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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.
Disclaimer: The basic health insurance coverage and premiums may vary from one health insurance plan to another.
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||Basic Health Insurance||Government Health Insurance Scheme|
|Eligibility||Available to all sections of society||Available to lower-income groups only|
|Sum Insured||Maximum sum insured of up to Rs 1 crore||Maximum sum insured of up to Rs 5 lakh|
|Premium||Rs 200 per month onwards (depending on the plan)||Rs 100 per month onwards or fully paid by the government(depending on the plan)|
|Coverage||Offers a broader coverage||Offers a narrow coverage|
|Private Hospital Room||Available(depending on the plan)||May or may not be available|
|Policy Purchase||Policy can be purchased instantly||Policy purchase may take time|
|Network Hospitals||Wide network of empanelled private hospitals||A large number of public and private network hospitals|
|Maternity Benefits||Available(depending on the plan)||Available(Only for a single child under some cases)|
|Ambulance Charges||Available under most plans||Available under a few plans|
|Domiciliary Hospitalization Cover||Available(depending on the plan)||Not available|
|Online Renewal||Can be renewed online||May or may not be renewed online|
|Cumulative Bonus||Available if no claim was filed in the previous policy year||Not available|
|Health Check-up||Covered under some plans||Not covered|
|Monthly Premium Instalment Facility||Available under some plans||Not available|
|Tax Benefits||Available under Income Tax Act 1961||Not available|
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 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:
The following categories of entities are not covered under the Ayushman Bharat Yojana:
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.
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:
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 Ayushman card online-
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 Scheme 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 letters 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 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.
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.
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
Family identification proofs that can be produced include a government certified list of members, PM letter and an RSBY card. Once the verification is completed, the e-card is printed along with the unique AB-PMJAY ID.
On the other hand, if you want to check your eligibility under PMJAY you check the Empanelled Health Care Provider or dial the PMJAY helpline number i.e. 14555 or 1800-111-565
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.
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