Ayushman Bharat PM-JAY Mizoram

How PM-JAY Works in Mizoram

The Ayushman Bharat PM-JAY scheme in the state of Mizoram is administered through the Mizoram State Health Care Society (MSHCS), which functions as a department within the state government’s Department of Health & Family Welfare. The state health agency, MSHCS, administers the implementation of the scheme on a daily basis, taking responsibility for empanelment of public as well as private hospitals, processing of medical claims, and maintenance of quality healthcare service. Locally, assistance in terms of implementation is provided by local administration offices and Arogya Mitras located at empanelled hospitals within the districts.

Key Highlights - PM-JAY Mizoram

Who is eligible for PM-JAY in Mizoram

• SECC 2011 Deprived Families: Families identified as deprived as per the socio-economic criteria in the Socio-Economic and Caste Census (SECC) 2011 (such as families of landless labourers, families living in one-room kuchha housing, SC/ST families, and families comprising informal workers).
• Former RSBY Cardholders: Families with a valid Rashtriya Swasthya Bima Yojana (RSBY) card as of 2018.
• Senior Citizens (Age 70+): As per the extended central guidelines, all senior citizens aged 70 years and above, irrespective of socio-economic background and family income, are eligible for a ₹5 lakh top-up cover.
• BPL Families & Low-Income Groups: Have full coverage, with enrollment fees waived or reduced.
• APL Families & State Residents: Families not falling under the central SECC category (Above Poverty Line / non-PM-JAY families) may enroll themselves under the state health insurance scheme, where they will have to pay an annual nominal enrollment fee to avail state health benefits.

Benefits and Coverage under PM-JAY Mizoram

• Financial Cover: Up to ₹5 lakh per family per year on a family floater basis for secondary and tertiary care hospitalisation.
• Cashless & Paperless Treatment: The beneficiaries get entire cashless treatment in all empanelled public and private hospitals of Mizoram and across India.
• No Restrictions: There are no restrictions regarding the family size, age group, or gender of the beneficiary.
• Pre-existing Conditions Covered: All the pre-existing conditions are also covered from the very first day of registration.
• Nationwide Portability: The beneficiary can receive treatment at any of the empanelled hospitals of the PM-JAY Scheme in India.
• Medical Services & Package Coverages: The scheme covers almost 1,900+ procedures in 27+ speciality areas, which include:
• Hospitalisation: Charges for the room, nursing service, ICU charges, physician/ surgeon charges and diagnostic tests.
• Surgical & Medical Packages: Surgeries (Cardiology, Orthopaedics, Neurosurgery, Oncology, etc.), implants, and medical consumables.
• Prehospitalization and Posthospitalization Expenses: For expenses incurred 3 days before and 15 days after the hospitalisation (including medicines and follow-up visits).

Documents Required to Apply for PM-JAY Mizoram

• Aadhaar Card (Primary Documentation): Necessary for individual identification and biometric / mobile OTP-based e-KYC.
• Family Identity Proof: Required to establish that the family is listed in the SECC 2011 / state beneficiary list.
• Documentation options include: State Ration Card (Smartcard / Booklet) with names of all family members, Mizoram Universal Health Care Scheme (MUHCS) registration form/card, PM Letter (Personalised letter from Prime Minister to eligible SECC families).
• Active Mobile Number: Required to receive registration OTP in the e-KYC procedure.

Additional Documents (Where Applicable)

• Proof of Age (Senior Citizens above 70 years of age): Aadhaar Card or Voter ID proving age 70 years and above (Senior Citizen cover of ₹5 Lakhs).
• Caste Certificate: Where applicable for SECC inclusion (SC/ST).
• Income / Disability Certificate: As per the state inclusion schemes' priority criteria.

How to Apply Step by Step to PM-JAY Mizoram

If you are applying for (PM-JAY) Mizoram, it can be done through both online and offline modes.

1. Method 1: Apply Online via the Official NHA Beneficiary Portal

   Step 1: Visit the Official Portal

   Go to the official National Health Authority (NHA) Beneficiary Portal at beneficiary.nha.gov.inor download the Ayushman App.

   Step 2: Log in as Beneficiary

   Select the Beneficiary login option and enter your active mobile number. Click Verify and enter the OTP received on your phone along with the CAPTCHA.

   Step 3: Search for Your Family/name

   Select State as Mizoram, and then select Scheme as PM-JAY.

   Step 4: Choose your district and search parameter:

   Aadhaar Number, Family ID / Ration Card Number, or Name/Location.

   Step 5: Select Family Member & Initiate e-KYC:

   • Once your family details appear, check the status next to each member's name.
   • If the status shows "Not Generated" or "Action Required", click the e-KYC icon next to the member's name.

   Step 6: Complete Aadhaar e-KYC

   • Select e-KYC mode : Aadhar OTP, Finger Print, or Iris Scan (If your mobile number is linked to Aadhaar, then Aadhar OTP will be the quickest).
   • Enter Aadhar OTP to verify your identity.
   • Upload your latest photograph and also fill in any missing information, such as your mobile number and address.

   Step 7: Submit & Download Card:

   • Apply for the card and wait for your approval. The approval process takes only a few hours or at most two days.
   • If you get approval, go back to the portal and click on “Download Ayushman Card” to download the printable PDF card. You may even apply for ABHA Health ID or ABHA Card while downloading the Ayushman card.

2. Method 2: Apply Offline Process for Registration / Verification (Face-to-Face)

   In case of any problem in registering online, or in case your mobile number is not associated with your Aadhaar card, then you should visit:

   • Nearest Common Service Centre (CSC) / Kiosk / Ayushman Mitra Help Desk at empanelled hospitals in Mizoram (such as Zoram Medical College (ZMC) / Civil Hospitals).
   • Documents Needed: Show your Aadhaar card and State Ration Card / Family ID to the kiosk operator or Ayushman Mitra.
   • Biometric Verification: The operator will do a thumb / iris scan to register for e-KYC offline.
   • Card Issue: After approval from the State Health Agency, the card can be printed in the form of a physical Ayushman Card.

Helpline and Support

Other Government Schemes

• MUHCS (Mizoram Universal Health Care Scheme): State Government Scheme that ensures the coverage of people who are not covered under the central PM-JAY scheme.
• Pradhan Mantri Suraksha Bima Yojana: It is a health scheme offered by the central government of India that offers up to ₹2 lakh insurance cover in case of death or permanent disability due to an accident.
• Central Government Health Scheme: It is a health scheme that offers medical cover to government employees, central Pensioners, and eligible family members of the aforementioned categories of people.
• Employees' State Insurance (ESI) Scheme: This scheme offers comprehensive medical cover to insured workers earning up to ₹21,000 a month. There is no fixed amount for this scheme.