Ayushman Bharat: Pradhan Mantri Jan Arogya Yojana (PMJAY) - Eligibility, Benefits & Application Process Explained

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.

What is PMJAY ( Ayushman Bharat Yojana Scheme )?

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 plans 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.

PM-JAY ( Ayushman Bharat Yojana ) Overview

PM-JAY ( Ayushman Bharat Yojana Scheme) Eligibility Criteria for Rural and Urban Population:

PM-JAY 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

• Sweeper/Mali/Sanitation Worker

• 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

• Mechanic/Electrician/Repair Worker/Assembler

• Chowkidar/Washer-man

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:

Here are the notable features & key highlights of the Ayushman Bharat Yojana (आयुष्मान भारत योजना) scheme, also known as PMJAY:

• 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 & Advantages of Ayushman Bharat Yojana Scheme:

The Ayushman Bharat Yojana Scheme, or Pradhan Mantri Jan Arogya Yojana (PMJAY), is specifically designed to benefit the vulnerable and underprivileged sections of society. Here are the key advantages & benefits of PMJAY:

1. It covers all hospitalisation expenses with cashless transactions to beneficiaries.

2. Accommodation during hospitalisation.

3. Pre and post-hospitalisation costs.

4. Any complications arising during the treatment.

5. Can be used by all family members.

6. No cap on family size, age or gender.

7. 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.

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

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.

• Government employees.

• 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.

PM-JAY Enrollment Process:

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).

Documents Required to Apply For Ayushman Bharat Yojana Scheme:

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.

• Caste certificate

• Income certificate

• Documents stating your current family status.

Also, read: Organ transplant expenses cover in health insurance

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 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.

How To Download Ayushman Bharat Yojana Card Online?

To ensure cashless, paperless and portable transactions through the PM-JAY 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.

Also, read: Do’s and Don’ts of Buying Health Insurance Policy

PMJAY Scheme: COVID-19 Coverage

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.

How To Check The Name in the PMJAY List 2023?

To check if your name is in the PMJAY list 2020, you can check it through different methods. They are:

1. 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.

2. Helpline Numbers: PMJAY helpline numbers are available to get information about your eligibility for the scheme. You can contact 14555 or 1800-111-565.

3. Online: Visit the official website of the scheme (https://www.pmjay.gov.in/) and check if you are eligible for the scheme.

Medical Packages:

As a beneficiary of the scheme, families, as well as individuals, can avail nearly 25 specialities, which include:

• Cardiology

• Oncology

• Neurology

• Paediatrics

• Orthopaedics

• COVID-19

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.

Hospitalisation Process in Ayushman Bharat Scheme (PMJAY):

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. 

PMJAY Hospital List:

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.

PMJAY Toll-free Number and Address:

What is an ABHA account?

On September 27th, 2021, the Indian Government kickstarted the Ayushman Bharat Digital Health Mission (ABDM). The aim? Handing every Indian a digital health ID called the ABHA Card. Picture it as a 14-digit superpower that unlocks your medical records anytime, anywhere in India. Now, you can effortlessly share your health info with doctors all over the country, no matter the distance.

Overview of ABHA Health Card

Here is an overview of the ABHA card scheme.

What are the benefits of creating an ABHA account number?

You get the following benefits for creating an ABHA Health card.

1. Easily retrieve your complete medical history, from test results to prescriptions, with just a few clicks.

2. Effortlessly share your medical records with hospitals, clinics, and doctors, ensuring seamless care even in unfamiliar locations.

3. Explore the Healthcare Professional Registry (HPR) for comprehensive details on all doctors across India.

4. Access the Health Facility Registry (HFR) to find both government and private medical facilities throughout the country.

5. Benefit from the versatility of this card, as it's recognized in AYUSH treatment centres, encompassing Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy.

How to quickly create an ABHA health card online?

Setting up your ABHA account is now a breeze with the user-friendly ACKO app. The entire process is quick, taking no more than five minutes of your time.

