The Pradhan Mantri Jan Arogya Yojana (PMJAY) popularly known as the Ayushman Bharat Yojana Scheme is a key program of the Government of India. It is a health insurance scheme that caters for the poor, the lower part of the community and the number of people at risk. The plan provides financial protection in the event of hospitalization due to medical emergencies. This article is a comprehensive guide to the validity of the government's health insurance policy, features, benefits and application process.
Considered as one of the biggest healthcare schemes in the world, Ayushman Bharat Yojana aims to cover more than 50 crore Indian citizens. It is designed especially for the economically weaker sections of the country. The PMJAY was launched in September 2018 providing health insurance coverage of a maximum sum insured amount of Rs.5 lakh.
The government health insurance scheme covers most of the medical treatment costs, medicines, diagnostics and pre-hospitalisation expenses. Additionally, the scheme offers cashless hospitalisation services through the Ayushman Bharat Yojana e-card which you can use to get healthcare services at any of the empanelled hospitals across the country. Beneficiaries of the scheme can avail hospitalisation for necessary treatment by showing their PMJAY e-card.
What is Covered Under Ayushman Bharat Yojana Scheme?
With the intention to provide accessible healthcare to the poor and needy, 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 hospitalization costs of beneficiaries and includes the below components:
Medical examination, consultation and treatment.
Pre-hospitalisation.
Non-intensive and intensive care services.
Medicine and medical consumables.
Diagnostic and laboratory services.
Accommodation.
Medical implant services, wherever possible.
Food services.
Complication arising during treatment.
Post-hospitalisation expenses for up to 15 days.
COVID-19 (Coronavirus) treatment.
What is Not Covered Under Ayushman Bharat Yojana Scheme?
Similar to other types of health insurance policies, the Ayushman Bharat Yojana Scheme has some exclusions. Below components are not covered under the scheme:
Out-Patient Department (OPD) expenses.
Drug rehabilitation.
Cosmetic surgeries.
Fertility treatments.
Individual diagnostics.
Organ transplant.
Features of Ayushman Bharat Yojana Scheme:
Below are some of the key features of the PMJAY scheme:
It is one of the world’s largest health insurance schemes financed by the government of India.
Coverage of Rs.5 lakh per family per annum for secondary and tertiary care across public and private hospitals.
Approximately 50 crore beneficiaries (over 10 crore poor and vulnerable entitled families) are eligible for the scheme.
Cashless hospitalisation.
Covers up to 3 days of pre-hospitalisation expenses such as medicines and diagnostics.
Covers up to 15 days of post-hospitalisation expenses which include medicines and diagnostics.
No restriction on the family size, gender or age.
Can avail services across the country at any of the empanelled public and private hospitals.
All pre-existing conditions covered from day one.
The scheme includes 1,393 medical procedures.
Includes costs for diagnostic services, drugs, room charges, physician’s fees, surgeon charges, supplies, ICU and OT charges.
Public hospitals are reimbursed at par with private hospitals.
Benefits of Ayushman Bharat Yojana Scheme:
The scheme is targeted at the vulnerable and underprivileged sections of the society. To cater to them, below are the benefits of the PMJAY:
It covers all hospitalisation expenses with cashless transactions to beneficiaries.
Accommodation during hospitalisation.
Pre and post-hospitalisation costs.
Any complications arising during the treatment.
Can be used by all family members.
No cap on family size, age or gender.
Pre-existing conditions are included from day one.
List of Critical Diseases or Illnesses Covered Under Ayushman Bharat Yojana Scheme:
The medical care scheme extended coverage for more than 1300 medical packages at empanelled public and private hospitals in the country. Below are some of the critical illnesses covered under the Ayushman Bharat Yojana:
Prostate cancer.
Double valve replacement.
Coronary artery bypass graft.
COVID-19.
Pulmonary valve replacement.
Skull base surgery.
Anterior spine fixation.
Laryngopharyngectomy with gastric pull-up
Tissue expander for disfigurement following burns.
Carotid angioplasty with stent.
Ayushman Bharat Yojana Scheme Eligibility Criteria for Rural and Urban Population:
The scheme has been launched to cover the bottom 40% of poor and economically weaker sections of the country. This was based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 for rural and urban areas. The Ayushman Bharat Yojana Eligibility is designed with pre-conditions so that only the underprivileged people of the society benefit from the initiative.
