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What is Pradhan Mantri Jan Arogya Yojana (PMJAY)?

Pradhan Mantri Jan Arogya Yojana (PMJAY) Scheme

Features of the PMJAY Scheme

Features

Description

Funding and Financial Structure

The Government entirely funds it, and the funding is shared between the Centre and State governments as per prevailing guidelines of the Ministry of Finance.

Coverage and Beneficiaries

PMJAY provides health cover up to Rs. 5 lahks per family per year for secondary and tertiary hospitalisation to around 12 crore poor and vulnerable families (approx. 55 crore beneficiaries).

Implementation and Operational Framework

PMJAY is an entitlement-based scheme. It covers poor and vulnerable families based on deprivation and occupational criteria, as per the SECC database.

Inclusivity and Scope

PMJAY provides cashless and paperless access to services for the beneficiary at the point of service in any (both public and private) impanelled hospitals across India.

Mixed Model Implementation

Under PMJAY, the states are free to choose the implementation modalities. They can implement the scheme through insurance companies, directly through the trust/society, or through a mixed model.

Restrictions 

There is no restriction on family size, ensuring all members of designated families, specifically girl children and senior citizens, get coverage.

Complaints and Grievance Mechanism 

A well-defined Complaint and Public Grievance Redressal Mechanism has been put in place through which complaints/ grievances are registered, acknowledged, escalated for relevant action, resolved, and monitored.

Technological Infrastructure

PMJAY has created a robust IT system for the implementation and role of real-time transaction data.

Administrative Oversight

At the national level, the National Health Authority (NHA) has been set up as an attached office to the Ministry of Health and Family Welfare to manage the scheme's implementation.

Resources and Information

The details of the package, operational guidelines, and key features are available at www. pmjay.gov.in

Benefits of the PMJAY Scheme

What is Covered Under the PMJAY?

What is Not Covered Under the PMJAY?

Who is Eligible for Pradhan Mantri Jan Arogya Yojana?

List of Critical Diseases Covered by Pradhan Mantri Jan Arogya Yojana

Each of these procedures addresses specific medical conditions or injuries, aiming to improve the quality of life and long-term health outcomes for patients. The PMJAY covers all of the following diseases

Sl.No. Disease Description
1 Prostate Cancer Treatment options depend on the stage and include surgery, radiation therapy, hormone therapy, chemotherapy, or a combination.
2 Coronary Artery Bypass Grafting Surgery to improve blood flow to the heart by bypassing blocked arteries using healthy blood vessels.
3 Double Valve Replacement Surgery to replace both the aortic valve and the mitral valve in the heart with prosthetic valves.
4 Carotid Angioplasty with Stent Procedure to open narrowed carotid arteries (neck arteries that supply blood to the brain) using a stent to prevent stroke.
5 Pulmonary Valve Replacement Surgery to replace a defective pulmonary valve in the heart with a prosthetic valve.
6 Skull Base Surgery Complex surgery to treat tumours or abnormalities located at the base of the skull often involves collaboration between neurosurgeons and ENT specialists.
7 Laryngopharyngectomy with Gastric Pull-up Surgery to remove the larynx (voice box) and pharynx, then reconstruction using a portion of the stomach to restore swallowing function.
8 Anterior Spine Fixation Surgical procedure to stabilise the spine from the front (anterior) using rods, screws, or plates to treat spinal instability or fractures.
9 Tissue Expander for Disfigurement Following Burns A procedure involves inserting a tissue expander under the skin near the burn scar to stretch healthy tissue for subsequent reconstruction gradually.

How to Apply for Pradhan Mantri Jan Arogya Yojana Online?

Documents Required to Apply for the PMJAY Scheme

How to Download a PMJAY Card Online?

How to Generate PMJAY Patient Card?

How to Check Your Name in the PMJAY Beneficiary List?

