Ayushman Bharat Yojana: Pradhan Mantri Jan Arogya Yojana (PMJAY)

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is a government health insurance scheme providing free healthcare coverage of up to INR 5 lakh per family per year for economically vulnerable sections. Ayushman Bharat Yojana covers secondary and tertiary treatments, benefiting over 10 crore families. Eligibility is determined based on SECC 2011 data for rural and urban households. Benefits include hospitalization, daycare procedures, and coverage of pre-existing conditions. The scheme supports various empaneled public and private hospitals.

What is Pradhan Mantri Jan Arogya Yojana (PMJAY)?

Launched in 2018, PMJAY, also known as Ayushman Bharat Yojana, is the world’s largest government-funded health insurance program. It covers over 13 crore families, which equates to around 50 crore individuals. Under this scheme, each family is entitled to health insurance coverage of up to INR 5 lakh annually for secondary and tertiary treatments.

Also Read: Bangla Shasya Yojana

Benefits of Ayushman Bharat Yojana (PMJAY)

The PMJAY scheme offers several benefits to its beneficiaries, which include:

1. Comprehensive Health Coverage: Up to INR 5 lakh per family for treatments at empaneled hospitals, both private and public.
2. No Premium: The scheme is free, with no premiums charged to beneficiaries.
3. Wide Network: Beneficiaries can access healthcare services across an extensive network of empaneled hospitals across India.
4. Pre-Existing Diseases Covered: The scheme covers pre-existing conditions, ensuring holistic care.
5. Daycare and Major Treatments: Hospitalization expenses for surgeries, daycare procedures, and serious treatments are all covered under PMJAY.

PMJAY (Ayushman Bharat Yojana) Overview

We, Bloglynk, have mentioned some of the specifications of PMJAY (Ayushman Bharat Yojana):

PMJAY (Ayushman Bharat Yojana) Eligibility Criteria for Rural and Urban Population

The Pradhan Mantri Jan Arogya Yojana (PMJAY) is a government scheme to provide healthcare coverage to the bottom 40% of the country’s economically weaker sections. The eligibility criteria for PMJAY Rural include households falling under five deprivation categories, such as families with only one room, no adult male members, and SC/ST households. For PMJAY Urban, 11 occupational categories include domestic workers, street vendors, construction laborers, and sanitation workers. The scheme ensures healthcare access for the most vulnerable.

PMJAY Rural

• No adult member in the age group between 16 and 59 years.
• Having only one room with Kucha structures and roofs.
• Households having disabled and no-abled members.
• Scheduled Caste (SC) and Scheduled Tribe (ST) families are eligible.
• Landless households rely primarily on manual, casual labor for income.

PMJAY Urban

• Street Vendors/Hawkers/Cobblers/Other service providers on the street
• Domestic worker
• Ragpicker
• Beggar
• Construction Worker/Plumber/Mason/Labour/Painter/WelderCoolie/Security Guard
• Sanitation Worker/Sweeper/Mali
• Handicrafts Worker/Artisan/Home-based Worker/Tailor
• Transport Worker/Driver/Cart or Rickshaw Pullers/Conductor/Helper to Drivers or Conductors
• Peon in Small Establishments/Shop Workers/Attendants/Delivery Assistants/Assistants/Helpers/Waiter
• Assembler/Electrician/Mechanic/Repair Worker
• Washer-man/Chowkidar

Coverage Benefits Under the Ayushman Bharat Yojana Scheme

The Ayushman Bharat Yojana provides up to INR 5 lakh per family annually for secondary and tertiary hospital care. This scheme ensures accessible healthcare for the economically weaker sections. Coverage includes hospitalization costs such as:

• Medical consultation and treatment.
• Pre-hospitalization and post-hospitalization care (up to 15 days).
• Intensive and non-intensive care services.
• Medicines, medical consumables, and implants.
• Diagnostic and lab services.
• Hospital stay and food services.
• Treatment for complications during care.
• COVID-19 treatment.

What is Not Covered Under the Ayushman Bharat Yojana Scheme (PMJAY)?

The Ayushman Bharat Yojana has certain exclusions. The below-mentioned components are not covered under the PMJAY scheme:

• Out-Patient Department (OPD) expenses.
• Drug rehabilitation services.
• Cosmetic and elective surgeries.
• Fertility treatments.
• Individual diagnostic tests.
• Organ transplants.

