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PMJAY: Ayushman Bharat Yojana, Eligibility & Features

Prime Minister Shri Narendra Modi announced the launch of (PMJAY) Ayushman Bharat Yojana in his Independence Day speech of the year 2018. Pradhan Mantri Jan Arogya Yojana (PMJAY) is a flagship National Health Protection Scheme funded by the Government of India. Ayushman Bharat Yojana subsumes the Senior Citizen Health Insurance Scheme (SCHIS) and Rashtriya Swasthya Bima Yojna (RSBY) and is also known as the AB-PMJAY scheme. Ayushman Bharat Yojana scheme caters not only the poor but rural families too, which is why it is economically beneficial to the poor and destitute households in rural and urban areas.

What is Ayushman Bharat Yojana Schema (PMJAY)?

PMJAY is also known as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana Scheme, one of the biggest healthcare schemes that is sponsored by the Government of Inidia. Prime Minister, Narendra Modi rolled out Pradhan Mantri Jan Arogya Yojana healthcare scheme with an aim to cover more than 50 crore Indian citizens and nearly 10 Crore underprivileged families without any limitations pertaining to family size and age. Ayushman Bharat Yojana (PMJAY) will help these households avail the bet healthcare services with insurance coverage up to INR 5 lakh for each family per year for tertiary and secondary hospitalization expenses.

PM Ayushman Bharat Yojana scheme is paperless and offers cashless hospitalization cover at public hospitals and network private hospitals. Ayushman Bharat health insurance covers the cost of hospitalization, pre-hospitalization, medication, and post hospitalization expenses incurred during the treatment, which is applicable to almost all tertiary and secondary care procedures.

Moreover, Ayushman Bharat Yojana scheme includes nearly 1,400 exorbitant treatments like skull surgery, knee replacements, and the likewise. And the patients can also follow-up for the treatments to ensure full recovery. Read all about (PMJAY) Ayushman Bharat Yojana scheme features, eligibility criteria & application process imentioned below.

Features of PMJAY: Ayushman Bharat Yojana Scheme

In addition to be a life saver scheme for lower middle income the other key features of Pradhan Mantri Ayushman Bharat Yojana (PMJAY) are as follows:

  • Ayushman Bharat Yojana scheme is a family floater scheme with a sum assured of Rs. 5 lakh per family enrolled
  • This scheme is specially designed for people below the poverty line who do have access to internet or online health plans
  • PMJAY scheme facilitates cashless healthcare services to its beneficiary in any of the public sector hospitals and private network hospital
  • Moreover, Pradhan Mantri Ayushman Bharat Yojana also recompenses the transportation cost incurred by the beneficiary during the pre and post-hospitalization period
  • Along with medical treatment expenses, Ayushman Bharat Yojana insurance package also covers the day-care expenses incurred by the beneficiary
  • PMJAY scheme also covers some of the specific pre-existing diseases
  • The payment for medical expenses is to be made based on the package rate as pre-determined by the government
  • Under the government backed scheme, a considerate number of health and wellness centres will be established asper the Socio-Economic Caste Census data

Benefits of Ayushman Bharat Yojana Scheme

Ayushman Bharat Yojana scheme insures almost 40% of the vulnerable and needy families in India. The healthcare services and benefits that they can avail are listed below:

  • The treatment and healthcare facilities under PMJAY is available across India and is free of cost
  • The Ayushman Bharat Scheme offers 25 specialty categories and it covers a wide range of 1,354 medical and surgical packages such as neurosurgery, cardiology, etc.
  • Ayushman Bharat Yojana scheme also covers post-hospitalization expenses
  • In case of multiple surgeries, the cost shall be covered with the highest package. And for second and third surgery it should be covered 50% an 25% respectively
  • The scheme also covers the treatment cost of oncology with chemotherapy for 50 different types of Cancer. However, both medical and surgical package cannot be availed at the same time.
  • The beneficiaries under PMJAY scheme can also avail follow-up treatment coverage

What is Covered under Ayushman Bharat Yojana Scheme?

