family is eligible to be covered under the scheme or not.

The eligibility criteria for rural beneficiaries under the PMJAY scheme are listed below:

  • Families with no adult or male earning member aged between 16 and 59 years
  • Individuals belonging to scheduled caste and scheduled tribe families
  • Families living in one room with Kuccha walls and roof
  • Manual scavenger families
  • Households without any healthy adult individual and one physically challenged member
  • Landless households who are earning the most part of their family income by working as casual manual laborers
  • Primitive tribal communities
  • Legally released bonded laborers

The eligibility criteria for urban beneficiaries under the PMJAY scheme are listed below:

  • Domestic worker
  • Ragpicker
  • Washer-man/Chowkidar
  • Beggars and those who survive on alms
  • Assistant/Peons of smaller organizations/Delivery men/Shopkeeper/Waiter
  • Sanitation workers, mali (gardeners), and sweepers
  • Street vendor/Cobbler/Hawker/Other services provided on the street
  • Home-based artisans or handicrafts workers, tailors
  • Transport workers like rickshaw or cart pullers, drivers, conductors, helpers
  • Plumber/Mason/Security Guard/Coolie/Construction Worker/Painter/Labour/Welder
  • Electrician/Mechanic/Assembler/Repair Worker

Who Is Not Eligible To Avail The Ayushman Bharat Yojana Scheme?

Individuals who are not eligible to avail the benefits of Ayushman Bharat Yojana Scheme are:

  • Those who have Kisan Cards with a credit limit of Rs 50,000
  • Individuals living in decent, solidly built houses
  • One who possess merchandised farming equipment
  • One who owns a two, three or four-wheeler
  • Government employees
  • Individuals earning more than Rs 10,000 per month
  • One who possess landline phones and refrigerators
  • Those who own a motorized fishing boat
  • Individuals working in government-managed non-agricultural enterprises
  • Those who own more than five acres of agricultural land

How To Apply Online For Ayushman Bharat Yojana?

Ayushman Bharat Yojana is applicable to all beneficiaries who are identified by Socio-Economic Census 2011 data and those who are already a part of the Rashtriya Swasthya Bima Yojana scheme. To find out if you are eligible for Ayushman Bharat Yojana registration, follow the steps below:

  • Visit the official government website https://www.pmjay.gov.in/
  • Click on ‘Am I Eligible’ tab
  • Enter your mobile number, CAPTCHA code, and click on ‘Generate OTP’ button
  • Now select your state and search by name/ration card number/household number/mobile number
  • If your family is covered under Ayushman Bharat Yojana scheme, then your name will be displayed in the search results

Documents Required to Apply For PMJAY Scheme

  • Age and Identity proof details such as Aadhaar card/PAN card
  • Mobile number, email ID and residential address
  • Caste certificate
  • Income certificate (maximum annual income must be around Rs 5 lakh a year)
  • Documents stating the current status of your family

How To Download PMJAY or Ayushman Bharat Yojana Card Online?

The Ayushman Bharat Yojana Card/PMJAY e-card consists of all the important information of the beneficiary and is issued at the time of registration. PMJAY beneficiaries can avail of the benefits of cashless healthcare services at any of the empanelled hospitals of the country by using the PMJAY e-card.

To get this Ayushman Bharat Yojana Card, follow the steps below:

  • Visit the official government website https://www.pmjay.gov.in/
  • Log in with your registered mobile number
  • Enter the ‘Captcha Code’ to generate the OTP
  • Select the HHD code
  • Give the correct HHD code to the Common Service Centre (CSC) so that they can check and verify the details provided
  • The CSC representative who is also referred to as ‘Ayushman Mitra’ will complete the rest of the process
  • You will have to pay 30 rupees to get the Ayushman Bharat Yojana Card

How To Check Your Name in the PMJAY Beneficiary List 2020?

There are various methods to check your name in the PMJAY beneficiary list 2020. Try the following methods listed below to check your name:

  • Common Service Centre (CSC): If you are a beneficiary of the PMJAY scheme, you can visit your nearest CSCs or any of the empanelled hospitals to collect the information form. You can check the list of hospitals under this scheme on their site or in your policy documents.
  • Online: You can visit the official government website https://www.pmjay.gov.in/ to check if you have your name in the beneficiary list.
  • Contact their Helpline Number: You can contact the customer care helpline numbers 14555 or 1800-111-565 provided by the government of India to know if you are eligible for this scheme or to seek other related information of Ayushman Bharat Yojana.

PMJAY Scheme cover COVID-19

The Insurance Regulatory and Development Authority of India (IRDAI) has issued an advisory to all the health insurance providers for covering COVID-19 hospitalization and treatment expenses. Even the government-backed Ayushman Bharat Yojana/PMJAY scheme is offering coverage against the COVID-19 pandemic. COVID-19 patients can avail treatment free of cost at empanelled hospitals via the PMJAY scheme. All the empanelled hospitals under the AB-PMJAY scheme are thoroughly equipped to carry out Coronavirus tests, treatments, and quarantine facilities.

