PMJAY Scheme: Ayushman Bharat Yojana - Eligibility & Online Registration

What is Ayushman Bharat Yojana (PM-JAY)?

The Ayushman Bharat Yojana is a centrally sponsored health insurance scheme of the Government of India for over 12 crore poor and vulnerable families. The scheme provides a cover of 5 lakh for secondary and tertiary hospitalisation expenses cashless and paperless with public and private empanelled hospitals all over the country and beneficiaries should carry their Ayushman Bharat card.

Key Highlights of Ayushman Bharat PM-JAY Scheme

Did You Know? PM-JAY covers approximately 1,929 medical procedures, the official figure per NHA, including life-saving treatments like knee replacements, cardiac procedures, and cancer treatments.

Regular Health Insurance Plan vs Ayushman Bharat Health Insurance (PM-JAY)

Features of AB-PMJAY Scheme

PM-JAY is the world's biggest health assurance scheme that is very advantageous and makes healthcare more accessible and affordable to vulnerable groups. The major highlights of the Ayushman Bharat scheme are as mentioned below:

• Family Floater Scheme: Covers all family members with one policy without any restriction on family size, age or gender.
• Cashless & Paperless Healthcare: Beneficiaries can avail of cashless treatment at empanelled public and private hospitals across India using their Ayushman Bharat card.
• No waiting period for any pre-existing disease: Coverage from the first day of Policy activation.
• Pre & Post-Hospitalisation Expenses: Up to 3 days of pre-hospitalization and 15 days of post-hospitalization expenses, including medicines and diagnostics.
• Extensive Treatment Coverage: Provides consultation, medication, diagnostics, surgical expenses, charges for the intensive care unit, implants, hospitalisation costs and food while in the hospital.
• Transport Costs Reimbursed: reimburses costs of getting to hospital.
• Day Care Expenses Included: These are treatments which don't need 24 hours of hospitalisation.
• Extensive Procedure Coverage: Covers some 1929 medical procedures in secondary and tertiary care.
• Health and Wellness Centres: Establishment of 1.5 lakh Health and Wellness Centres (HWCs), providing comprehensive primary healthcare in India.
• Nationwide Portability: Any hospital that is empanelled can claim benefits irrespective of the home state of the person.

Benefits of Ayushman Bharat Yojana

PM-JAY is ensuring that the most vulnerable groups of the population get access to quality and affordable healthcare. Below are some of the major advantages of Ayushman Bharat health insurance scheme:

• Wide Coverage: The scope covers around 1,929 medical procedures, spanning 27 specialities including oncology, cardiology, orthopaedics and more.
• Cashless & Paperless Treatment: Beneficiaries can get end-to-end cashless and paperless treatment facility at any empanelled Public or Private Hospitals throughout the country.
• Follow-up Treatments: Cost of post-discharge treatment and medicines is covered for up to 15 days after hospitalisation.
• Multiple Surgery Coverage: If the patient is hospitalized for multiple surgeries, then the different surgeries are covered at varying rates, 100% for the first surgery, 50% for the second, and 25% for the third.
• Critical Illness Coverage: Includes treatments for critical illnesses such as cancer, heart surgery, organ transplants, and more.
• No denial of coverage for pre-existing diseases: It will cover all pre-existing diseases from day one without any waiting period.
• Treatment Complication Coverage: Any complications that occur while you are undergoing treatment is also covered by PM-JAY.
• No Restrictions: This government health insurance scheme imposes no restriction on the family size, gender and age.

Ayushman Bharat Eligibility Criteria

Ayushman Bharat Yojana (PM-JAY) eligibility is determined based on SECC-2011 data.

For Rural Households:

Families meeting at least one of the following criteria are eligible:

• Families living in kutcha houses with only one room
• Households with no adult member between ages 16 to 59 years
• Households with no adult male member between ages 16 to 59 years
• Families with a disabled member and no able-bodied adult member
• SC/ST households
• Landless families dependent on manual casual labour

Automatically included categories:

• Households without shelter, destitute/living on alms, manual scavenger families, primitive tribal groups, and legally released bonded labour

For Urban Households:

Workers in the following 11 occupational categories are eligible for the PM-JAY scheme:

• Ragpicker
• Beggar
• Domestic worker
• Street vendor/Hawker/Cobbler/other service provider working on streets
• Construction worker/Mason/Plumber, Painter, Labour, Welder, Coolie, Security guard and other head-load workers
• Sweeper/Mali/Sanitation worker
• Home-based worker/Handicrafts worker/Artisan/Tailor
• Transport worker,Conductor, Driver, Cart puller, Rickshaw puller, Helper to drivers and conductors
• Shop worker/Peon in small establishment, Assistant, Helper, Attendant, Delivery assistant, Waiter
• Electrician/Assembler/Mechanic/Repair worker
• Washer-man/Chowkidar

For Senior Citizens Above 70 Years:

On 11th September 2024, the Union Cabinet approved free health insurance for all senior citizens aged 70+ under AB PM-JAY, benefiting around 6 crore senior citizens across 4.5 crore families.

Key points:

• Eligible senior citizens will receive a separate, distinct Ayushman Bharat Card
• Senior citizens in families already covered under AB-PMJAY will get an additional ₹5 lakh top-up cover exclusively for themselves, not shared with other family members under 70
• Senior citizens not part of an existing AB-PMJAY family will receive a fresh cover of ₹5 lakh per year on a family basis
• Those already covered under CGHS, ECHS, or Ayushman CAPF can choose between their existing scheme or AB-PMJAY
• Those with private insurance or ESI can also avail AB-PMJAY benefits

Note: Ayushman card eligibility criteria remains the same as mentioned above.

