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The progress of a nation depends on the welfare of its people. The government of India accordingly launched several healthcare schemes time and again. However, the aim to strengthen the healthcare framework of the country was not achieved. Similarly, Ayushman Bharat Yojana is an initiative launched by the Prime Minister in 2018. This new scheme ensures affordable healthcare facilities for the needy. The Pradhan Mantri Jan Arogya Yojana or PMJAY is government-sponsored. It was introduced under the Ayushman Bharat Yojana initiative. It aims to provide quality healthcare services to all classes of people. Hence, PMJAY is a public health insurance scheme.

What is the Ayushman Bharat Initiative?

Ayushman Bharat Yojana is a flagship health insurance and protection scheme. The Government of India launched it under the National Health Policy 2017. It aims to achieve Universal Health Coverage (UHC) for all citizens. As a result, all needy individuals can benefit from it. Location and economic status are not limiting factors. The initiative is designed as per WHOs Sustainable Development Goals (SDGs). PMJAY scheme was announced as a component of the Ayushman Bharat Yojana. It is the world’s largest health insurance scheme. Hence, a commitment to provide healthcare for all.

The Ayushman Bharat Yojana was announced on September 23, 2018. It caters to poor and needy families in rural and urban areas. It provides them with need-based health care services. The beneficiaries can avail of paperless and cashless hospitalization. Secondary and tertiary hospitals are member hospitals. They include a network of private healthcare establishments in addition to the public ones.

Components of Ayushman Bharat Yojana

The initiative assures health service delivery through Health and Wellness Centers (HWCs). A health insurance cover up to Rs 5 lakh per family is provided under the PMJAY scheme.

The following are the components of ABY:

1. Health and Wellness Centres (HWCs): The government announced the establishment of 1,50,000 Health and Wellness Centres (HWCs) by 2022. It is a measure to strengthen the healthcare infrastructure across the country. HWCs will widen the availability of Comprehensive Primary Health Care (CPHC). Additionally, it guarantees affordable healthcare to poor and vulnerable communities.

2. Pradhan Mantri Jan Arogya Yojana (PMJAY): Hon’ble Prime Minister of India launched the PMJAY Scheme under the Ayushman Bharat Yojana. It offers health assurance to around 50 crore underprivileged individuals. Thereby, covering health expenses for up to Rs 5 lakh per family. Consequently, the scheme is the world’s largest health insurance scheme. The beneficiaries are identified using the data of the Socio-Economic Caste Census 2011 (SECC 2011). PMJAY assimilates the features and benefits of the National Health Protection Scheme (NHPS). Additionally, it offers coverage of the Rashtriya Swasthya Bima Yojana (RSBY). Families listed for RSBY are eligible for health coverage under PMJAY. Even if their details are not available in SECC 2011 database they can avail of PMJAY.

Features of Pradhan Mantri Jan Arogya Yojana

  • PMJAY Scheme is fully financed by the government. Consequently, all the expenditure is shared among Central and State Governments.
  • PMJAY Scheme covers a large population. As a result it is the world’s largest health insurance scheme.
  • Eligible families are entitled to a cover for secondary and tertiary medical treatment.
  • The beneficiaries of PMJAY can claim up to Rs 5 lakh per family per year.
  • The PMJAY scheme offers cashless access to healthcare services at all empanelled hospitals.
  • Healthcare expenses including up to 3 days of pre-hospitalization. Additionally, the entire duration of hospitalization. Afterward 15 days post-hospitalization are all covered under the scheme.
  • Costs of diagnostics, surgeon’s fee, and physician’s fee are covered. In addition, you can claim room charges, and expenses on medicines.
  • A beneficiary can claim charges for over 1393 procedures. This includes OT and ICU expenses as well.
  • Reimbursement for public and private hospitals in the network is uniform.

The eligibility for Pradhan Mantri Jan Arogya Yojana

The SECC 2011 database is the basis of deciding eligibility for the PMJAY scheme. The Ayushman Bharat Yojana offers health coverage for individuals and families with lower middle income. Therefore, it can benefit around 10 crore families (approximately 8 crore rural families and remaining urban). Ayushman Bharat Yojana is estimated to benefit over 50 crore individuals. Moreover, the delivery of benefits depends upon their occupation, income, location, and living conditions.

PMJAY Scheme – Eligibility for Access of Health Facilities

The eligibility criteria for PMJAY Scheme are outlined separately for rural and urban beneficiaries.

PMJAY Rural 

PMJAY rural offers health facilities to the beneficiaries in the following eligibility criteria-

  • Individuals and families belonging to scheduled caste and scheduled tribe (SC/ST) category or primitive tribal communities.
  • Families with no male members between the age of 16 to 59 years.
  • Beggars or individuals surviving on alms.
  • Families with no healthy adults.
  • Families with at least one physically challenged/ disabled member and no healthy adult.
  • Landless households depend on manual labor for a living.
  • Families living in one-room Kucha (temporary walls and roof) houses or makeshift houses.

PMJAY Urban 

PMJAY urban considers the eligibility of the beneficiaries in the following occupational categories-

  • Ragpicker
  • Beggar
  • Domestic worker/ Gardener/ Washerman
  • Street vendor/ service provider like Cobbler/ Hawker/ Individuals working on streets
  • Construction workers like Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard
  • Heavy/ Head-load worker such as Coolie
  • Sweeper/ Sanitation worker
  • Home-based worker/ Artisan/ Handicrafts creator/ Tailor
  • Transport worker/ Driver/ Conductor/ Helper/ Cart puller/ Rickshaw puller
  • Shop worker/ Assistant/ Peon in small establishment
  • Helper/ Delivery assistant/ Attendant/ Waiter
  • Electrician/ Mechanic/ Assembler/ Repair worker

Who is not eligible to apply for PMJAY Scheme?

