- What is Ayushman Bharat Yojana
- Ayushman Bharat eligibility: PMJAY For Rural & Urban
- Who is not entitled to avail coverage under the Ayushman Bharat Yojana?
- How to check your name in Ayushman Bharat Yojana Scheme List?
- PMJAY Patient Card Generation
- Documents required to Apply For Ayushman Bharat Yojana Scheme
- How to Download Your Ayushman Bharat Yojana Card Online?
- PMJAY Toll-free Number and Address
- Features of Ayushman Bharat Yojana Scheme
- List of critical disease coverage
- Aayushman Bharat Scheme Hospitalisation Process
- COVID-19 Treatment Covered under Ayushman Bharat Yojana
- Advantages of Health Insurance
- Regular Health Insurance Plans vs Government Health Insurance Scheme
- Conclusion
- FAQ's on PMJAY Scheme
The word Ayushman means one who lives long. Ayushman Bharat Yojna of Pradhan Mantri Jan Arogya Yojana (PMJAY) focuses on advancing the healthcare facilities for economically poor Indians.
The Ayushman Bharat scheme was started by the Prime Minister on 23 September 2018 to ensure better health for Indian citizens. About 50 crore citizens have already taken the Ayushman Bharat benefit in more than 18,000 hospitals around the country. According to the data of September 2019, over 4,406,461 beneficiaries were admitted in 18,059 hospitals with more than ten crore e-cards issued.
The Ayushman Bharat Yojana, renamed Pradhan Mantri Jan Aarogya Yojana (PMJAY) grants the underprivileged section an e-card that can be used to avail free and cashless treatment in any of the empanelled hospitals, public or private. The scheme covers three days of pre-hospitalisation and 15 days of post-hospitalisation care. PMJAY provides Rs. 5 lakh coverage per year for every family, thus covering all the necessary healthcare expenses which the lower section of society cannot afford.
Ayushman Bharat Eligibility: PMJAY Rural & PMJAY Urban
PMJAY aims to cater to excellent level healthcare facilities to 10 crore families with low or middle levels of income, out of which, 8 crore families live in rural areas and the other 2 crores reside in urban areas.
Eligibility criteria for PMJAY Rural
85.9% – that’s the number of rural households without any health assurance, as analysed in the 71st round of the National Sample Survey. Moreover, about 24% of rural households borrow money to access even the most basic of facilities. PMJAY aims to tackle this paramount issue by assisting these households.
The Ayushman Bharat scheme can be availed by these in the rural areas:
- Households enrolled in the Rashtriya Swasthya Bima Yojana (RSBY).
- A family with no male between the age of 16 and 59.
- Scheduled cast and scheduled tribe households.
- Bonded labourers who were released legally.
- Families who are living in a one-room house without a proper roof or wall.
- Beggars, scavengers and casual labours without lands.
- Families with at least one physically disabled member and no adult member who is able-bodied.
Eligibility criteria for PMJAY Urban
As found in the 71st National Sample Survey, 82% of urban households are living without health insurance. Also, 18% of urban families have to borrow money to meet their health expenses. Those who can avail benefits of PMJAY urban are:
- Families present in the occupational category of the Socio-Economic Caste Census of 2011.
- Anyone enrolled in Rashtriya Swasthya Bima Yojana (RSBY).
- All repair workers: mechanics, electricians, plumbers, handymen, etc.
- Domestic helpers, washermen, gardeners, sweepers and sanitation workers.
- Those who provide their services on pavements or streets, for example, hawkers and cobblers.
- Construction workers, welders, painters, security guards, masons.
- Transport workers – conductors, drivers, rickshaw or cart pullers, helpers.
- Small shopkeepers, waiters, tailors, handicraft workers and artisans, peons and delivery boys.
How to check your name in Ayushman Bharat Yojana Scheme List?
There exists no definite procedure for the PMJAY registration as the beneficiaries are identified using the Socio-Economic Caste Census 2011. Those enlisted in the RSBY scheme already come under the beneficiaries of PMJAY. However, you can check if you are eligible for the scheme or not by doing the following:
- Go to the official Ayushman Bharat online portal (www.pmjay.gov.in). You’ll see “Am I Eligible” written on the screen, click on it.
- It will ask you to enter your mobile number and then the image CAPTCHA. After you do that, click on “Generate OTP”.
- An OTP will come, enter that. Then in the new screen, select your state and then search by Name/ HHD Number/ Ration Card Number/ Mobile Number.
- According to the search results, you can clarify if your family is a beneficiary of the PMJAY scheme or not.
Alternatively, you can also call the Ayushman Bharat Yojana call center. Moreover, you can ask the Empaneled Health Care Provider (EHCP) which is enlisted in the PMJAY hospital list if you are eligible or not.
PMJAY Toll-free Number and Address
Toll-free number:
14555 / 1800-111-565
Address:
9th floor, Tower-I, Jeevan Bharati Building, Connaught Place, New Delhi – 110001
Who is not entitled to avail coverage under the Ayushman Bharat Yojana?
