PMJAY: Ayushman Bharat Yojana – Things You Need To Know
What is Ayushman Bharat Yojana (PMJAY)?
Ayushman Bharat Yojana is a program intended to support financially needy Indians who need treatment. The program is also named Pradhan Mantri Jan Arogya Yojana (PMJAY).
On 23 September 2018, Prime Minister Narendra Modi unveiled the health insurance system covering over 50 Indian crore people and already has many success stories. As of September 2019, 18,059 hospitals, 4,406,461 lakh beneficiaries and ten crore e-cards were admitted. were reported to have been empanelled.
The national health care scheme Ayushman Bharat Yojana-now called Pradhan Mantri Jan Arogya Yojana-aims to make secondary and tertiary healthcare completely free.
The beneficiaries of PM Jan Arogya Yojana are issued with an e-card, which can be used in a public or private hospital anywhere in the world to provide treatment. You can enter a hospital with it and receive cashless treatment.
This covers 3 pre-hospitalization days and 15 post-hospitalization days. In addition, approximately 1,400 procedures are taken care of at all associated costs such as OT expenses.
All in all, PMJAY and the e-card provide a coverage of Rs. 5 lakh per family, per year, thus helping the economically disadvantaged obtain easy access to healthcare services.
PMJAY Health Categories: Rural and Urban Eligibility Criteria
The PMJAY program seeks to provide 10 crore households with lower medium-sized incomes to health care with a Rs. 5 lakh per household. PMJAY offers health insurance coverage. Eight crore families in rural areas and 2.33 crore families in urban areas are part of the 10 crore families. Split into smaller parts, this ensures that the scheme will benefit 50 crore beneficiaries.
However, the program requires other prerequisites for deciding who will benefit from the insurance plan. While the list is most frequently listed in rural areas on housing scarcity, inadequate wages and other deprivations, the urban list of PMJAY beneficiaries is based on jobs.
PMJAY in Rural:
In the 71st round of the National Sample Survey, 85,9% of rural households did not have access to health care or savings. In fact, 24% of poor households are raising funds to provide healthcare services.
The goal of PMJAY is to help deter debt traps and services by offering Rs. 5 lakh per family annually in funding. According to data in Socio-Economic Caste Census 2011, the scheme will benefit economically disadvantaged families.
The households inscribed in this field too will be part of the Rashtriya Swasthya Bima Yojana (RSBY) PM Jan Arogya Yojana.
PMJAY Health Cover Categories: Eligibility Criteria for Rural & Urban People
The PMJAY scheme aims to provide healthcare to 10 crore families, who are mostly poor and have lower middle income, through a health insurance scheme providing a cover of Rs. 5 lakh per family. The 10 crore families comprise 8 crore families in rural areas and 2.33 crore families in urban areas. Broken into smaller units, this means the scheme will aim to cater to 50 crore individual beneficiaries.
However, the scheme has certain pre-conditions by which it picks who can avail of the health cover benefit. While in the rural areas the list is mostly categorized on lack of housing, meagre income and other deprivations, the urban list of PMJAY beneficiaries is drawn up on the basis of occupation.
The 71st round of the National Sample Survey Organisation reveals that a staggering 85.9% of rural households do not have access to any healthcare insurance or assurance. Additionally, 24% of rural families access healthcare facilities by borrowing money. PMJAY’s aim is to help this sector avoid debt traps and avail services by providing yearly assistance of up to Rs. 5 lakh per family. The scheme will come to the aid of economically disadvantaged families as per data in the Socio-Economic Caste Census 2011. Here too, households enrolled under the Rashtriya Swasthya Bima Yojana (RSBY) will come under the ambit of the PM Jan Arogya Yojana.
In the rural areas, the PMJAY health cover is available to:
- 1) Those living in scheduled caste and scheduled tribe households
- 2) Families with no male member aged 16 to 59 years
- 3) Beggars and those surviving on alms
- 4) Families with no individuals aged between 16 and 59 years
- 5) Families having at least one physically challenged member and no able-bodied adult member
- 6) Landless households who make a living by working as casual manual labourers
- 7) Primitive tribal communities
- 8) Legally released bonded labourers
- 9) Families living in one-room makeshift houses with no proper walls or roof
- 10) Manual scavenger families
PMJAY in Urban:
82 per cent of city households do not have access to health insurance or insurance, according to The National Sample Survey Organization (71st round). Furthermore, 18% of urban Indians have dealt with healthcare costs in one form or the other.
Jan Arogya Yojana funds these families by the allocation of funding up to Rs. 5 lakh per family a year in healthcare facilities. As per the 2011 Socioeconomic Caste Census, PMJAY would benefit families of urban workers in the occupational group.
In fact, every family registered with the Rashtriya Swasthaya Bima Yojana also has the advantage of PM Jan Arogya Yojana.
