Ayushman Bharat Yojana (PMJAY) – Features, Benefits, Eligibility

Ayushman Bharat Yojana is also known as ‘Pradhan Mantri Jan Arogya Yojana (PMJAY)’. Keeping the economically vulnerable Indians in consideration, this scheme was introduced so that they can get better healthcare facilities when needed. The scheme has made secondary and tertiary medical treatments absolutely free for people in empanelled hospitals.

This scheme was introduced by the Prime minister of India on 23rd September 2018. It has the aim to cover at least 50 crore Indians. According to the records published in September 2019, 18,059 hospitals are enrolled in this scheme in which approximately 4,406,461 people are admitted and the government has issued over 10 crore Ayushman Bharat cards.

Highlights of Ayushman Bharat Yojana (PMJAY)

• This scheme includes expenses of 3 days before hospitalization and 15 days of post-hospitalization. 
• Approximately 1400 procedures with their total cost are included in the scheme.

Ayushman Bharat Yojana (PMJAY) – Features

The main features of Ayushman Bharat Yojana (PMJAY) are:

• It comes under the world’s largest health insurance schemes financed by the Government of India. 
• It gives coverage of Rs. 5 lakh per annum/ family for secondary and tertiary medical care across the public and private sector hospitals.
• It is estimated that approximately 50 crore Indians are eligible to get benefits from this scheme.
• It gives cashless hospitalization
• It covers 3 days of pre-hospitalization like charges of medicines and diagnostics.
• Covers up to 15 days of post-hospitalization which includes charges of medicines, diagnostics, and procedures.
• No restrictions on areas like gender, family size, age, etc.
• It can be availed in any public and private hospitals which are enrolled in it.
• All the pre-existing conditions are covered from Day 1.
• 1,393 medical procedures are included under this scheme.
• It includes the cost of drugs, room charges, physician’s fees, surgeon charges, supplies, ICU and OT charges, and diagnostics charges.
• Government hospitals are also reimbursed the same as private hospitals.

Benefits of Ayushman Bharat Yojana (PMJAY)

The main benefits of Ayushman Bharat Yojana (PMJAY) are:

• It gives cashless complete hospitalization to the people having the Ayushman Bharat card.
• Accommodation during hospitalization.
• Pre and post-hospitalization expenses are also covered under the scheme.
• It also takes care of any complications which may arise during the treatment.
• It can be used by all the family members of a family.
• It does not have restrictions like gender, age limit, family size, etc.
• All the pre-existing conditions are taken care of from day 1.

Covered and Not covered under Ayushman Bharat Scheme

Covered under Ayushman Bharat Yojana

• Consultation, medical examination, and treatment cost
• Pre-hospitalization cost
• Intensive and non-intensive care services
• Medicines cost
• Laboratory and diagnostics services expenses
• Accommodation
• Medical implant services (wherever possible)
• Food services
• Any critical cases arising during treatment
• Post- hospitalization expenses up to 15 days are also covered
• COVID-19 treatment

Not Covered under Ayushman Bharat Yojana

• OPD expenses
• Drug rehabilitation expenses
• Cosmetic surgeries
• Fertility treatments
• Individual diagnostics
• Organ transplant

PMJAY Eligibility for Rural and Urban People

This scheme aims to provide healthcare facilities to approximately 10 crore families who are economically backward or of low middle-class background. This insurance scheme gives a cover of Rs.5 lakh per family. 10 crore families include 8 crores from Rural areas and 2.33 crores from Urban areas. If this is further broken into smaller units (size of family), it aims to caster approximately 50 crore Indians who are in need.

Ayushman Bharat eligibility criteria can tell about the people who can take benefit from it. Eligibility for this scheme is different in rural and urban areas.

PMJAY Rural Areas

National sample survey organization in its 71st round revealed that approximately 85.9% of the total rural household does not have any healthcare insurance. 24% borrow money for getting healthcare facilities. The households listed under Rashtriya Swasthya Bima Yojana can get benefit from this scheme.

In PMJAY Rural areas, this scheme is available to –

• The families living in SC/ST households.
• Families without any male members between the age of 16 to 59 years.
• Beggars
• Families which have no individual aged between 16 to 59 years.
• Families which have at least one physically challenged member.
• Families who work on other people’s land for their survival or simply landless labourers.
• Primitive tribal communities.
• Legally released bonded labor.
• Families who live in one-room makeshift houses having no proper roof or walls.
• Manual scavengers and their family.

PMJAY Urban Areas

National sample survey organization in its 71st round revealed that approximately 82% of total urban households do not have healthcare insurance. 18% borrows money for undertaking healthcare. Here also the households listed under Rashtriya Swasthya Bima Yojana can get benefit from this scheme.

