Prime Minister Shri Narendra Modi announced the launch of 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 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 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.
PMJAY-Ayushman Bharat Scheme is one of the biggest healthcare schemes in the world that is sponsored by the government. Prime Minister, Narendra Modi rolled out Pradhan Mantri Jan Arogya Yojana healthcare scheme with an aim to cover more than 50 crore citizens and nearly 10 Crore underprivileged families without any limitations pertaining to family size and age. Ayushman 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.
PM Ayushman yojana 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 scheme includes nearly 1400 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 Ayushman scheme features, Eligibility criteria & Application Process in the page below.
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 insures almost 40% of the vulnerable and needy families in India. The healthcare services and benefits that they can avail are listed below:
PMJAY covers the following expenses during the treatment:
PMJAY does not cover treatment expenses incurred on cosmetic surgeries, fertility treatment, drug rehabilitation, organ transplantation. For details you can check your policy documents.
To avail the benefits of Ayushman Bharat 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.
The eligibility criteria for rural beneficiaries under the PMJAY National Health Protection Scheme is defined as under:
Urban beneficiaries under the following occupational categories can also get insured under PMJAY:
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:
You can also check with any of the panel hospitals or call at PMJAY’s helpline number i.e. 14555 or 1800-111-565.
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:
If your name is there in the list, then only you will get the Ayushman Bharat Card.
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:
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-
Under Ayushman Bharat Yojana 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.
You can apply for an e-card once you find out your eligibility for Ayushman Bharat 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.
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.
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 Yojana?
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?
Ans: Yes, Ayushman 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 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.
Q7. 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).