Team AckoDec 2, 2022
The Pradhan Mantri Jan Arogya Yojana (PMJAY) popularly known as Ayushman Bharat Yojana Scheme is the flagship scheme by the Government of India. It is essentially a health insurance scheme to cater to the poor, lower section of the society and the vulnerable population. The scheme offers financial protection in case of hospitalization due to medical emergencies. This article is a detailed guide about the government’s health insurance scheme’s eligibility, features, benefits and the 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.
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.
Non-intensive and intensive care services.
Medicine and medical consumables.
Diagnostic and laboratory services.
Medical implant services, wherever possible.
Complication arising during treatment.
Post-hospitalisation expenses for up to 15 days.
COVID-19 (Coronavirus) treatment.
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.
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.
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.
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.
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:
Double valve replacement.
Coronary artery bypass graft.
Pulmonary valve replacement.
Skull base surgery.
Anterior spine fixation.
Laryngopharyngectomy with gastric pull-up
Tissue expander for disfigurement following burns.
Carotid angioplasty with stent.
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.
Learn more about Ayushman Bharat Health Account Card
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.
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:
Cobbler/Street Vendor/Hawker/Other service providers on the street.
Plumber/Construction Worker/Mason/Painter/Labour/Welder/Security Guard/Coolie
Artisan/Handicrafts Worker/Tailor/Home-based Worker
Driver/Transport Worker/Conductor/Cart or Rickshaw Pullers/Helper to Drivers or Conductors
Shop Workers/Peon in Small Establishment/Assistant/Helper/Attendant/Delivery Assistant/Waiter
Below is the list of people who are not entitled to avail healthcare services under the scheme:
Those who have mechanised farming equipment.
Who owns a two, three or four-wheeler.
Those who hold a Kisan card.
Those who own a motorised fishing boat.
Those who are earning more than Rs.10,000 per month.
Those who are working in government-run non-agricultural enterprises.
Those who own more than 5 acres of agricultural land.
Those who own landline phones or refrigerators.
Those who live in decently built houses.
The scheme is an entitlement based initiative launched by the government of India for the poor and the venerable sections of the society. Hence there is no enrolment process. Beneficiaries are selected based on the SECC 2011 and who are part of the RSBY plan. If you would like to know if you are eligible for the scheme, follow these steps:
Step 1: Visit the government website exclusive for PMJAY scheme (https://pmjay.gov.in/) and click on “Am I Eligible” icon.
Step 2: Enter your contact details and generate OTP.
Step 3: Choose your state.
Step 4: Now, search either by your name, mobile number, HHD number or your ration card number.
Step 5: The result will let you know if you are eligible for the PMJAY scheme.
Also, you can contact the Ayushman Bharat Yojana customer care at 1800-111-565 or 14555 or you can reach out to any of the Empanelled Health Care Providers (EHCP).
Below is the list of documents required to apply for PMJAY scheme:
Identity and Age Proof (Aadhaar Card/PAN Card)
Details of your mobile number, email address and residential address.
Documents stating your current family status.
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 PMJAY (https://pmjay.gov.in/) and click on the “Am I Eligible” icon.
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.
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.
To enable beneficiaries to avail the COVID-19 coverage, the Insurance Regulatory and Development Authority (IRDAI) has issued an advisory to all health and general insurance companies to cover COVID-19 (Coronavirus) hospitalisation and treatment costs. The PMJAY or the Ayushman Bharat Yojana Scheme covers COVID-19 treatment and hospitalisation.
COVID-19 patients can avail free treatment at empanelled hospitals through the PMJAY scheme. Ensure you are a beneficiary of the government-funded Ayushman Bharat Scheme.
To check if your name is in the PMJAY list 2020, you can check it through different methods. They are:
Common Service Centre (CSC): Visit the nearest CSCs or you can visit any of the empanelled hospitals to check if you are eligible for the healthcare scheme.
Helpline Numbers: PMJAY helpline numbers are available to get information about your eligibility for the scheme. You can contact 14555 or 1800-111-565.
Online: Visit the official website of the scheme (https://www.pmjay.gov.in/) and check if you are eligible for the scheme.