In PMJAY Urban areas, this scheme is available to –

• Chowkidars/ washerman.
• Ragpickers 
• Mechanics, electricians, and repair workers.
• Domestic helpers.
• Sanitation workers,   gardeners, sweepers
• Tailors, home-based artisans
• Cobblers or any other providing services in streets
• Plumbers, construction workers, security guards, etc. 
• Transport workers
• Assistants, peons, delivery boys

People who do not come under Ayushman Bharat Eligibility criteria

• Those people who own two, three, or four-wheeler vehicles or a motor fishing boat.
• Those who own mechanized farming equipment.
• Those who have Kisan cards with a credit limit of Rs. 50000.
• People who are employed by the government.
• People who work in government-managed non-agricultural organizations.
• Those who have monthly income above 10000.
• Those owning landlines and refrigerators.
• Those with decent houses.
• Those having 5 acres or more agricultural land.

Ayushman Bharat Registration – How to apply for Ayushman Bharat Yojana?

The scheme is launched by the government of India for benefit of poor and vulnerable sections of society. Hence, it has no Ayushman Bharat registration process. People are selected based on SECC 2011 and those who are a part of the RSBY plan. But there is a procedure through which you can check whether you are eligible or not for this scheme.

Steps-

• Visit the website https://pmjay.gov.in/ ad click on the ‘I am eligible’ icon
• Enter the contact details and enter the OTP sent on the entered mobile number
• Choose your state
• Now search yourself by your name or mobile number or HDD number or your ration card number
• The result will let you know that whether you are eligible or not.

Documents Required

• Age and identity proof ( aadhar or PAN card)
• Your mobile number, e-mail ID, and residential address
• Caste certificate
• Income certificate
• Documents which state your current family status. 

Check your name in Ayushman Bharat List

To check your name in Ayushman Bharat Yojana (PMJAY) you can-

• Visit the nearest common service center or you can visit any enrolled hospital to check whether you are listed under the Ayushman Bharat beneficiaries list or not.
• Call on the helpline number.
• Visit the official website and check whether you are eligible or not. 

Diseases covered under Ayushman Bharat Yojana (PMJAY)

Here is a list of diseases cured under the Ayushman Bharat Yojana:

• 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 or disfigurement following burns
• COVID 19

Some medical packages are also involved in this scheme 

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

Diseases not covered under the Ayushman Bharat scheme

• Drug rehabilitation expenses
• Cosmetic surgeries
• Fertility treatments
• Individual diagnostics
• Organ transplant

How to download ABY Card Online?

An e-card will be given to each beneficiary as proof that he/she is permitted to get benefits from Ayushman Yojana. 

Steps to download Ayushman Bharat card online

• Visit the official website and log in with your mobile number.
• Enter Captcha and generate OTP.
• Opt for HDD code.
• Give the HDD code to common service centers so that they can get your details. 
• The rest of the process will be completed by the common service center employees.
• You have to pay a fee of Rs.30 to get the card.

Patient Card Generation

Once you become eligible for the Ayushman scheme, you can work towards getting a card. Before the issuing of the Ayushman Bharat card, your identity shall be verified by the officials by the documents like your aadhar card, etc. Once the verification process is completed you will get your Ayushman card printed. 

Ayushman Bharat Hospital List

To find the Ayushman Bharat hospital list, follow the steps listed below.

• Click on PMJAY – Hospitals List
• Select your state and district
• Now choose the type of hospital (e.g. private hospital, government hospital, etc.)
• Choose the medical specialty for that you are looking
• Enter the CAPTCHA code and click on the search

You will get the Ayushman Bharat hospital list available nearby depending upon the details filled above. 

How to file a complaint in case of any inconvenience?

Beneficiaries are free to file a complaint online on the CGRMS portal.

For filing complaint offline- 

• Contact your PMJAY Helpline center in your state.
• Send a letter or fax to the official address of the SHA/NHA.
• You can directly meet the District Grievance Nodal Officer (DGNO) of your district.

PMJAY Helpdesk

In the case of any inquiry, you can contact officials.

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

Frequently Asked Questions

Q1. I have a private job and my salary is less than Rs.10,000. Can I avail the benefits of this scheme?
Ans. Yes, You can avail the benefits. Please check the website to know your eligibility.

Q2. Is cancer treatment covered under Ayushman Bharat Yojana?
Ans. Yes, Cancer treatment is available.

Q3. Do we require to pay any fees to be covered under the scheme?
Ans. No, Beneficiaries are eligible to avail of the cashless and paperless services for secondary and tertiary medical treatments in empanelled hospitals.

Q4. Will beneficiaries get an Ayushman Bharat card?
Ans. Eligible families will get a PM-JAY identification Number and an e-card will be issued to the family during the hospitalization.

Q5. If I am in another state and fall ill there. Do I need to travel back to my state or can avail the services anywhere?
Ans. Beneficiaries can get benefits anywhere in the empanelled hospitals. The services are portable. You can contact toll-free numbers for further details.