Features of Ayushman Bharat Yojana (PMJAY)

The Ayushman Bharat Yojana (PMJAY) is one of the world’s largest government-funded health insurance schemes, offering significant benefits:

• Coverage of up to INR 5 lakh per family annually for secondary and tertiary care across public and private hospitals.
• 50 crore beneficiaries, covering over 10 crore underprivileged families.
• Cashless hospitalization services with coverage for 3 days of pre-hospitalization and 15 days of post-hospitalization expenses.
• No restrictions on family size, gender, or age.
• Coverage of all pre-existing conditions from day one, including 1,393 medical procedures.
• Can be availed nationwide at empaneled hospitals.
• Equal reimbursement for public and private hospitals.

This scheme aims to provide quality healthcare access for economically vulnerable populations, ensuring medical treatments without financial burden.

Also Read: Employee Provident Fund Organization

List of Critical Diseases Covered Under PMJAY (Pradhan Mantri Jan Arogya Yojana)

The Ayushman Bharat Yojana provides coverage for over 1,300 medical treatments across empaneled hospitals, ensuring comprehensive healthcare for its beneficiaries. Below are some major illnesses and treatments covered under the scheme:

• Prostate cancer
• Double valve replacement
• Coronary artery bypass graft
• COVID-19 treatment
• Pulmonary valve replacement
• Skull base surgery
• Anterior spine fixation
• Laryngopharyngectomy with gastric pull-up
• Tissue expander for burns-related disfigurement
• Carotid angioplasty with stent

How to Avail PMJAY Benefits?

Eligible families can avail of the benefits of the Ayushman Bharat Yojana by visiting any empaneled hospital. The process is as follows:

• Visit an Empaneled Hospital: Beneficiaries can visit any empaneled public or private hospital.
• Present PMJAY Card: Beneficiaries need to present their PMJAY card or verify their identity via Aadhaar or other government-approved identification documents.
• Cashless Treatment: Once verified, the patient can avail of treatment without any out-of-pocket expenses, as the entire process is cashless.

How to Find PMJAY Hospital List?

To find hospitals under the Ayushman Bharat PMJAY scheme, follow these steps:

1. Go to the PMJAY website’s hospital list section.
2. Select your state and district.
3. Choose the type of hospital (public, private-for-profit, or private not-for-profit).
4. Select the medical specialty.
5. Enter the Captcha code and search.

You will see a list of hospitals with contact details. You can also view the suspended hospital list on the same platform.

Also Read: NREGA

Total Number of PMJAY Empanelled Hospitals in Every States

The total number of Ayushman Bharat Yojana (PMJAY) empanelled hospitals in each state and union territory of India as of May 2024:

Ayushman Bharat Yojana (PMJAY) Enrollment Process

The Ayushman Bharat Yojana is an entitlement-based scheme aimed at providing healthcare to poor and vulnerable sections. There is no need for enrollment; beneficiaries are selected based on the SECC 2011 and the RSBY plan. To check your eligibility, follow these steps:

1. Visit the official PMJAY website and click “Am I Eligible.”
2. Enter your contact details and generate OTP.
3. Choose your state.
4. Search using your name, mobile number, ration card, or HHD number.

You can also contact PMJAY customer care at 1800-111-565 or 14555.

Documents Required for PMJAY Application

To apply for the Ayushman Bharat PMJAY scheme, you will need the following documents:

• Proof of identity and age (Aadhaar Card or PAN Card)
• Mobile number, email address, and residential address details
• Caste certificate
• Income certificate
• Documents reflecting your current family status

Ensure all documents are up-to-date to facilitate the application process.

How to Apply Online for Ayushman Bharat Yojana (PMJAY)?

To check if you’re eligible for Ayushman Bharat Yojana, follow these steps:

• Visit the official PMJAY website at pmjay.gov.in.
• Click on the “Am I Eligible” option.
• Enter your contact information and generate an OTP.
• Select your state and search using your name, mobile number, ration card number, or HHD number.
• The system will inform you if you qualify for the scheme.

How to Get the Ayushman Bharat Golden Card (PMJAY)?

The Ayushman Bharat Golden Card allows for cashless and paperless transactions under the PMJAY scheme. Follow these steps to obtain it:

1. Visit PMJAY’s portal and log in using your registered mobile number.
2. Enter the Captcha code and generate OTP.
3. Choose the HHD code.
4. Provide this code at the Common Service Centre (CSC).
5. The CSC representative (Ayushman Mitra) will assist you further.
6. Pay INR 30 to receive your Ayushman Bharat Golden Card.