As a beneficiary of the scheme, families, as well as individuals, can avail nearly 25 specialities, which include:
Please note that medical and surgical expenses cannot be reimbursed simultaneously. Also, if there are multiple surgeries, in the first instance the surgery with the highest cost will be paid. For the second you will receive 50% and the for the third it will be 25%
The PMJAY scheme does not take into consideration pre-existing illnesses as it comes under the massive scheme introduced by the government of India.
Also, read: Corona Kavach Policy
Any of your family members or you require hospitalisation, you need not pay anything under the PMJAY scheme subject to being admitted in any of the empanelled public or private hospitals. The entire process of hospitalisation and treatment is cashless since there is a 60:40 cost-sharing between the centre and the state, respectively.
As a beneficiary, you will receive the Ayushman health card which will enable you to avail cashless treatment and hospitalisation. With the golden card, you can avail the benefits of the scheme at any of the empanelled public and private hospitals.
To find out the Ayushman Bharat hospital list, follow the below steps to find out the PMJAY hospital list:
Step 1: Visit the official website of the PMJAY – Hospitals list section
Step 2: Select your state and the district.
Step 3: Now, choose the type of hospital (public/private-for-profit/private and not for profit)
Step 4: Choose the medical speciality you are looking for.
Step 5: Enter the “Captcha Code” and click on search.
You will be redirected to the list of Ayushman Bharat Yojana hospitals along with address, website and contact information. You can also check the ‘Suspended Hospital List’ on the same link provided above.
Below is the toll-free number and address of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana:
National Health Authority of India, 3rd, 7th and 9th Floor, Tower-L, Jeevan Bharati Building, Connaught Place, New Delhi – 110001
Grievance Portal:In case of grievances, you can visit PMJAY Grievance section and register your grievance. You can also check the status of your grievance on the same portal.
Below are some of the FAQs about the Ayushman Bharat Yojana (PMJAY) Scheme:
Under the scheme, medical care services such as pre and post hospitalisation, daycare surgeries, newborn child services, etc.
A dedicated ID card will be given to eligible family and a PMJAY ecard will be given at the time of hospitalisation.
The HH ID or Household ID number is provided to families who are identified under the SECC and contains 24 digits.
The initiative was launched by the government of India which is basically an entitlement based mission. Families identified by the government through the deprivation and occupational eligibility criteria based on the socio-economic status in both urban and rural areas are identified as beneficiaries of the scheme.
You can avail free treatment for the novel coronavirus or COVID-19 at an empanelled public or private hospitals under this scheme by submitting the Ayushman Bharat card and HHD number.
Under the scheme, you can avail both treatment and test for coronavirus.
Yes, the scheme covers pre-existing diseases.
Healthcare services such as cosmetic surgeries, drug rehabilitation, fertility treatment and organ transplant are excluded from the Ayushman Bharat Yojana scheme.
Beneficiaries should contact Ayushman Mitra at the empanelled hospital to avail cashless treatment at the hospital.
All beneficiaries can avail free treatment for tertiary and secondary hospital treatment for packages identified under the scheme at empanelled public and private hospitals.
There is no death benefit to the beneficiary of Ayushman car holders.
Under the scheme, medical procedures including Orthopedics are available for treatment.
Beneficiaries of the PMJAY is based on eligibility families as per SECC/RSBY data. Those families who have HHID, which is provided under the SECC are eligible for the scheme.
The primary objective of the scheme is to provide accessible and free healthcare to the poor and vulnerable sections of the society. For detailed information about the eligibility criteria can refer to the above mentioned details in the article.
Contact your State Health Agency (SHA) to change your mobile number in the scheme.
Under the scheme, there is no cap on the family size and age.
If you are a beneficiary of the scheme, then to update your data you need to visit the Common Service Centre (CSC) or you can call the Ayushman Bharat helpline number 14555 or 1800-111-565.