Who is Not Eligible for the Ayushman Bharat Yojana?

The following groups are excluded from PMJAY coverage:

• Households owning a two, three, or four-wheeler or a motorised fishing boat
• Government employees or those working in government-managed non-agricultural enterprises
• Families with a monthly income exceeding ₹10,000
• Owners of 5 acres or more of agricultural land
• Those owning mechanised farming equipment
• Those with Kisan cards having a credit limit of ₹50,000 or above
• Families owning refrigerators or landline phones
• Families living in solidly built/pucca houses

How to Register for Ayushman Bharat PM-JAY?

Online Ayushman Card Registration

Step 1: Visit www.pmjay.gov.in and click "Am I Eligible?"

Step 2: Select "Beneficiary" as your login type.

Step 3: Enter your mobile number and captcha code and click "Verify" to receive an OTP.

Step 4: Enter the OTP to log in to your Ayushman Bharat account.

Step 5: Select your state, district, and sub-scheme and enter details like name, ration card number, or household number.

Step 6: If eligible, your name will appear on the results screen confirming your PMJAY beneficiary status.

Note: Keep your Aadhaar and ration card handy during the PMJAY online registration process.

Offline Ayushman Card Registration

For Ayushman Bharat registration offline, take your Aadhaar card and ration card to your nearest empanelled hospital or Common Service Centre (CSC) and follow the given steps:

Step 1: Give the information such as PM letter, RSBY URN, ration card or mobile number to the Arogya Mitra so that it can search the beneficiaries of PMJAY.

Step 2: The Arogya Mitra checks your information with SECC and RSBY database to verify Ayushman card eligibility.

STEP 3: Provide proper ID documents to verify. The Arogya Mitra will upload the scanned copies.

Step 4: Family records are verified and presented to the trust or insurance company for approval.

Step 5: If the State Health Agency (SHA) approves your Ayushman Bharat e-card will be issued.

Documents Required for PMJAY Registration

To apply for PMJAY, ensure you have the following documents:

• Identity Proof: Aadhaar Card or PAN Card
• Income Certificate: Proof of your family's income
• Caste Certificate: For SC/ST households
• Residential Proof: Address verification
• Family ID: Ration card or household number for family identification

How to Apply for an Ayushman Card for Senior Citizens?

Follow these steps to complete your Ayushman Bharat registration for senior citizens on the BIS portal by the National Health Authority (NHA):

Step 1: Visit the official BIS website by NHA and enter your mobile number and captcha code, then click "Verify" to receive an OTP.

Step 2: Enter the OTP and captcha code to log in.

Step 3: Click the "Click Here to Enroll" button on the banner.

Step 4: Enter your Aadhaar number and captcha code and click "Search" to check if your Aadhaar already exists in the PM-JAY database.

Step 5: For fresh enrolment, click the "Click Here" button, verify your Aadhaar number, and provide consent.

Step 6: Enter both your Aadhaar OTP and Mobile OTP to proceed.

Step 7: Make the necessary selections on the declaration page and click "Proceed".

Step 8: Complete all KYC details accurately, certify the information, and click "Submit".

Upon successful e-KYC completion, your Ayushman Bharat card for senior citizens will be available for download shortly.

Note: Ensure your mobile number is linked to your Aadhaar card before beginning the Ayushman card online registration process for senior citizens.

How to Download Ayushman Bharat Card Online?

To download your Ayushman Bharat e-card from the official PM-JAY website, follow the below steps:

STEP 1: Go to www.pmjay.gov.in and click on "Am I Eligible?" in the top menu.

Step 2: Select "Beneficiary", enter your registered mobile number and captcha code.

Step 3: Check your number with the OTP received on your mobile phone.

Step 4: Click on your state, sub-scheme and district.

Step 5: Under the ‘Search By’ box, enter Aadhaar number, family ID or PMJAY ID and hit search.

Step 7: Find the name of the family member and click on the download button, the Ayushman Bharat card will be downloaded as a PDF on your device.

Note: Print the downloaded Ayushman card and have it with you when you go to a hospital in the future.

What is Covered Under PM-JAY?

The following treatment components are covered under Ayushman Bharat health insurance scheme:

• Medical examination, treatment and consultation.
• Pre-hospitalisation costs for 3 days
• Follow up care for 15 days after hospitalisation
• Medical products, including medicines, and medical consumables.
• Diagnostic and laboratory investigations.
• Non-intensive and intensive care (ICU)
• Medical implantation services
• When there are complications while receiving treatment
• Food and accommodation while in hospital.

What is Not Covered Under PM-JAY?

The Ayushman Bharat health insurance does not cover the following:

• Outpatient care (OPD)
• Drug rehabilitation
• Cosmetic treatments
• Fertility treatments
• Assistance for organ transplants (with exception of 1,929 covered procedures)

Common Treatments Covered Under PM-JAY

The PM-JAY scheme covers approximately 1,929 medical procedures across 27 speciality areas, including:

• Skull base surgery
• Double valve replacement
• Coronary artery bypass grafting (CABG)
• Pulmonary valve surgery
• Chemotherapy for cancer

Is COVID-19 Covered Under Ayushman Bharat PM-JAY?

Yes. The Ayushman Bharat scheme covers treatments for COVID-19 at empanelled hospitals such as:

• Quarantine and isolation costs
• Hospitalisation due to COVID-19 related complications
• Paper 2 will include diagnostic tests at empanelled hospitals.

PM-JAY Toll-Free Helpline

For any queries related to Ayushman Bharat registration, Ayushman card eligibility, or PMJAY beneficiary search, contact the official helpline: 14555 or1800-111-565