Ayushman Bharat Yojana PMJAY

Even though India’s constitution promises free healthcare for the natives, how many of them 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 exactly does it benefit 40% of India's population who are deprived of tertiary and secondary care services? (1) 

Read on to know more!

More than 50% of India’s total population is deprived of proper treatment due to financial shortage. PMJAY aims to help them access proper health services and prevent exorbitant medical expenses, eventually helping and supporting the middle-class population 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 provides coverage for nearly 1393 procedures, including room charges, doctor’s fees, diagnostic services, treatment cost, 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 cover for 3 days and post-hospitalisation cover 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 needs to keep a prescribed ID handy to utilize  Ayushman Bharat benefits at the hospital.

The eligibility criteria are a bit stringent since the government is focusing on extending these benefits to the economically challenged section of the 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:

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

In urban areas:

The government has come up with 11 occupational categories, and those who are part of these categories will only be eligible for 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

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 roof 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: Visit the online portal of PMJAY and click on the ‘Am I eligible’ option.

Step 2: It will ask for your contact details to generate a one-time password. 

Step 3: After providing all these details, go ahead with selecting your state. To find your name on the beneficiary list of PMJAY and verify if those medical benefits can be availed, search by the ration number/mobile number/name/HHD number, etc.

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 and Aadhaar Card as age and identity proof
• Income certificate (maximum annual income up to Rs.5 lakhs)
• Current status of the family (joint/nuclear) and supportive document regarding the same

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 and use your registered mobile number to login.

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. 

Furthermore, you will have to bear Rs.30 to obtain the card and utilize all the Ayushman card benefits.

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.

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 

Now, beneficiaries can also seek COVID-19 testing and treatment under this scheme for free.

While this scheme extends financial coverage for most critical illnesses,  certain exclusions are also there that you need to know. For instance:

• 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, Ayushman Bharat Yojana is an ideal health insurance policy for the citizens.  From pre-existing diseases to severe medical problems, now you can deal with all of it under the PMJAY scheme.