Ayushman Bharat PM-JAY Ladakh

How PM-JAY Works in Ladakh

In the Union Territory of Ladakh, AB-PMJAY operates under the State Health Agency (SHA) that has been formed by the Health Department. SHA is responsible for the identification of beneficiaries, panelling of health care facilities, and claim management for cashless treatments. Free healthcare services are provided to the beneficiaries at panel hospitals under the Ayushman card (PM-JAY e-card). AB-PMJAY has adopted a completely paperless and cashless approach, where the patients will not bear any financial burden of the medical procedure.

Both Ayushman Bharat PM-JAY and Ladakh's Universal Health Coverage (UHC) Scheme run under a convergence model,as two complementary components of a single integrated system rather than two separate healthcare products. On one side, PM-JAY is the central government plan that covers poor and low-income families. Whereas in Ladakh, UHC is the local government plan that covers everyone else in Ladakh who doesn't qualify for PM-JAY.

Key Highlights: PM-JAY Ladakh

Who is Eligible for PM-JAY Ladakh

Eligibility for the AB-PMJAY scheme is based upon the information obtained from the Socio-Economic and Caste Census 2011, which includes the following categories of households:

1. Urban Informal Workers: Informal and low-income occupational groups, including domestic workers, street vendors, ragpickers, construction workers, drivers, mechanics, delivery staff, and sanitation workers, are automatically covered.
2. Rural Vulnerable Households: Those Families living in single-room kucha houses, female-headed or disabled-member households without able-bodied adults, SC/ST families, and landless daily-wage labourers qualify.
3. Senior Citizens (70 Years and Above): Under the Ayushman Vaya Vandana Card, all seniors aged 70+ receive coverage regardless of family income.
   • If the family is already enrolled in PM-JAY, the senior gets a separate, dedicated ₹5 lakh annual top-up.
   • If the family is not covered, the senior citizen receives an individual ₹5 lakh annual health cover.
4. Frontline Healthcare & Anganwadi Workers: Active ASHA workers, Anganwadi Workers (AWW), and Anganwadi Helpers (AWH) in Ladakh, along with their immediate families, receive full benefits.

Benefits and Coverage Under PM-JAY Ladakh

• Financial cover: Up to ₹5 lakh per family annually for secondary and tertiary hospitalisation on a family floater basis.
• Treatment Packages: Includes treatment for 1,961 procedures under 27 specialities, which include General Surgery, Cardiology, Oncology, Orthopaedics, General Medicine, etc.
• Pre-Existent Conditions: Covered from Day 1 without any waiting period.
• Pre and Post Hospitalisation: Covers all medical costs incurred prior to hospitalisation up to 3 days and after discharge from hospitalisation up to 15 days (includes medications and diagnostics).
• Accommodation: Full reimbursement of expenses related to General Ward hospitalisation.
• Daycare Procedures: Includes medical procedures which require special care but don’t require complete hospitalisation for 24 hours.
• Nationwide Portability: Beneficiaries can get their treatment at any empanelled public or private hospital throughout India (for example, in Jammu, Srinagar, Chandigarh or Delhi).
• Medicines and Consumables: Includes all prescription medications, IV fluids, and surgical consumables during hospitalisation.
• Diagnostic Tests: All necessary pathology and radiology investigations required to diagnose, monitor, or treat a condition are completely included.
• 100% Cashless and Paperless: Patients or their families are not asked to buy medicines or surgical supplies from outside pharmacies during an admitted stay.

Documents Required to Apply for PM-JAY Ladakh

• Aadhaar Card of the Applicant: Mandatory for identity proof and e-KYC verification.
• Aadhaar Enabled Mobile Number: Essential for receiving OTP during the online verification process.
• Ration Card/Family Identification: Priority Ration Card, Antyodaya Anna Yojana card, or state family identification card for family members.
• Invitation Letter by PM/CM: Pradhan Mantri or CM/Governor official invitation letter (if issued to you).
• Residence/Domicile Certificate: Document for proof of residence in the Union Territory of Ladakh (Leh/Kargil).

Documents Required for Specific Category

• Senior Citizen (Aged 70 or more): Aadhaar Card as proof of age (70 or more).
• Low-Income/Priority Group: Income Certificate or Caste Certificate (SC/ST) in case of specific socio-economic categories.
• Building & Other Construction Workers (BoCW): For individuals applying under the BoCW category, they must submit a valid BoCW Registration Certificate or Labour Card issued by the Building and Other Construction Workers Welfare Board.

How to Apply Step by Step for PM-JAY Ladakh

The Ayushman Card (PM-JAY) can be applied for in Ladakh either Online (via a mobile phone/computer) or Offline (by visiting a physical location).

Method 1: Online Application (Self-Application)

Step 1: Visit the PM-JAY Beneficiary Portal or App, using your web browser

Visit the PM-JAY Beneficiary Portal alternatively: Download the Ayushman App via the Google Play Store.

Step 2: Register and log in to your account by selecting Beneficiary

Enter your 10-digit mobile number and click on Get OTP. Enter OTP received on your mobile number, enter the Captcha code and click on Login.

Step 3: Search for Your Family Member's Details and select the PMJAY Scheme

• Select Ladakh, choose PMJAY or SECC (Senior Citizens 70+), and pick your district (Leh or Kargil).
• Search using your Aadhaar, Family ID/Ration Card, or Name to view the family member details on your screen.

Step 4: Start e-KYC Process

• Find the name of the family member you wish to apply for. Check if Action Required or Not Generated, then click on Action/e-KYC.
• Select e-KYC Mode as Aadhaar OTP (or Iris/Face Authentication through app). Enter the Aadhaar OTP sent to your registered mobile number and click on Verify.

Step 5: Upload Image

• Click on the camera to capture/upload an image of the beneficiary. Check the personal details for the name.

Step 6: Approval and Download Ayushman Card

• After submitting the form, it gets forwarded to the health department for approval. After approval (it may take a few minutes to 48 hours), log in again tobeneficiary.nha.gov.in.
• Then download the Ayushman Card by clicking on Download Card near the approved name.

Method 2: Offline Approach

In case you have any problems with online authentication, the process can be completed offline in the following manner:

Step 1: Visit the nearest registration centre

• Ayushman Kiosk: Available at SNM Hospital (Leh) or District Hospital (Kargil).
• Common Services Centre (CSC): You can visit any nearby CSC/Digital Seva Kendra in your block/village.

Step 2: Document Submission

Submit your Aadhar Card, Ration Card/Family ID, and mobile phone number with an active connection.

Step 3: Live e-KYC

It will be conducted by the operator through the fingerprint scan, iris scan, or face authentication.

Step 4: Ayushman Card Printing

Once authenticated, your card is processed and issued to you in print form.

Other Government Health Insurance Schemes

State Government Schemes

• Universal Health Coverage (UHC) Scheme: The state health scheme of Ladakh, which offers coverage of up to ₹5 lakh per family per year and cashless hospitalisation cover to all residents of Ladakh who are not covered under Ayushman Bharat PM-JAY.

Central Government Schemes

• Ayushman Bharat Yojana: a centrally sponsored health insurance scheme that offers coverage of up to ₹5 lakh per family per year for secondary and tertiary hospitalisation.
• Central Government Health Scheme: a centrally sponsored scheme which offers medical coverage to Central Government Employees & Pensioners.
• Ex-Servicemen Contributory Health Scheme (ECHS): Offering complete services related to health in cashless mode via armed forces polyclinics (e.g., ECHS Polyclinic Leh) and empanelled private hospitals to the retired members of the armed forces and their dependents.