Stepwise Process to Check Names in PMJAY Beneficiary List Online

Medical Packages Under PMJAY Scheme

The PMJAY offers various medical packages for the benefit of the cardholders. Below is a list of specialty situations and the number of packages available for them:

S.No. Specialty Packages
1 Burns Management 12
2 Cardiology 39
3 Cardio-thoracic & Vascular surgery 92
4 Emergency Room Packages
(Care requiring less than 12 hours stay)
4
5 General Medicine 72
6 General Surgery 253
7 Interventional Neuroradiology 15
8 Medical Oncology 52
9 Mental Disorders Packages 17
10 Neo-natal care Packages 10
11 Neurosurgery 83
12 Obstetrics &Gynaecology 79
13 Ophthalmology 42
14 Oral and Maxillofacial Surgery 9
15 Orthopaedics 101
16 Otorhinolaryngology 94
17 Paediatric Medical management 102
18 Paediatric Surgery 34
19 Plastic & reconstructive Surgery 9
20 Polytrauma 12
21 Radiation Oncology 14
22 Surgical Oncology 48
23 Urology 161
24 Paediatric Cancer 38
25 Unspecified Surgical Package 1

Benefits coverage under India's different state-funded health insurance programmes has traditionally been capped at INR 30,000 per family per year, with the maximum amount varying across States, leading to a disjointed system.

  • Every qualifying household can receive a cashless cover of up to INR 5,00,000 from PM-JAY annually for specified secondary and tertiary medical problems. 
  • All costs related to the following treatment components are covered under the plan. 
  • Medical diagnosis, care, and advice.
  • Before hospitalisation, pharmaceuticals and supplies for healthcare.
  • Services for both intensive and non-intensive care.
  • Laboratory and diagnostic tests.
  • Services for medical implantation (when necessary).
  • Accommodation advantages.
  • Catering services problems that develop while receiving treatment up to fifteen days of post-hospitalisation follow-up care.

How to Find a Hospital List Under the PMJAY?

Hospitalisation Process in the PMJAY Scheme

PMJAY Toll-free Number and Address

What is an ABHA Account?

Benefits of Creating an ABHA Account

An ABHA card has many advantages and makes it easier to document your medical history. Here are a few of the ABHA card's features:

Benefits Description
Electronic Medical Records As previously mentioned, your Ayushman Bharat Health Account allows you to digitally store all your medical records and reports on one platform.
Mutual Consent for Access to Medical Records If you have an ABHA health card, your doctor can view your medical records. However, no doctor may obtain these documents without your permission.
Elevated Security With ABHA, you needn't worry about your medical information being compromised. The platform's robust encryption mechanism is a security precaution.
Availability of Multiple Physicians You can quickly, simply, and securely contact a licensed physician and/or other healthcare providers through ABHA to seek advice.
The Ability to Switch On or Off ABHA Having an ABHA health card to obtain medical care is unnecessary. With ABHA, you can generate a health card ID that you can deactivate whenever you stop using the site.
Choice to Add a Beneficiary Once you have your health card, you can add a beneficiary to your ABHA. This facility has not yet been introduced to the Indian public, but it will be accessible soon.

Regular Health Insurance Plan vs Ayushman Bharat Yojana Scheme

Point of Differentiation Regular Health Insurance Plan Ayushman Bharat Yojana Scheme
Coverage Typically covers hospitalisation, outpatient care, etc. Primarily focuses on hospitalisation
Scope Coverage based on chosen plan and premium paid Covers specified treatment packages
Target Audience Individuals and families based on the policy purchase Economically weaker sections and identified vulnerable groups
Government Involvement Provided by private insurers or government agencies Fully funded by the government
Premium Payments Premiums vary based on coverage, age, health status No premium for beneficiaries
Network Hospitals Access to network hospitals based on insurer's tie-ups Empaneled hospitals under the scheme
Cashless Treatment Available depending on policy terms and hospital network Available at empanelled hospitals
Beneficiary Identification Policyholders identified through standard procedures Identified based on the Socio-Economic Caste Census (SECC) database
Coverage Limit Limited by sum insured and policy terms No upper limit on family size or age
Benefits and Services Comprehensive as per plan coverage Pre-defined packages for specific treatments
Pre-existing Conditions Coverage may exclude pre-existing conditions Covered under the scheme's provisions
Portability Portability options available between insurers Portability not applicable
Administration Managed by insurance companies or TPA. Managed by the National Health Authority

The PMJAY programme is the best in India for impoverished people who lack access to online health insurance or the Internet. They are the target audience for this programme. It serves numerous families who cannot avail of quality treatment.

Use your PMJAY Card according to the diseases it covers to get its benefits. Check your eligibility before applying for the card, and enjoy the benefits once you have it. 

FAQs about the PMJAY Scheme