Some sections of society have been cast out from benefiting through PMJAY as they do not require it. This section includes:
- Owner of two, three or four-wheelers.
- Owner of a motorized fishing boat.
- Individuals with a Kisan card and a credit limit of Rs. 50,000.
- Those who worked in government jobs.
- An individual with a monthly income above 10,000 is not eligible.
- Those who own landlines or refrigerators.
- People with five or more acres of land.
- People with solidly built houses.
- Those who were employed in non-agricultural government-managed enterprises.
Patient Card Generation
If you’re identified as a true beneficiary, you can get a health card issued by Ayushman Mitras who manage kiosks in the enlisted hospitals.
Documents required to Apply For Ayushman Bharat Yojana Scheme
You will need to show some documents at the kiosk to get your patient card. Those documents are:
- Family identification proofs
- Aadhaar card or ration card
- PM letter or RSBY card
Once you get verified, an e-card will be printed with your unique AB-PMJAY ID which you can use to avail your benefits at any point in the future.
How to Download Your Ayushman Bharat Yojana Card Online?
To download your Ayushman Card, follow these steps:
- Go to the website of the Beneficiary Identification System (bis.pmjay.gov.in).
- If using a Desktop, you will see the “Download Ayushman Card” option, select it. If you are using a mobile, tap on the three lines at the top right and then click on “Download Ayushman Card”.
- Then select “Aadhaar”. A dialogue will appear.
- Now in the “Scheme” section select “PMJAY”. Select your state and enter your Aadhaar number that is linked with your PMJAY card.
- Then click on generate OTP. Enter the “OTP”.
- Now you can see the option for downloading your Ayushman Card, “click on it”.
Features of Ayushman Bharat Yojana Scheme
- Healthcare insurance of Rs. 5 lakh per family per year.
- Unlike other insurance policies, it covers pre-existing diseases.
- The technologically advanced mechanism as the whole process is paperless.
- Cashless treatment in any PMJAY empanelled hospital, with a zero out-of-pocket expenditure.
- Covers 25 different fields of medical specialities like cardiology, orthopaedics, neurosurgery, oncology, paediatrics, etc.
- Significant increase in the overall health of the nation.
List of critical disease coverage
Though the list of illnesses covered by PMJAY is very long.
Some of the common illnesses covered by it are:
- Skull base surgery
- Prostate cancer
- Double valve replacement
- Pulmonary valve replacement
- Carotid angioplasty with stent
- Anterior spine fixation
Some of the medical procedures that are not included in PMJAY are:
- Fertility related procedures
- Cosmetic related procedures
- Organ transplants
- Individual diagnostics for evaluation purposes
- OPD
- Drug rehabilitation programme
Aayushman Bharat Scheme Hospitalization Process
For those who are eligible, PMJAY provides health insurance up to Rs. 5 lakh per year per family. Unlike most health insurance schemes, PMJAY benefits even for pre-existing conditions or illnesses. It also covers surgical expenses; however, both medical and surgical expenses can’t be compensated simultaneously.
In the case of multiple surgeries, the first surgery gets insured with the highest cost. The second one gets a 50% discount, and the third one a 25%. More than 1,350 health packages are covered by PMJAY at empaneled public and private hospitals.
To be benefited under Ayushman Bharat Scheme, you need to be hospitalized in a hospital that is empaneled with PMJAY. Then, you need to present your e-card or the card number to the hospital staff so that they know you’re a beneficiary and grant you the benefits.
COVID-19 Treatment Covered under Ayushman Bharat Yojana
To counter the unprecedented growth of COVID-19, the Government of India added the test and treatment of COVID-19 under the Ayushman Bharat Yojana. Now like any other disease, a person who is enlisted as a beneficiary can get checked and treated for COVID-19.
The same rules for any other illness will apply here too.
Advantages of Health Insurance
The right health insurance can save you from multiple damages, whether it is financial or physical damage. Some of the advantages of health insurance are:
- You can avail best and most effective healthcare services without getting a permanent strain on your finances.
- You can also cover your pre and post-hospitalization costs.
- Sometimes, you are hospitalized only for a scheduled procedure. Health insurance can help you cover that too.
- You can also get hospital cash benefits to cover your daily expenses during the hospitalization period.
Regular Health Insurance Plans vs Government Health Insurance Scheme
The Government is surely doing its job to ensure that everyone gets the right amount of healthcare. Also, private health insurance companies are providing regular health insurance plans which make people wonder, which one is better.
- Both regular and Government health insurance plans are effective, but regular insurance plans are somewhat expensive. On the other hand, Government Health Insurance Scheme like PMJAY is free and cashless for the beneficiaries.
- Regular insurance plans offer high premiums but Government insurances don’t.
- Regular insurance plans offer tax benefits but Government plans don’t.
Conclusion
Without a doubt, the PMJAY scheme is working for the upliftment of the financially degraded section of society. The scheme is providing Rs. 50 lakh per family per year as health insurance so that they don’t suffer because of the lack of enough money. This policy isn’t only helping the lower class stand on their feet, but it is also standing the nation to stand on its feet.