This is a great initiative to offer financial cover to the poor and economically vulnerable families against the impact of deadly COVID-19 pandemic.

Medical Packages

There are around 25 facilities that can be availed by the beneficiaries of the PMJAY scheme. It includes:

  • Oncology
  • Cardiology
  • Neurology
  • Pediatrics
  • COVID-19
  • Orthopedics

However, it should be noted that medical and surgical expenses cannot be recompensed simultaneously. In the case of multiple surgeries, the surgery with the highest cost will be paid. And for the second and third you will receive 50% and 25% respectively. Also, unlike other health schemes, there is no waiting period for pre-existing diseases under the Ayushman Bharat Yojana scheme.

Hospitalization Process in PMJAY

PMJAY scheme offers health insurance coverage to the beneficiaries without any treatment cost during and after hospitalization. The scheme covers both pre and post-hospitalization expenses along with the in-patient charges. The whole process of hospitalization and treatment is cashless as there is a 60:40 cost sharing contract between the centre and states respectively. Once you are identified under this plan, you and your family members will be issued the Ayushman Bharat Yojana Card by specially trained professionals ‘Ayushman Mitras’. With the help of the e-card, you will be able to avail of all the benefits of Ayushman Bharat Yojana at any of the empanelled private/public hospitals in the country.

PMJAY Hospital List in India

Follow the steps stated below to find out PMJAY Hospital List:

  • Visit the official government website https://hospitals.pmjay.gov.in/Search/empnlWorkFlow.htm
  • Select the state and the district where you live
  • Choose the hospital type (public/private-for-profit/private but not for profit)
  • Select the medical specialty you are searching for
  • Enter the ‘Captcha Code’ and click on the search tab
  • Now, you will be redirected to the list of PMJAY hospitals along with the address, website, and contact details. You can also check the ‘Suspended Hospital List’ from the same link provided above.

PMJAY Contact Address and Toll-free Number

The toll-free number of Pradhan Mantri Jan Arogya Yojana (PMJAY) is:

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

In case you have any complaints, you can visit https://cgrms.pmjay.gov.in/GRMS/loginnew.htm and register your complaint. You will be able to check the status of your complaint from the same portal.

Latest News Related to Ayushman Bharat Yojana Scheme

Our honorable Prime Minister Shri Narendra Modi recently in his ‘Mann ki Baat’ radio program said that more than one crore patients have benefited from the Ayushman Bharat Yojana scheme. According to PM, most of these beneficiaries were suffering from diseases that couldn’t have been treated with standard medicines. He further said that more than 80% of these beneficiaries live in rural areas and 50% are women beneficiaries. He applauded the honest taxpayers of the country for their contribution in helping the poor to avail of free treatment costs under this scheme.

Govt. Approved Ayushman Bharat Yojana’s Official Website

The government has disapproved of a fake website named the ‘Ayushman-Yojana.Org’ that was circulating in social media lately and claimed to be the official website of Ayushman Bharat Yojana. The PMJAY authorities have confirmed the correct URL of Ayushman Bharat Yojana scheme is https://www.pmjay.gov.in/

Conclusion

Hence it can be said that Ayushman Bharat Yojana is a very good health insurance scheme for poor and needy people who can avail of medical treatment including life-threatening diseases free of cost.

 Ayushman Bharat Yojana/PMJAY FAQs

Q: Are diabetic patients covered under the Ayushman Yojana scheme?

A: Yes, the AB-PMJAY scheme covers diabetic patients from the very first day for in-patient hospitalization expenses. However, OPD expenses are not covered.

Q: What is an HH ID number?

A: The HH ID/Household No. is given to the families who are recognized under the Socio-Economic Census 2011 data and consists of 24 digits.

Q: What is the death benefit for Ayushman Bharat Yojana beneficiaries?

A: There is no death benefit available for the Ayushman Bharat Yojana beneficiaries.

Q: What to do if the hospital refuses to treat the beneficiary under the PMJAY scheme?

A: You can file your complaint at https://cgrms.pmjay.gov.in/GRMS/loginnew.htm and your grievance will be redressed within 30 days of filing by the Grievance Redressal Committee that is appointed at a national/state/district level.

Q: Are cancer patients covered under the PMJAY scheme?

A: Yes. However, the type and duration of treatment is different for different kinds of cancer. The cancer treatment under this scheme has to undergo a treatment plan and some approvals that is similar to ‘tumor board concept’ to decide the best patient management.

Q: How to change my mobile number in PMJAY?

A: You need to contact your State Health Agency (SHA) to change your mobile number in the scheme.

Q: Does Ayushman Bharat Yojana cover individuals above 80 years of age?

A: Yes. There are no restrictions put by this scheme irrespective of family size, age, or gender.

Q: Who should the beneficiaries contact at the time of hospitalization?

A: Beneficiaries are required to contact Ayushman Mitra at the respective empanelled hospital to avail of cashless treatment.

Q; How to update data in the Ayushman Bharat Yojana scheme?

A: You can either call the helpline numbers 14555/1800-111-565 or visit the nearest Common Service Centre (CSC) to update your data.

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