What is Pradhan Mantri Jan Arogya Yojana (PMJAY)?

Even though India’s constitution promises free healthcare for the natives, how many have access to proper medical facilities? Amidst the growing incidence of lifestyle diseases, people often struggle to get adequate treatment due to the monetary crunch.

However, the healthcare scenario has changed with the introduction of several government initiatives. For instance, government-backed health protection schemes like Pradhan Mantri Jan Arogya Yojana (PMJAY), also known as the Ayushman Bharat Yojana, provide financial coverage to people belonging to the economically weaker section during medical emergencies. 

So how does it benefit 40% of India's population deprived of tertiary and secondary care services?

Read on to know more!

The Government of India's Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is a national public health insurance system designed to give low-income individuals in the nation free access to health insurance coverage. 

Participants in the programme can see their family doctor initially for primary care, but when they require further care, PMJAY offers free secondary and tertiary healthcare for people who need hospitalisation or specialised treatment. The means-tested scheme is a component of the Indian government's national health policy. 

The government of India launched the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) on September 23, 2018. It is a centrally sponsored scheme. Here are the features of the PMJAY scheme:

PMJAY aims to help them access proper health services and prevent exorbitant medical expenses, eventually helping and supporting the middle-class population to avoid poverty.

So, here are some of the benefits you can expect from this government-backed health insurance scheme:

• The beneficiary family under this scheme is supposed to receive a benefit cover of Rs.5 lakhs per year. 
• The scheme covers nearly 1929 procedures, including room charges, doctor’s fees, diagnostic services, treatment costs, ICU and operation theatre expenses, etc. 
• The beneficiary can claim cashless medical facilities across both public and private hospitals in India.
• Under this scheme, you will get pre-hospitalisation coverage for 3 days and post-hospitalisation coverage for 15 days. During that time, the patient will also get complete coverage for medicines and diagnostics.

One of the great advantages of this scheme is that it does not restrict anyone to avail of these benefits based on their gender, age, or family size. However, one must keep a prescribed ID handy to utilise Ayushman Bharat benefits at the hospital.

Know about: Pre-Post Hospitalization Expenses in Health Insurance

The PMJAY covers critical diseases and pre and post-hospital expenses. Here is a list of diseases covered under the Ayushman Bharat Yojana:

• Coronary artery bypass grafting 
• Skull base surgery 
• Anterior spine fixation 
• Double valve replacement 
• Prostate cancer
• Pulmonary valve replacement 
• Laryngopharyngectomy with gastric pull-up 
• Carotid angioplasty with stent 
• Tissue expander for disfigurement following burns 

Beneficiaries can also seek free COVID-19 testing and treatment under this scheme.

While this scheme extends financial coverage for most critical illnesses, there are certain facilities that the PMJAY scheme does not cover. Here are a few things that PMJAT does not cover

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

With all the necessary facilities and monetary coverage without any premium cost, the Ayushman Bharat Yojana is an ideal health insurance policy for citizens. From pre-existing diseases to severe medical problems, you can now deal with all of them under the PMJAY scheme.

The eligibility criteria are stringent since the government focuses on extending these benefits to the economically challenged section of society. Therefore, make sure to go through the following eligibility parameters of this national health protection policy and see if you are qualified to avail its benefits:

The following are the ones who will receive health coverage under the PMJAY scheme:

Eligible for PMJAY in Urban Areas

The government has created 11 occupational categories, and only those who belong to these categories will be eligible for the Ayushman Bharat Yojana. 

• Electrician/repair worker/mechanic 
• Construction worker/ security guard/ plumber/ painter/ etc.
• Washerman/chowkidar
• Ragpicker
• Beggar 
• Domestic worker
• Driver/ transport worker/conductors and other people associated with this 
• Cobbler/ street vendor/hawker/other service providers who are working on streets
• Home-based worker/tailor/artisan
• Delivery assistant/shop worker

Eligible for PMJAY in Rural Areas

• SC/ST households
• Families having physically challenged members (at least one)
• Female-led family with no male adult member aged between 16 and 59 years
• Legally released bonded labourers 
• Landless households whose sole earning source is manual casual labour 
• People living in single-room houses with kutcha roofs and walls

There is no separate process for Ayushman Bharat registration since all the recipients who are already part of the Rashtriya Swasthya Bima Yojana were identified by the SECC 2011 data. Besides checking the eligibility parameters, you can directly check if you are eligible for the scheme using the PMJAY website. Here is what you need to do: 

Step 1: Log in to their official website: https://pmjay.gov.in/.

Step 2: Enter the captcha code on the screen and your mobile number now. 

Step 3: You can access the PMJAY login screen by entering the OTP issued to your registered mobile number. 

