Ayushman Bharat PM-JAY Sikkim

How PM-JAY works in Sikkim

The PM-JAY scheme in Sikkim is managed by the state Health Agency (SHA), Health & Family Welfare Department, Government of Sikkim. This scheme is often combined with state-level health schemes, such as the Mukhya Mantri Jeevan Raksha Kosh (MMJRK).

The State Health Agency (SHA) takes care of the day-to-day functioning of the AB-PMJAY Sikkim. It empanels and continuously monitors the quality of healthcare facilities in public as well as private sectors to ensure the best standards in patient care. SHA implements the entire process of pre-authorisation and claim settlement through central digital platforms. This ensures fast cashless payment to hospitals and the elimination of any out-of-pocket medical expenses.

Key Highlight- PM-JAY Sikkim

Who is eligible for PM-JAY Sikkim

• All Senior Citizens (Above Age 70): All senior citizens of Sikkim aged 70 or more are eligible, irrespective of family income.
• Rural Households: Those who satisfy the deprivation criteria as per SECC 2011, such as families living in one-room kuchha houses, women-headed families without adult male members, families from SC/ST communities, landless manual labourers, and are automatically included as vulnerable or destitute.
• Urban Occupation Categories: Vulnerable urban workers such as those in sanitation, domestic help, street vendors, drivers, cobblers, construction workers, mechanics, and peons.
• State Welfare Scheme: those who hold PHH/AAY ration cardholders or state-identified beneficiaries are covered, Antyodaya Anna Yojana (AAY) cards issued by the state government or Priority ration cards of the state MMJRK scheme.
• ABHA Account Holder Integration: To streamline the verification and access digital health records across government health insurance schemes, beneficiaries are encouraged to create an ABHA Health ID and link their ABHA Card with their PM-JAY registration.

Benefits and Coverage under PM-JAY Sikkim

• Financial Health Coverage: Offers a floating annual health coverage with a limit of ₹5 lakh per family per year for secondary and tertiary hospitalisation in healthcare facilities.
• Basis of Family Floater : The total amount is available to be used by either one family member or all members of the family plan; there is no limit to the size of the family, gender, or age.
• Medical Procedures: Covers serious diseases in the areas of cardiology, oncology, orthopaedics, neurosurgeries, urology, and nephrology.
• Pre-Existing Diseases: Covers all the pre-existing medical conditions from Day 1 without any waiting period.
• Day Care: Covers expenses for the medical procedures which require less than 24 hours of hospitalisation, such as hemodialysis and cataract surgery.
• Consultation & Diagnostics: Covers examination of medical procedures, consultations with doctors, laboratory tests, and advanced diagnostics.
• In-Patient Care: Fully pays for intensive care unit (ICU) charges, room/bed rent, and nursing services.
• Treatment & Surgery: Covers surgical procedures, medical consumables, prescription drugs, and necessary implants.
• Pre & Post-Hospitalisation: Includes medical costs incurred up to 3 days prior to admission and 15 days after discharge (including follow-up medicines).
• Patient Amenities: Covers food services and accommodation for the patient during the hospital stay.

Documents Required for PM-JAY Sikkim

• Aadhaar Card: Essential for all individual family members for biometric or OTP-based e-KYC.
• Active Mobile Number: Connected with the Aadhaar account for sending OTPs while authenticating and downloading the card.
• Ration Card/Family Register: Main document which is used for identifying the family structure and proving eligibility based on the Socio-Economic and Caste Census (SECC) database.
• Letter from PM/State Nodal Agency (SNA): Official letter issued by the government to each applicant regarding his/her eligibility with Family ID/HHID.
• Residential Certificate: A document to prove one’s official residence in Sikkim.

Supporting Documentation Category-wise (If Any)

• Senior Citizens (Above 70 Years of Age): Only an Aadhaar card with the correct date of birth is required.
• Construction and Building Workers (BoCW): A valid BoCW registration certificate.
• SC/ST Eligibles: Valid caste certificate from the state government of Sikkim.

How to Apply to PM-JAY Sikkim and Download the Ayushman Card

Through Online Mode

Step 1: Access the PM-JAY Sikkim Portal or App

Access the official NHA Beneficiary Portal (beneficiary.nha.gov.in) via your browser or you can also download the official Ayushman App on your smartphone.

Step 2: Login & Choose the State as Sikkim

Select "Beneficiary" and provide your 10-digit mobile number. Provide the one-time password sent to your mobile, choose Sikkim as your state, choose the Scheme name as PM-JAY and finally complete the Captcha verification to log in.

Step 3: Search for Family or Household Details

Search for your family details through your Family ID (ration card number), or through your Aadhaar Number, or Name and location of your District . Then click Search, a list of displaying all matched family members linked to your record will appear on the screen.

Step 4: Complete e-KYC Verification

Find your name through the results and select e-KYC. Then select your e-KYC authentication method either through Aadhaar OTP, Iris Scan or Facial Recognition. Complete the e-KYC process.

Step 5: Approval and Download Ayushman Card

• After your e-KYC verification process matches your demographic information in the system, the status of your application will become either “Pending” or “Approved.”
• The State Health Agency (SHA) Sikkim verifies and approves the e-KYC data.
• After the approval process (green colour "Approved" comes), click on the Download Card icon.
• Download the Ayushman Card (PM-JAY Card) in PDF format. This card is valid at any empanelled hospital in Sikkim, such as STNM Hospital, Gangtok or anywhere else in India with a cashless treatment benefit of ₹5 Lakh per year.

Through Offline mode

• Go to any one of the District Hospitals, or a Common Services Centre (CSC) in Sikkim.
• Show your Aadhar Card and Ration Card to the Ayushman Mitra.
• Perform the biometric e-KYC authentication at that very spot to get your physical Ayushman card.

Helpline and Support

Other Government Schemes

• Su-Swastha Yojana: State government Health Insurance Scheme that offers coverage of up to ₹10 Lakh to government employees and their dependent family members.
• Mukhya Mantri Jeevan Raksha Kosh (MMJRK): a state health insurance scheme that offers coverage to permanent non-BPL residents of Sikkim, where it offers coverage ranging from ₹20,000 up to ₹2 lakh depending on the medical procedure.
• Sikkim State Illness Assistance Fund (SSIAF): A state health insurance scheme that offers coverage to BPL families who require specialised medical treatments.
• PM-JAY Ayushman Bharat: a centrally sponsored scheme that offers up to ₹5 lakh per family per year on a family floater basis.
• Central Government Health Scheme: Central Government Health insurance scheme that offers coverage to government employees, dependents and retirees.