What is Pradhan Mantri Jan Arogya Yojna (Ayushman Bharat Yojana) ?

What is Pradhan Mantri Jan Arogya Yojna

Pradhan Mantri Jan Arogya Yojana (PMJAY), also known as the Ayushman Bharat Yojana, is a Government scheme that aims to help economically weak residents of India who are in need of healthcare facilities. This scheme was launched on 23 September 2018, inaugurated by the Prime Minister Sh. Narender Modi to cover near about 11 crore families of india and it already have several success stories till now. The Ayushman Bharat Yojana is a National Health Protection Scheme, which has now been renamed as Pradhan Mantri Jan Arogya Yojana, plans to make secondary and tertiary healthcare completely cashless. The Pradhan Mantri Jan Arogya Yojana enrolled beneficiaries get an e-card that can be used to avail services at an empanelled hospital, public or private, anywhere in the country. the enrolled beneficiaries can get admitted into a hospital and obtain cashless and hustle free treatment.

The scheme coverage includes 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses. Moreover, around 1,400 procedures with all related costs like OT expenses are covered herein. And above all, PMJAY and the e-card provides coverage of up to Rs. 5 lakh per family, annually, thus helping the economically weak section can easily access healthcare services.

List of Critical Diseases covered under PMJAY

PMJAY helps beneficiaries to access secondary and tertiary care via funding up to Rs. 5 lakh per family, annually. 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
  • Double valve replacement
  • Pulmonary valve replacement
  • Coronary artery bypass grafting
  • Carotid angioplasty with stent
  • Laryngopharyngectomy with gastric pull-up
  • Anterior spine fixation
  • Skull base surgery
  • Tissue expander for disfigurement following burns

PMJAY has a minimal list of exclusions. They are as follows.

  • OPD
  • Organ transplants
  • Fertility related procedures
  • Drug rehabilitation programme
  • Cosmetic related procedures

Eligibility Criteria for Rural 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 of 8 crore families in rural areas and 2 crore families in urban areas. It simply means that the scheme will aim to cover up to 50 crore individual beneficiaries. This scheme has certain pre-conditions by which it classify, who can get enrolled as a beneficiary. While in the rural areas the list is mostly categorized on lack of housing, low 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 to 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 weak sections 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.

Eligble family for PMJAY yojna in rural areas:

  •  Families with no male member aged in between 16 to 59 years
  •  Primitive tribal communities
  •  Beggars and those surviving on alms.
  •  Landless households who make a living by working as casual manual labourers.
  •  Families with no individuals aged in between 16 and 59 years
  •  Families having at least one physically challenged member and no able-bodied adult member.
  •  Those living in scheduled caste and scheduled tribe households
  •  Legally released bonded labourers.
  •  Families living in one-room makeshift houses with no proper walls or roof
  •  Manual scavenger families

Eligibility Criteria for Urban Residents

 According to the National Sample Survey Organisation (71st round), 82% of urban households do not have access to healthcare insurance or assurance. Further, 18% of Indians in urban areas have addressed healthcare expenses by borrowing money in one form or the other. Pradhan Mantri Jan Arogya Yojana helps these households avail healthcare services by providing funding of up to Rs. 5 lakh per family, per year. PMJAY will benefit urban workers’ families in the occupational category present as per the Socio-Economic Caste Census 2011. Further, any family enrolled under the Rashtriya Swasthaya Bima Yojana will benefit from the PM Jan Arogya Yojana as well.

In the urban areas, those who can avail of the government-sponsored scheme consist mainly of:

  • Rag pickers
  • Domestic help
  • Washerman / chowkidars
  • Mechanics, electricians, repair workers
  • Sanitation workers, gardeners, sweepers
  • Home-based artisans or handicraft workers, tailors
  • Plumbers, masons, construction workers, porters, welders, painters and security guards
  • Transport workers like drivers, conductors, helpers, cart or rickshaw pullers
  • Cobblers, hawkers and others providing services by working on streets or pavements
  • Assistants, peons in small establishments, delivery boys, shopkeepers and waiters

Class which are not entitled to be enrolled under Pradhan Mantri Jan Arogya Yojana Scheme:

  • Those with decent, solidly built houses
  • Those who own a two, three or four-wheeler or a motorised fishing boat
  • Those earning a monthly income above Rs.10000
  • Those who own mechanised farming equipment
  • Those employed by the government
  • Those who have Kisan cards with a credit limit of Rs.50000
  • Those who work in government-managed non-agricultural enterprises
  • Those owning refrigerators and landlines
  • Those owning 5 acres or more of agricultural land

Medical Packages and Hospitalization Process in Ayushman Bharat Scheme (PMJAY)

The Rs. 5 lakh insurance cover provided by the PMJAY can be utilized not just by individuals in particular, but also by families in general. The total amount is enough to cover both the medical and surgical treatments in 25 specialities among which are cardiology, neurosurgery, oncology, pediatrics, orthopedics, etc. But most importantly, medical and surgical expenses cannot be reimbursed simultaneously. If multiple surgeries are necessary, the highest package cost is paid for in the first instance followed by a 50% waiver for the second and a 25% discount for the third. Unlike other health insurance schemes, there is no waiting period for pre-existing diseases under PMJAY scheme, which comes under the larger circumference scheme of Ayushman Bharat Yojana. If any beneficiary or anyone in their family require any kind of hospitalization, they need not to pay anything, provided that if they are admitted to any empanelled government or private hospital under Ayushman Bharat Scheme. The cashless treatment and hospitalization is made possible due to a 60:40 cost sharing agreement between the Centre and states. Once identified as a genuine beneficiary, you or your family member will be issued a health card by specially trained Ayushman Mitras at kiosks located in hospitals for those who are unaware of the PMJAY scheme. With these details in hand, you can help someone else to get the healthcare benefit through Ayushman Bharat Yojana.

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 Survey of 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.

  1. Visit https://www.pmjay.gov.in/ and click on ‘Am I Eligible’
  2. Enter your mobile number and the CAPTCHA code and click on ‘Generate OTP’
  3. Then select your state and search by name/ HHD number/ ration card number/ mobile number
  4. Based on the search results you can verify if your family is covered under PMJAY

Alternatively you can dial the Ayushman Bharat Yojana call centre number i.e: 14555 or 1800-111-565

PMJAY Patient E-Card Generation

Once you are eligible for the PMJAY benefits, you can look forwards for getting an e-card. Prior to 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.