Families not eligible to avail of the benefits of the PMJAY scheme as per SECC 2011 are:

  • Households having motorized 2/ 3/ 4-wheeler.
  • Owners of mechanized 3/ 4-wheeler agricultural equipment, or a fishing boat.
  • Individuals owning Kisan Credit Card with available credit of Rs. 50,000/-.
  • Families whose members work in government departments.
  • Households with registered non-agricultural enterprises.
  • Families where any member is earning more than Rs. 10,000/- in a month.
  • Income tax payee.
  • Professional tax payee.
  • Owners of pucca (permanent walls and roof) house with three or more rooms.
  • Families owning a refrigerator/ landline phone.
  • Landowners with more than 2.5 acres of land and at least 1 irrigation equipment. Those with 5 acres or more of irrigated land for two or more crop seasons.

PMJAY scheme automatically covers all beneficiaries of the Rashtriya Swasthya Bima Yojana (RSBY). You can check your eligibility on the government portal. Enter your mobile number and verify it by submitting an OTP.

Benefits of Pradhan Mantri Jan Arogya Yojana- PMJAY Scheme

Benefits of the PMJAY scheme include all expenses incurred on healthcare up to Rs 5 lakh. The amount is fixed for each eligible family for a year. For instance, the cover is available on a family floater basis. In contrast to other schemes, it is available for one or all family members. Beneficiaries include the elderly, women, and children. Therefore, you can visit secondary and tertiary healthcare centers in your area for assistance. All beneficiaries can avail of the following components:

  • Medical examination and after that consultation with a doctor. Qualified and specialist doctors are also available for chronic diseases
  • Proper Medical treatment of identified diseases. Thereafter treatment up to 3 days
  • Pre-hospitalization diagnostic services
  • Medicine and also medical consumables
  • Non-intensive and even intensive care services
  • Diagnostic and laboratory investigations during hospitalization
  • Medical implantation services
  • Hospital accommodation additionally accompanied by meal services
  • Consultation regarding complications arising during treatment
  • In addition, it includes post-hospitalization care and medication for up to 15 days

Treatments Under PMJAY scheme

Treatment is available for the following under PMJAY-

  • Emergency care
  • Communicable diseases
  • Non-communicable
  • Pregnancy care and maternal health services
  • Neonatal and infant health services
  • Child health
  • Mental health care
  • Dental care
  • Eyecare
  • Geriatric care

Unlike Rashtriya Swasthya Bima Yojana, AB Pradhan Mantri Jan Arogya Scheme is open for all. PMJAY Scheme does not restrict benefits to any family. Unlike, earlier schemes the size or age of the members is not a limiting factor. It covers any pre-existing health conditions or chronic diseases. The coverage starts from the date of enrolment.

How to Check AB-PMJAY Hospital List?

AB-PMJAY scheme has a network of over 15,000 empanelled hospitals from across the country. This network includes public and private hospitals. To check the list of PMJAY hospitals under Ayushman Bharat Yojana you can:

  1. Firstly, you can visit the PMJAY portal. Afterwards you will get the updated List Of Empanelled Hospitals in India
  2. Secondly, select state and district of residence/ treatment in the country
  3. Thirdly, choose the type and name of the hospital
  4. Fourthly, choose the specialty of medical assistance needed
  5. Lastly, enter the captcha code and click ‘Search’

The list of empanelled hospitals in India displays on the screen. You can access their contact information, addresses, and the official website (if any).

How to apply for Ayushman Bharat Yojana Card?

You can currently avail of the cashless health care service under the PMJAY scheme. It is available through the Ayushman Bharat Yojana Card, also known as AB-Golden Card. As a result of successful Ayushman Bharat registration, you get an e-Card. To sum up, this AB-Golden card is necessary for availing of the benefits of this scheme.

Steps to apply for Ayushman Bharat Yojana Card

Following are the steps to apply for the Ayushman Bharat Yojana Card:

1. Firstly, you can log in to the PMJAY website. Use the registered mobile number of the beneficiary

2. Secondly, enter the given captcha code to generate the OTP (One-Time-Password). After that you will immediately receive a password on your registered mobile number.

3. Thirdly, request HHD code upon successful login.

4. Fourthly, share the HHD code at the Common Service Centre (CSC).

5. Lastly, the CSC representative (Ayushman Mitra) will verify your details.

You can then collect the Ayushman Bharat Yojana Golden Card by paying Rs. 30/- at the CSC.

Which illnesses are covered under PMJAY?

The Ayushman Bharat Yojana covers a large number of chronic diseases. It includes pre and post-hospitalization charges. As a result, beneficiaries can claim health insurance benefits. It includes hospitalization and treatment at any of the specifically designated hospitals in the country.

PMJAY scheme covers the following diseases-

  • Prostate cancer
  • Coronary artery bypass grafting
  • Double valve replacement
  • Carotid angioplasty with stent
  • Pulmonary valve replacement
  • Skull base surgery
  • Laryngopharyngectomy with gastric pull-up
  • Anterior spine fixation
  • Tissue expander for disfigurement following burns

The PMJAY health insurance scheme does not cover costs for the following:

  • OPD (Outpatient Department)
  • Drug rehabilitation program
  • Cosmetic procedures
  • Fertility procedures
  • Organ transplant
  • Individual diagnostics