Here's your easy guide to creating your ABHA account number using the ACKO app:

Step 1: Download or Open ACKO App

For new users, simply download the ACKO app from the Play Store or App Store, depending on your device.

Step 2: Login and Tap on 'Discover'

Log in with your phone number using the One Time Password (OTP) and tap on 'Discover' at the bottom right corner of your screen.

Step 3: Tap on 'Get Started'  'Create ABHA Number'

Tap on 'Get Started,' and if you're an existing customer, we'll preload your member information. You can also add members to create their own ABHA accounts.

Step 4: Select member

Tap the create button for the member you wish to create an ABHA health card. You can also add a new member on this page.

Step 5: Enter Details

Proceed to enter details like your Aadhar number and mobile number. 

Step 6: Create ABHA address

Create a unique username, known as the ABHA address.

You've successfully generated your ABHA account number. If you'd like to keep a record, simply click on the 'Download Card' option for future reference. It's that simple!

Frequently Asked Questions (FAQs)

Below are some of the FAQs about the Ayushman Bharat Yojana (PMJAY) Scheme:

What services are offered under the Ayushman Bharat Scheme?

Under the scheme, medical care services such as pre and post hospitalisation, daycare surgeries, newborn child services, etc.

Will an ID card be given to beneficiaries of the Ayushman Bharat scheme (PMJAY)?

A dedicated ID card will be given to eligible family and a PMJAY ecard will be given at the time of hospitalisation.

What is the HHD number in PMJY?

The HHD number in PMJAY, which stands for Household Identification number, it is a unique 25-character code that identifies households.

How do I find my HHD number?

The HH ID or Household ID number is provided to families who are identified under the SECC and contains 24 digits.

What is the process to get an Ayushman card?

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.

Can I avail treatment for coronavirus through the Ayushman Bharat Yojana 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.

Does the Ayushman Bharat scheme cover coronavirus test expenses?

Under the scheme, you can avail both treatment and test for coronavirus.

Does PMJAY cover pre-existing diseases?

Yes, the scheme covers pre-existing diseases.

What is not covered under the PMJAY scheme?

Healthcare services such as cosmetic surgeries, drug rehabilitation, fertility treatment and organ transplant are excluded from the Ayushman Bharat Yojana scheme.

Who should the beneficiaries contact at the time of hospitalisation?

Beneficiaries should contact Ayushman Mitra at the empanelled hospital to avail cashless treatment at the hospital.

Will beneficiaries of the scheme have to pay to get the healthcare coverage under the scheme?

All beneficiaries can avail free treatment for tertiary and secondary hospital treatment for packages identified under the scheme at empanelled public and private hospitals.

What is the death benefit for Ayushman card holders?

There is no death benefit to the beneficiary of Ayushman car holders.

Is cold Orthopedics covered under Ayushman Bharat scheme?

Under the scheme, medical procedures including Orthopedics are available for treatment.

How can Kashmir migrants get an Ayushman card?

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.

Is Ayushman Bharat Yojana applicable for farmers?

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.

How to change mobile number in PMJAY?

Contact your State Health Agency (SHA) to change your mobile number in the scheme.

Does Ayushman insurance cover people above the age of 80?

Under the scheme, there is no cap on the family size and age.

How to update data in PMJAY?

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.

News Related to Ayushman Bharat Yojana Scheme:

Ayushman Bharat Yojana Scheme completes 4 years since its inception

-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.

PMJAY: Ayushman Bharat Yojana Scheme to include informal sanitation workers

-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.

Central Government to provide health insurance coverage for transgender persons

-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.

COVID-19: Ayushman Bharat-PMJAY Will Provide Health Insurance To Migrant Workers

– 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.

PMSBY: Premium To Be Paid By Due Date 31 May 2020

– 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.

PM Thanks Taxpayers As Beneficiaries of Ayushman Bharat Cross 1-Crore

– 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.

Govt. Confirms The Correct Ayushman Bharat Yojana’s Official Website

– 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.

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