In the urban areas, those who can avail of the government-sponsored scheme consist mainly of:
- 1. Washerman/chowkidars
- 2. Ragpickers
- 3. Mechanics, electricians, repair workers
- 4. Domestic help
- 5. Sanitation workers, gardeners, sweepers
- 6. Home-based artisans or handicraft workers, tailors
- 7. Cobblers, hawkers and others providing services by working on streets or pavements
- 8. Plumbers, masons, construction workers, porters, welders, painters and security guards
- 9. Transport workers like drivers, conductors, helpers, cart or rickshaw pullers
- 10. Assistants, peons in small establishments, delivery boys, shopkeepers and waiters
People not entitled for the Health Cover under Pradhan Mantri Jan Arogya Yojana:
- 1. Those who own a two, three or four-wheeler or a motorised fishing boat
- 2. Those who own mechanised farming equipment
- 3. Those who have Kisan cards with a credit limit of Rs.50000
- 4. Those employed by the government
- 5. Those who work in government-managed non-agricultural enterprises
- 6. Those earning a monthly income above Rs.10000
- 7. Those owning refrigerators and landlines
- 8. Those with decent, solidly built houses
- 9. Those owning 5 acres or more of agricultural land
Ayushman Bharat Scheme (PMJAY) Health services and hospitalization phase
Not only persons but families, in general, can use the 5-lakh insurance cover offered by the Pradhan Mantri Jan Arogya Scheme. This lump sum is sufficient in 25 specialities including cardiology, neurosurgery, oncology, pediatrics, orthopaedics etc. for both medical and surgical treatments. Medical and operational expenses, however, can not be reimbursed at the same time.
When more than one operation needs to be done, the full price of the kit is charged first, followed by a concession of 50% for the second and a discount of 25% for the third.
Unlike other health insurance programs, under the PMJAY system that falls under Ayushman Bharat Yojana, there is no time waiting for pre-existing diseases. When any patient or anyone of his family has to be hospitalised, they do not have to pay anything as long as they are taken to any public or private institutions.
Due to a 60:40 cost-shared agreement between the Center and the States cashless treatment and hospitalization are possible. If confirmed as a legitimate beneficiary, a specially qualified Ayushman Mitras, who operates kiosks in hospitals for citizens unfamiliar with the PMJAY scheme, is provided you or your family member with a medical card.
You can benefit from Pradhan Mantri Jan Awas Yojana ‘s features with these details or help someone else benefit from healthcare coverage.
PMJAY Illness Coverage: List of Critical Diseases covered under PM Jan Arogya Yojana
PMJAY helps households access secondary and tertiary care via funding of up to Rs. 5 lakh per family, per year. This assistance is valid for day care procedures and even applies to pre-existing conditions. PMJAY extends coverage for over 1,350 medical packages at empanelled public and private hospitals.
Some of the Critical illnesses that are covered are as follows.
- Prostate cancer
- 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
PMJAY has a minimal list of exclusions. They are as follows.
- Drug rehabilitation programme
- Cosmetic related procedures
- Fertility related procedures
- Organ transplants
- Individual diagnostics (for evaluation)
Advantages of Health Insurance in India
The main advantage of having a health insurance policy is that you can avail medical treatment without suffering any strain on your finances. Moreover, as a significant number of Indians end up borrowing money informally to pay medical bills, utilising the features of PMJAY helps avoid the risk of a debt trap. You can get upto Rs. 5 lakh treatment under PMJAY but you can also buy health insurance from Bajaj Finserv to avail more coverage & benefits for yourself and your family.
Alternately, you can explore other health policies too like Pocket Insurance by Bajaj Finserv which offers affordable policies to take care of your specific needs. What’s more, you can apply for these policies easily online. For instance, Dengue Cover helps you pay for diagnostic tests in case you contract malaria or dengue, while Hospital Cash Cover gives you daily cash assistance of up to Rs.1,000 per day that you can use for a range of expenses. You can also purchase plans such as Adventure Cover if you get injured or Kidney Stones Cover in case you suffer from this condition. Regardless of the policy you choose, you can get substantial coverage at a nominal premium and protect every aspect of your health in an instant.
Additional Read: How To Choose The Right Health Insurance Policy For Yourself
Ayushman Bharat Registration: How to Apply for Ayushman Bharat Yojana (Application Process)
There is no special Ayushman Bharat registration procedure pertaining to PMJAY. This is because PMJAY applies to all beneficiaries as identified by the SECC 2011 and those who are already part of the RSBY scheme. However, here’s how you can check if you are eligible to be a beneficiary of PMJAY.
- Visit https://www.pmjay.gov.in/ and click on ‘Am I Eligible’
- Enter your mobile number and the CAPTCHA code and click on ‘Generate OTP’
- Then select your state and search by name/ HHD number/ ration card number/ mobile number
- Based on the search results you can verify if your family is covered under PMJAY
Alternatively, to know if you are eligible for PMJAY you can approach any Empanelled Health Care Provider (EHCP) or dial the Ayushman Bharat Yojana call centre number: 14555 or 1800-111-565
Ayushman Bharat Yojana: PMJAY Patient Card Generation
Once you are eligible for the PMJAY benefits, you can work towards getting an e-card. Before this card is issued, your identity is verified at a PMJAY kiosk with the help of a document like your Aadhaar card or ration card. Family identification proofs that can be produced include a government certified list of members, PM letter and an RSBY card. Once the verification is completed, the e-card is printed along with the unique AB-PMJAY ID. You can use this as proof at any point in the future.
PMJAY: Ayushman Bharat Yojana – Things You Need To Know