Ayushman Bharat PM-JAY Puducherry

How PM-JAY works in Puducherry

The State Health Agency (SHA), which is under the ambit of the Department of Health & Family Welfare, acts as the main nodal agency responsible for the implementation of the Ayushman Bharat scheme known as PM-JAY in Puducherry. The SHA handles end-to-end digital transactions and hospital networks with the help of NHA systems.

Key Highlights - PM-JAY Puducherry

Who is eligible for PM-JAY in Puducherry

• AAY & PHH Cardholders: Families owning Antyodaya Anna Yojana (AAY) or Priority Household (PHH) ration cards.
• Universal Senior Citizen Coverage: All senior citizens above the age of 70 living in Puducherry are eligible for the Ayushman Vaya Vandana Card that gives up to ₹5 lakh coverage every year, irrespective of the household's economic status.
• ASHA & Anganwadi Employees: All ASHA workers, Anganwadi Workers (AWWs), Anganwadi Helpers (AWHs) and their dependents.
• SECC Category Eligibles (Standard Eligibility Criteria): Families listed in the Socio-Economic Caste Census (SECC) data from rural as well as urban areas:
  1. Rural Families: Families residing in one-room huts without adult earning members between the ages of 16-59 years, female-headed families without adult males, families having disabled persons, SC/ST families and landless casual labourers.
  2. Urban Families: Workers belonging to SECC listed informal sectors of employment like street vendors, sanitation workers, domestic workers, construction site labourers, mechanics, transport drivers/conductors and ragpickers.

Benefits and Coverage under PM-JAY Puducherry

• ₹5 Lakh Coverage: It offers health insurance cover worth up to ₹5,00,000 per family per year for secondary and tertiary healthcare services.
• Unlimited Family Members: Covers all the family members in eligible families without setting limits for the number of family members or age.
• Cashless & Paperless Access: 100% cashless treatment is provided to beneficiaries in all empanelled public and private hospitals. Beneficiaries don't have to make any cash payment or out-of-pocket expenses.
• Portability: Benefits are portable and hence beneficiaries can avail themselves of benefits from any empanelled hospital across the country.
• Health Benefit Packages (HBP 2.0): Includes costs associated with hospitalisation, surgery, medical procedures, diagnostic costs, and costs before and after hospitalisation as per the standard packages.
• Pre-Existing Conditions Covered: The scheme covers pre-existing diseases right from Day 1.
• SECC/Standard PM-JAY Target Beneficiaries: Poor and vulnerable households eligible under SECC (jointly funded by the Centre and UT Government in the 60:40 ratio).
• Non-SECC BPL Households: All below poverty line cardholders in Puducherry, which includes Antyodaya Anna Yojana (AAY) and Priority Household (PHH) cardholders, will be covered (fully funded by Puducherry UT Government).
• Senior Citizens (Above 70 Years): Under the revised guidelines of the scheme, senior citizens above 70 years will get top-up/extension coverage of Ayushman Bharat.

What is not covered under PM-JAY Puducherry

• Outpatient Department (OPD): Routine OPD services as well as independent routine check-ups/diagnosis.
• Cosmetic / Aesthetic Surgeries: Surgical procedures undertaken for purely aesthetic/cosmetic purposes.
• Routine Dentistry Procedures: Procedures that do not necessitate emergency/in-patient hospitalisation.
• Infertility Procedures: Procedures related to fertility and assisted reproduction.
• Non-Medical Individual Expenses: Expenses such as travel, attendant charges, or other individual expenses not included in Health Benefits Packages.

Documents Required to Apply for PM-JAY Puducherry

• Aadhaar Card: Necessary for authentication and completing e-KYC through Aadhaar.
• Active Mobile Number: Needed for OTP authentication during registration/e-KYC procedure.
• Ration Card: AAY (Antyodaya Anna Yojana) or PHH (Priority Household) ration card to show eligibility under the Convergence Scheme of Puducherry.
• For Senior Citizens (70 years and above): Only an Aadhaar Card is necessary to enrol in the Ayushman Vaya Vandana Scheme.
• For ASHA & Anganwadi Workers: Government ID card or verification certificate from the government department with Aadhaar details of the family.
• For SECC / Convergence Scheme Participants: PM-JAY letter, state-level beneficiary ID or household ID (if already in database).

How to Apply step by step for PM-JAY Puducherry

1. Method 1: Through the Internet using the NHA Portal or the Ayushman App

   Step 1: Log In to NHA Portal

   Visit beneficiary.nha.gov.in or launch the Ayushman App. Go to the Beneficiary tab, enter your mobile number, and log in through OTP.

   Step 2: Search Family Details

   Select Puducherry as the location, pick scheme PMJAY, and then do a search either by entering an Aadhar number or Ration card number (PHH/AAY).

   Step 3: Complete e-KYC

   Select e-KYC from beside your name, validate it through Aadhar OTP or Fingerprint/face authentication.

   Step 4: Download Ayushmann Card

   After getting approved by the State Health Agency, select the Download Card option to download the Ayushman Card PDF.

2. Method 2: Offline via CSC or Hospital Helpdesk

   Step 1: Documents Required

   Ensure you carry original Aadhaar Cards of all family members, the Puducherry Ration Card and a working mobile phone.

   Step 2: Visit a Centre

   Visit a CSC centre or the PM-JAY Helpdesk in the premises of a Government hospital, such as JIPMER, IGMCRI.

   Step 3: Complete Biometric Verification

   The details provided by you will be verified through biometric verification in the database.

   Step 4: Receive the Ayushman Card

   Collect the printed Ayushman Card after getting approved.

   Step 5: Senior Citizens (more than 70 Years)

   They can register directly on the NHA website through the Ayushman Vaya Vandana program using an Aadhaar Card only.

Helpline and Support

Other Government Health Insurance Schemes

1. State Government Schemes

   • Chief Minister's Health Assurance: a state scheme of Puducherry that is designed to provide financial protection of up to ₹3 lakh to ₹5 lakh per family per year.
   • Puducherry Government Pensioners' Health Insurance Scheme: Group Health Insurance Policy that offers medical coverage to retired UT government employees and their dependents.

2. Central Government Schemes

   • Ayushman Bharat Yojana (AB-PMJAY): The scheme is centrally sponsored and provides health insurance cover up to ₹5 Lakhs per family annually.
   • Central Government Health Scheme (CGHS): It provides health insurance to employees and pensioners of the central government.
   • Pradhan Mantri Suraksha Bima Yojana (PMSBY) is a health insurance scheme that offers financial protection against accidental death and disability.
   • Ex-Servicemen Contributory Health Scheme (ECHS): It provides all healthcare services on a cashless basis through Armed Forces Polyclinics.
   • Employees' State Insurance Scheme (ESIS): provides coverage for formal sector employees and their dependents.