PMJAY covers the following expenses during the treatment:

  • Ayushman Bharat Yojana Scheme provides coverage for medical examination, treatment and consultation fee
  • Pre-hospitalization expenses are covered under Ayushman Bharat Yojana policy
  • Post-hospitalization expenses are covered for 15 days
  • The policy also covers the cost of medicine and medical consumables
  • Hospital accommodation charges are also covered
  • Non-intensive and ICU services
  • The expenses incurred on the Diagnostic procedures are also covered
  • Medical implantation services are covered where required
  • Expenses incurred on complications arising during the medical treatment
  • Food services

What is Not Covered Under Ayushman Bharat Yojana Scheme?

PMJAY does not cover treatment expenses incurred on cosmetic surgeries, fertility treatment, drug rehabilitation, organ transplantation. For details you can check your policy documents.

Ayushman Bharat Eligibility Criteria for Rural and Urban People

To avail the benefits of Ayushman Bharat Yojana health insurance scheme, it is essential for all the people to check for their names in the Socio-Economic Caste Census-2011 data. This will ensure if their family is eligible to be covered under Ayushman Yojna or not. And only those households whose name is listed in SECC database and active RSBY card holders are entitled to avail PMJAY benefits.

Pradhan Mantri Jan Arogya Yojana allows the eligible members to avail the healthcare services across India.

PMJAY Eligibility Criteria for Rural

  • Household with no adult/male/ earning member within the age group of 16-59 years
  • Families living in one room with Kuccha Kuccha walls and roof
  • Families with no members within the age group of 16-59 years
  • Household without a healthy adult member and one disabled member
  • Manual scavenger families
  • Landless households earning a major part of their family income from manual labour

PMJAY Eligibility Criteria for Urban

  • Domestic worker
  • Beggar
  • Ragpicker
  • Home-based Artisans/ Tailor Sweeper/ Handicrafts worker/ Sanitation worker/ Mali
  • Construction worker/ Labour/ Painter/ Welder/ Security guard/ Coolie
  • Washer-man/ Plumber/ Mason
  • Electrician/ Mechanic/ Assembler/ Repair worker
  • Transport worker/ Rickshaw puller/ Conductor/ Cart puller/
  • Waiter/Shop worker/ Assistant/ Peon/Delivery assistant
  • Street vendors/ hawker / Cobbler

How to Register for PMJAY Scheme Online?

PMJAY Toll-free Number and Address:

PM Ayushman Bharat scheme enables the applicants to call on their helpline number for any grievances 14555 & 1800111565.

Address: 7th and 9th Floor, Tower-L, Jeevan Bharati Building, Connaught Place, New Delhi - 110001

It is quite simple to register for PMJAY scheme. It is applicable to all beneficiaries who are identified under the SECC 2011 list and those who are as part of the RSBY scheme. However, if you want to register for PMJAY online, you can follow the steps given below:

  • Visit the official government website for PMJAY scheme
  • You will find Am I Eligible tab, simply click on it
  • Submit your mobile number, CAPTCHA code, and click on Generate OTP button
  • Now enter your State and your name, ration card number, household number, or mobile number
  • If your family is covered under Ayushman Bharat Yojana, then you name will be displayed in the results

You can also check with any of the panel hospitals or call at PMJAY’s helpline number i.e. 14555 or 1800-111-565.

For Ayushman Bharat Registration following documents need to be submitted:

  • Age & Identity Proof (Aadhaar Card/PAN Card)
  • Contact details (mobile, address, email)
  • Caste certificate
  • Income certificate (maximum annual income to be only up to Rs. 5 lakh a year)
  • Document proof the current status of the family to be covered (Joint or nuclear)

How to Check your Name in Ayushman Bharat Yojana Scheme List?