PMJAY Rural:
The Socio-Economic Caste Census 2011 (SECC 2011) involves the ranking of households based on their socio-economic status. The rural households are ranked based on their status of seven deprivation criteria. Of these, the scheme covers all beneficiaries who fall under at least one of below six deprivation categories and automatically includes destitute, manual scavenger families, living through alms, primitive tribal group, bonded labourers:
Households with only one room with Kucha walls and roof.
No adult member in the age group between 16 and 59 years.
No adult male member in the age group between 16 and 59 years.
Disabled member and no-abled bodied member in the household.
SC and ST
Landless households and major sources of income are through manual casual labour.
PMJAY Urban:
Under the scheme, urban households are categorised based on occupation. Below are 11 occupational categories of workers who are eligible for the Ayushman Bharat Yojana Scheme:
Beggar
Domestic worker
Ragpicker
Cobbler/Street Vendor/Hawker/Other service providers on the street.
Plumber/Construction Worker/Mason/Painter/Labour/Welder/Security Guard/Coolie
List of Critical Diseases or Illnesses Covered Under Ayushman Bharat Yojana Scheme:
The medical care scheme extended coverage for more than 1300 medical packages at empanelled public and private hospitals in the country. Below are some of the critical illnesses covered under the Ayushman Bharat Yojana:
Prostate cancer.
Double valve replacement.
Coronary artery bypass graft.
COVID-19.
Pulmonary valve replacement.
Skull base surgery.
Anterior spine fixation.
Laryngopharyngectomy with gastric pull-up
Tissue expander for disfigurement following burns.
Carotid angioplasty with stent.
Ayushman Bharat Yojana Scheme Eligibility Criteria for Rural and Urban Population:
The scheme has been launched to cover the bottom 40% of poor and economically weaker sections of the country. This was based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 for rural and urban areas. The Ayushman Bharat Yojana Eligibility is designed with pre-conditions so that only the underprivileged people of the society benefit from the initiative.
PMJAY Rural:
The Socio-Economic Caste Census 2011 (SECC 2011) involves the ranking of households based on their socio-economic status. The rural households are ranked based on their status of seven deprivation criteria. Of these, the scheme covers all beneficiaries who fall under at least one of below six deprivation categories and automatically includes destitute, manual scavenger families, living through alms, primitive tribal group, bonded labourers:
Households with only one room with Kucha walls and roof.
No adult member in the age group between 16 and 59 years.
No adult male member in the age group between 16 and 59 years.
Disabled member and no-abled bodied member in the household.
SC and ST
Landless households and major sources of income are through manual casual labour.
PMJAY Urban:
Under the scheme, urban households are categorised based on occupation. Below are 11 occupational categories of workers who are eligible for the Ayushman Bharat Yojana Scheme:
Beggar
Domestic worker
Ragpicker
Cobbler/Street Vendor/Hawker/Other service providers on the street.
Plumber/Construction Worker/Mason/Painter/Labour/Welder/Security Guard/Coolie
How To Apply Online For Ayushman Bharat Yojana?
The scheme was launched by the government of India to cater to the healthcare needs of the vulnerable sections of the population. In keeping with the basic requirements of the scheme, it does not have an enrolment process. To apply online for Ayushman Bharat Yojana Scheme, you need to find out if you are a beneficiary of the scheme. Below is the process to find out you are eligible for the Ayushman Bharat Yojana Registration:
Step 1: Visit the exclusive website for P
Step 2: Input your contact details and click on “Generate OTP”.
Step 3: Now, select your state and search by your name, mobile number, HHD number or your ration card number.
Step 4: You can view if you are eligible for the government healthcare scheme.
How To Download Ayushman Bharat Yojana Card Online?
To ensure cashless, paperless and portable transactions through the PNJAY scheme, the Ayushman Bharat Yojana Golden Card will be issued to beneficiaries. The PMJAY e-card contains all required information of the patient. It is mandatory to present this card at the time of availing the treatment at the empanelled hospital.
To get this PMJAY Golden Card, follow the process below:
Step 1: Visit the PMJAY website (https://mera.pmjay.gov.in/search/login) and log in with your registered mobile number.
Step 2: Enter the ‘Captcha Code’ to generate the OTP.
Step 3: Opt for the HHD code.
Step 4: Provide the HHD code to the Common Service Centre (CSC), where they would check the HHD code and other details.
Step 5: The CSC representatives who are known as Ayushman Mitra will complete the rest of the process.
Step 6: You will have to pay Rs.30 to get the Ayushman Bharat card.
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