-September 27, 2022
The world’s largest government-sponsored health insurance scheme, Ayushman Bharat Yojana Scheme, otherwise known as Pradhan Mantri Jan Arogya Yojana (PMJAY), completes 4 years today. The health scheme offers health insurance coverage of up to Rs. 5 lakh per year for underprivileged and low-income families. Through this scheme, the Centre seeks to prevent financial challenges due to medical expenses incurred by the deprived section of society. It offers cashless hospitalisation along with other features such as no cap on family size or age, coverage for pre and post-hospitalisation, no restrictions on pre-existing conditions, access to empanelled private or public hospitals and coverage for more than 1500 treatments, including organ transplant and cancer care.
-September 27, 2022
The Central Government has decided to include informal sanitation workers under its Pradhan Mantri Jan Arogya Yojana (PMJAY) health insurance scheme. The initiative by the Centre is to increase its outreach to the grass root level workers through its government schemes. Sanitation workers involved in the casual sanitation works and septic tank cleaning shall be covered under the scheme. Under this health plan, the beneficiaries shall receive health insurance coverage of Rs. 5 lakh per family per year. The Centre said that if an informal sanitation worker is not listed under the beneficiaries list, then the government will include the worker and their family members under the scheme.
-August 25, 2022
The Central Government shall provide health insurance coverage for transgender persons under its Ayushman Bharat health insurance scheme, also known as Pradhan Mantri Jan Arogya Yojana (PM-JAY). Those holding a transgender certificate issued by the National Portal for transgender people shall be eligible for coverage under the scheme. With this initiative, transgender people can avail of Rs. 5 lakh coverage per annum. They can benefit from the healthcare services at PM-JAY-empanelled hospitals.
– June 11, 2020
A large number of workers that were dependent on daily wages for livelihood lost their jobs due to the Coronavirus pandemic. Getting hit by a medical emergency in this situation is even worse. To mitigate the sufferings, such workers will be included as beneficiaries under the Central Government’s flagship health insurance scheme – Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. The National Health Authority (NHA) is responsible for identifying and enrolling the beneficiaries of AB-PMJAY scheme. The agency is actively coordinating with various state governments to find migrant workers and get them enrolled under this scheme. The AB-PMJAY program provides coverage for diagnostics, hospitalizations, patient’s food, post-hospitalization charges, etc. for various health-related contingencies including COVID-19. The sum insured of this health insurance plan is Rs. 5 Lakh per eligible family per year. Since this is a card-based health insurance programme, the migrant workers may not have to worry about extensive documentation or complex claim procedures.
– June 4, 2020
The Central Government launched two ambitious schemes: Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY) and Pradhan Mantri Suraksha Bima Yojana (PMSBY). While the former provides life insurance, the latter provides health coverage on payment of a nominal premium. The PMSBY scheme is for a period of one year beginning from 1 June to 31 May. The scheme has to be renewed by the 31st of May every year to continue enjoying the benefits. The premium will be auto-debited from their bank account. The PMSBY offers insurance against accidental death and disability with an annual premium of Rs.12 and coverage of Rs.2 lakh.
– June 1, 2020
During his ‘Mann ki Baat’ radio address, the Prime Minister thanked taxpayers for paying their taxes and they deserve credit for enabling the poor to get free medical treatment through the Ayushman Bharat health insurance scheme. The number of beneficiaries has crossed the 1-crore mark since it was launched back in September 2018. The scheme has been dubbed as the world’s biggest government-sponsored health insurance scheme. He added during his address that the one core beneficiary translates to the cumulative population of two Singapores and two Norways. He said honest taxpayers deserve the “punya” for paying taxes regularly, which has helped fund the scheme and provide free healthcare.
– May 14, 2020
The Government of India has debunked a piece of fake news which has been circulating on social media which claims that the official website of Ayushman Bharat Yojana is ‘https://ayushman-yojana.org’. However, the Centre has confirmed the correct URL is pmjay.gov.in. The Press Information Bureau Fact Check tweeted that the claim through a WhatsApp forward that https://ayushman-yojana.org is the official website of the scheme; however, the National Health Authority has confirmed that the only official website of Ayushman Bharat Yojana is https://pmjay.gov.in. The tweet was confirmed by the National Health Authority.
|Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.|
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