There are various methods to check your name in the PM Jan Arogya Yojana -PMJAY beneficiary list. Listed below are some of the ways that you can try:

  • Online Method- Ayushman Bharat online list can be checked by the beneficiaries. All you need to do is visit the official online site of the National Health Authority for Ayushman Bharat Yojana.
  • Common Service Centres (CSC)- If you are a beneficiary of Ayushman Yojna you can also visit the nearest Common Service Centres. If it is not possible to do so you can also visit any of the empanelled hospitals to collect the information form. You can check the Ayushman Bharat hospital list on their site or in your policy documents.
  • Contact their Helpline No.- You can call on any of the government of India provided helpline numbers (e.g. 1800111565) to contact their customer care and seek the information about PMJAY Scheme, Ayushman card/e-card, Ayushman card apply, Ayushman card download and even Ayushman Bharat Scheme registration.

If your name is there in the list, then only you will get the Ayushman Bharat Card.

List of Critical Diseases covered under PM Jan Arogya Yojana (PMJAY)

PMJAY offers nearly 1,350 medical packages at any of the private network hospitals and all the public hospitals. Below are some of the critical illnesses that Ayushman Yojna covers:

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

How to Download your Ayushman Bharat Yojana Card Online?

It is important to apply for the Ayushman card as it consists of a dedicated family identification number. AB-NHPM is provided to every beneficiary household. Below are the steps that you can follow to apply or download your card online-

  • Firstly, visit Ayushman Bharat Yojana official website
  • Now login with your email id and generate password
  • Enter your Aadhaar number to proceed further
  • Click on the approved beneficiary option
  • It will be redirected to their help centre
  • Now enter your password in CSC and the pin number
  • It will be redirected to the home page
  • You will see the download option form where you can download your Ayushman Bharat golden card

Ayushman Bharat Scheme Hospitalization Process

Ayushman Bharat Yojana scheme offers health insurance cover to beneficiaries without any premium cost, treatment cost during and after the hospitalization. Ayushman Bharat scheme covers both pre and post hospitalization expense in-addition to the in-patient charges.

And all the empanelled hospitals under PMJAY would have appointed Ayushman Mitra’s who will aid the patent by coordinating with the hospital’s beneficiary in order to cut the expenses. You will find these Ayushman Mitra at their help desk where they will be verifying the eligibility criteria, documents, and the enrolment process. They provide letter to all the beneficiaries with respective QR codes.

Furthermore, this QR code is scanned and verified for authentication to check the eligibility for people to avail Ayushman Bharat Yojana benefits.

And the best part about Ayushman Bharat scheme is that it offers coverage across PAN India and offers cashless hospitalization benefits to the enrolled families in both the public and private hospitals.

PMJAY Patient Card Generation

You can apply for an e-card once you find out your eligibility for Ayushman Bharat yojana scheme. But before you get this e-card, you will have to go through an identity verification at one of the PMJAY kiosk based on your documents like Aadhaar card or ration card. Even your family identification can be furnished including the RSBY cars, or a govt. certified list of members.  After this verification is done, you patient e-card is printed along with your Ayushman Bharat ID, which can be used for future references.

COVID-19 Treatment Covered under Ayushman Bharat Yojana Scheme (PM-JAY)

As per the IRDAI’s regulation all the health insurance providers are covering COVID-19 hospitalization expenses. Even the Government backed Ayushman Bharat scheme also offers coverage against the Global pandemic COVID-19. The beneficiary can avail medical test facilities at any of the panel hospitals without any money being charged as per the NHA’s announcement. Ayushman Bharat scheme also covers the isolation and quarantine expenses.

All the empanelled hospitals under this policy are well-equipped to carry out Coronavirus testing, treatment, and quarantine facilities. It is great initiative to offer protection to the poor and needy families against the impact of the deadly COVID-19.

As this policy is for people below the poverty line, those in the higher income groups who can pay premium on their own should also get adequate health cover. Considering the ongoing medical inflation, a health cover of minimum Rs. 10 lakhs is recommended that can go up to of Rs. 1 Crore & more as per your requirement. This is required to avail the best possible treatment for emergency medical treatment including life threatening diseases like cancer, organ transplant, heart surgeries, etc. 