Medical Packages Under Pradhan Mantri Jan Arogya Yojana (PMJAY)

The Ayushman Bharat Yojana offers access to nearly 25 medical specialties for beneficiaries, including:

• Cardiology
• Oncology (Cancer treatment)
• Neurology
• Pediatrics
• Orthopedics
• COVID-19 treatment

This scheme also covers pre-existing conditions from the start, ensuring that no prior illnesses are excluded from healthcare benefits.

Ayushman Bharat Yojana (PMJAY) Contact Details

To contact Ayushman Bharat Yojana (PMJAY), you can reach out via the following methods:

• Helpline Numbers: 14555 or 1800-111-565 (toll-free).
• Official Website: https://pmjay.gov.in – Access the portal for queries and support.
• Grievance Portal: PMJAY Grievance

These contact details can be used for assistance related to eligibility, hospital lists, or any other inquiries about the PMJAY scheme.

Latest Update Regarding Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

Ayushman Bharat Yojana: Health Coverage for Senior Citizens

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY) extends health insurance to individuals over 70 years of age, regardless of family income. This initiative aims to provide healthcare coverage up to INR 5 lakh for over six crore senior citizens. It addresses the gap in insurance availability for older individuals and allows those enrolled in other government health schemes to switch to PMJAY for better benefits.

Ayushman Bharat Yojana (PMJAY) FAQs

1. What is Ayushman Bharat Yojana (PMJAY)?

Answer. PMJAY is a government-funded health insurance scheme providing coverage of up to INR 5 lakh per family per year for secondary and tertiary care.

2. Who is eligible for the Ayushman Bharat Yojana?

Answer. Eligibility is based on the Socio-Economic Caste Census (SECC 2011) and includes families under the RSBY scheme.

3. How do I check my eligibility for PMJAY?

Answer. Visit the official website pmjay.gov.in, click “Am I Eligible,” and search using your mobile number, name, or ration card.

4. What diseases are covered under PMJAY?

Answer. PMJAY covers over 1,300 medical procedures, including treatments for cancer, heart disease, COVID-19, and orthopedic surgeries.

5. How much coverage is provided under the Ayushman Bharat scheme?

Answer. The scheme provides coverage of INR 5 lakh per family annually.

6. Are pre-existing conditions covered under PMJAY?

Answer. Yes, all pre-existing conditions are covered from the first day.

7. What documents are required to apply for PMJAY?

Answer. Documents include identity proof (Aadhaar or PAN card), caste certificate, income certificate, and family status documents.

8. How do I apply for the Ayushman Bharat Golden Card?

Answer. Visit mera.pmjay.gov.in, log in with your mobile number, and follow the instructions to generate your card.

9. Is there a fee to get the Ayushman Bharat Golden Card?

Answer. Yes, you need to pay INR 30 to receive the card.

10. Can I avail services outside my state under PMJAY?

Answer. Yes, PMJAY offers portability, allowing you to access benefits at empaneled hospitals across India.

11. How can I find hospitals empaneled under PMJAY?

Answer. Visit the PMJAY website, select your state, district, and hospital type, and search for a list of hospitals.

12. Is there a cap on family size or age for PMJAY?

Answer. No, there are no restrictions on family size, age, or gender.

13. Does PMJAY cover outpatient services (OPD)?

Answer. No, PMJAY does not cover OPD services.

14. What is the helpline number for Ayushman Bharat?

Answer. You can contact PMJAY customer care at 14555 or 1800-111-565.

15. What are the benefits of the Ayushman Bharat Yojana?

Answer. Benefits include cashless hospitalization, coverage of 1,300+ treatments, and pre- and post-hospitalization expenses.

16. Does PMJAY cover COVID-19 treatment?

Answer. Yes, PMJAY includes coverage for COVID-19 treatment.

17. What medical specialties are covered under PMJAY?

Answer. Specialties include cardiology, oncology, neurology, pediatrics, orthopedics, and more.

18. Are cosmetic surgeries covered under PMJAY?

Answer. No, cosmetic surgeries are excluded from the scheme.

19. How long is pre- and post-hospitalization covered under PMJAY?

Answer. PMJAY covers 3 days of pre-hospitalization and 15 days of post-hospitalization expenses.

20. How can I contact Ayushman Bharat for more information?

Answer. You can visit the official website or call the helpline numbers if you need help.