Step 4: Now, choose the state in which you want to apply for this programme. 

Step 5: Choose how you wish to look up your eligibility requirements: Name, RSBY URN, Ration card number, or mobile number 

Step 6: If you are eligible, your name will appear on the right side of the page. 

Step 7: You can view the beneficiary data by selecting the 'Family Members' tab.

Know More About: Best Health Insurance Plan

If you are thinking about applying for an Ayushman Bharat card online to get all of its salient advantages, keep these documents prepared:

• Caste certificate
• PAN Card and Aadhaar Card as age and identity proof
• Voter ID, passport, or utility bill as proof of residence
• Income certificate (maximum annual income up to Rs.5 lakhs)
• Current status of the family (joint/nuclear) and supportive document regarding the same
• Caste Certificate 
• Bank Account Details

Beneficiaries can apply for the Ayushman Bharat Yojana Golden Card to get the convenience of paperless, cashless, and portable transactions under the PMJAY scheme. You can simply present the card at the hospital to get fast and hassle-free service. 

Here is the process to avail the card:

Step 1: Visit the official website of PMJAY website and use your registered mobile number to log in.

Step 2: Generate the OTP by entering the captcha code and look for the HHD code.

Step 3: After that, you need to provide the HHD code to CSC or the Common Service Center, where Ayushman Mitra or CSC representatives will help you complete this process.

You can obtain a PMJAY patient card through the official website after qualifying for PMJAY benefits. Here are the steps for card generation:

Step 1: Log in to the official website.

Step 2: At the PMJAY kiosk, your ration card or Aadhaar card will be validated before a card is issued.

Step 3: Verify family identification of the certified list using a PM letter and an RSBY card.

Step 4: Print the e-card with the unique AB-PMJAY ID after verification.

Step 5: Use the e-card as proof in the future.

There are different methods you can use to check if your name is on the PMJAY beneficiary list. As mentioned earlier, you can simply use the online portal to check whether you are eligible for the scheme or not. Apart from the online process, there are two other convenient methods you can try out:

• Common Service Centre (CSC): Find the nearest CSC or any empanelled hospital to determine your eligibility for the healthcare scheme. 
• Helpline numbers: You can also use the helpline numbers 1800-111-565 or 14555 to acquire all the necessary information.

You can check the names in the PMJAY beneficiary list online using the Beneficiary NHA portal. Below are the steps to log in:

• Step 1: Visit the official website beneficiary.nha.gov.in.
• Step 2: Input your mobile number and verify. Enter OTP from your mobile.
• Step 3: Select the scheme name, state, sub-scheme, and district.
• Step 4: Get beneficiary details on the screen after adding all details.

Numerous hospitals have been empanelled since the Ayushman Bharat Yojana was implemented. The Ayushman Hospital list is available on the official PMJAY website. Here, you can quickly find out how to check the Ayushman Card list. You must follow these steps to locate the list of Ayushman Card hospitals: 

Step 1: Go to hospitals.pmjay.gov.in to view registered hospitals. 

Step 2: Decide the state and district you live in. 

Step 3: Decide if you want to go for a public, private, for-profit, or nonprofit hospital. 

Step 4: Decide which medical specialisation you require. For instance, paediatric, general, neurosurgery, cancer, etc.

Step 5: Type the Captcha.

Step 6: Click on ‘Search’.

As a recipient, you will be given the Ayushman health card, allowing you to access hospital stays and treatments without using cash. You can use your golden card to get the program's benefits at any public or private hospital with an affiliation.

The hospitalisation and treatment procedure is cashless because the centre and the state have a 60:40 cost-sharing agreement. You have access to around twenty-five different medical specialities. Anyone hospitalised under the PMJAY can get free hospitalisation at any government or private hospital.

Beneficiaries can call the ESIC toll-free number: 1800-11-4477/ 1477 or mail ayushmanbharat.csc@gmail.com for further information. The address for the PMJAY office is 7th & 9th Floor, Tower-L, Jeevan Bharati Building, Connaught Place, New Delhi - 110001.

The Ministry of Health and Family Welfare introduced the Ayushman Bharat Digital Mission (ABDM) programme, which is primarily concerned with laying the groundwork for the nation's healthcare system to become digital. One of the main components of India's government's ABDM plan is the Ayushman Bharat Health Account (ABHA), which provides you with a health card bearing a unique identifying number.

India's residents benefit greatly from this mission, which includes easy access to healthcare facilities and medical treatments, simple options for signing up for personal health record applications (like the ABDM ABHA app), and reliable identities.

Here's a comparison table between a Regular Health Insurance Plan and the Ayushman Bharat Yojana Scheme (PMJAY):