PMJAY FAQs

Q1. Do the beneficiaries have to pay anything to get coverage under Ayushman Bharat health insurance scheme?

Ans: The scheme offers the beneficiaries free healthcare services for both secondary and tertiary inpatient hospitalization as per identified packages at empanelled private hospitals and the government hospitals. Moreover, they are given cashless and paperless access to inpatient hospital care under this Ayushman Yojana.

Q2. Are diabetic patients covered under PM Ayushman Bharat Yojana Scheme?

Ans: Yes, you will be insured from Day 1 under this scheme even if you have diabetes but only for inpatient hospitalization, as it covers pre-existing diseases. But, OPD expenses will not be covered.

Q3. How would I know whether the hospital provides the relevant package under Ayushman Bharat Yojana while I am traveling to another state?

Ans: To know if the hospital offers the desired health package you can call at Ayushman Bharat tollfree helpline number i.e. 14555 and check with their Ayushman Mitra who are appointed in that hospital.

Q4. Will I get maternity coverage under JSY a part of AB-NHPM?

Ans: The Ayushman Bharat Yojana compensates for Normal Labour and delivery, C-sections, as well as high risk deliveries. But it does not cover JSY and another voucher scheme benefit.

Q5. What should I do if the hospital refuses to treat a beneficiary under Ayushman Bharat Scheme?

Ans: The grievance will be redressed within 30 days of filing the complaint by a dedicated Grievance Redressal Committee that is appointed at national, state, and district level.

Q6. Is Cancer covered under Ayushman Bharat Yojana Scheme?

Ans: Yes, Ayushman Bharat Yojana covers cancer treatment, but the cancer type and duration vary for different type of Cancers. The treatment for this disease needs to undergo a treatment plan and some approvals like a ‘tumour board concept’ to decide the best patient management.

It also requires mandatory approval for clinical treatment for cancer care, as it involves a multi model approach requiring coverage for chemotherapy, surgeries and radiotherapy and another supported care for best patient care and management. it involves 2 step approach for pre-authorisation for the complete course of cancer treatment mentioning the different stages after treatment. It also requires signing and filling the detailed oncology treatment form and needs to be uploaded as per pre-authorisation for each selected package and predefined cancer stage.

Q7. Is health insurance cover under Ayushman Yojana scheme enough?

Ans: This scheme is launched by government to ensure healthcare services to below the poverty line and those who cannot afford to pay the premium amount every year. However, others who can pay the premium should have an adequate health insurance plan starting from Rs. 10 lakh health insurance (nowadays) that covers the treatment cost of diseases like Diabetes, Cancer, Heart Attack and other illnesses. You can also buy that a Rs. 1 Crore health insurance and more as per your pocket.

Q8. How to update data in PMJAY?

Ans: All the beneficiaries of the scheme can update their data by calling at their helpline number i.e. 14555 or 1800-111-565 or by visiting the Common Service Centre (CSC).

Q9. How to change mobile number in PMJAY?

Ans: To change your registered mobile number under PMJAY you can check with your State Health Agency (SHA).

Q10. Does PMJAY cover people above the age of 80 years?

Ans: Yes, it covers people above the age of 80 years as the scheme does not have any age limit criteria. 

Q11. Does PMJAY scheme offer coverage to farmers?

Ans: The scheme offers coverage to people in both rural and urban area. 

Q12. Does Ayushman Bharat scheme cover Orthopaedics treatment?

Ans: The scheme offers coverage for Orthopaedics treatment up to a specified limit. 

Q13. Does PMJAY cover pre-existing diseases?

Ans: All the pre-existing diseases are covered under PMJAY from day 1. 

Q14. How can I find my Household ID number for PMJAY?

Ans: The HH ID number is of 24 digits and is provided to families who are identified under the SECC.

Written By: PolicyBazaar - Updated: 28 July 2020
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