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Ayushman Bharat Yojana Scheme, Eligibility, Registration Online
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What is the Ayushman Bharat Yojana or PMJAY Scheme?
Basic healthcare facilities for the population of a country are a critical necessity. NSSO surveys show that over 7% of India’s population is pushed into poverty every year due to healthcare costs, and at least 30% of the Indian population is devoid of any financial protection for health. This led to the introduction of the PMJAY (Ayushman Bharat) scheme, also known as "Ayushman Bharat Yojana", launched by the Government of India.
According to the government, the Ayushman Bharat Yojana aims to provide quality healthcare services to 50 crore Indians. The scheme was launched in September 2015 after it had been announced by Prime Minister Narendra Modi in his Independence Day speech that year. Under the scheme, the government provides financial assistance to poor families who have been selected based on their medical needs.
The PM Jan Arogya Yojana scheme is to improve access to affordable quality healthcare services among poor people living in rural India. The vision behind this scheme is “Healthy India'' where no citizen shall suffer due to any illness or disability. Under this scheme, citizens would get free treatment for certain illnesses. This government scheme provides comprehensive hospitalization cover to the bottom tier of the population, but not many people are aware of it.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana has a network of empaneled private and government hospitals to offer cashless hospitalization to beneficiaries. It covers hospitalization, pre-hospitalization, post-hospitalization and medication expenses incurred during the treatment. PMJAY stands for 'Pradhan Mantri Jan Arogya Yojana' i.e., Prime Minister's Comprehensive Health Protection Mission. It is a nationwide programme that provides comprehensive healthcare facilities to Indians who live below the poverty line.
Launching this scheme is part of the initiatives taken by the government to improve the public health infrastructure and eliminate the inequalities existing between urban and rural citizens. According to the World Bank, the number of people suffering from extreme poverty is increasing day by day. Therefore, it is quite obvious that the government must focus on the healthcare sector to ensure no individual remains deprived of basic necessities for any reasons whatsoever.
Ayushman Bharat Eligibility Criteria for Rural and Urban People
This scheme aims to cover the needy with no security in terms of hospitalization and finances to manage even basic illnesses due to poor financial conditions. Just as other government schemes, Ayushman Bharat Yojana too comes with certain norms you need to meet to get its benefits. Below are some of the norms or the eligibility criteria of the PMJAY scheme for both rural and urban areas. Take a look!
Eligibility Criteria for Rural Areas
- Disabled member in the family
- SC and ST are not eligible for the Ayushman Bharat Yojana
- Families with no adult/male/earning member falling within 16-59 years
- Household with kuccha walls and roof
- Landless household whose major family income is from manual labour
- Manual scavenger families
Eligibility Criteria for Urban Areas
- Ragpicker (anyone who sells or collects rags)
- Domestic worker
- Cobbler/ hawker/ street vendor/ other service providers on the street
- Driver/ conductor/ transport worker/cart puller/rickshaw puller
- Plumber/ coolie/ mason/ construction worker/ washer-man
- Electrician/ mechanic/ repair worker
- Waiter/ peon/ delivery assistant
How to Check Your Eligibility for PMJAY?
PMJAY(Pradhan Mantri Jan Arogya Yojana) is launched for the poor and vulnerable so that they can get access to healthy quality services. Close to 10 crore families either deprived rural families or occupational urban worker’s families are listed by the Socio-Economic Caste Census (CESS) data. To check if you and your family fall under the Ayushman Bharat Yojana list created by the government, follow the below-mentioned steps:-
- Open Paytm App and search PMJAY or click on https://m.paytm.me/pmjay.
- Click on ‘check eligibility’ & select your location.
- You can choose to search by name, mobile number, ration card number, HHD number or RSBY URN.
- If searching by name, enter your name and other details like father’s name, gender, and date of birth for better search results.
- Go through the list that appears and search your name.
- Once located it will display your details and your family members who are covered under the PMJAY scheme.
How to Register for PMJAY Scheme Online?
Online PMJAY Registration for the scheme is vital to receive health insurance benefits as mentioned above. If you are wondering about the steps involved in Ayushman Card registration, don’t fret! We’ve listed the steps for PMJAY registration below.
- Step 1: Go to the official website of PMJAY and log in with your registered mobile number.
- Step 2: Write down the captcha code shown on the screen and click on generate OTP.
- Step 3: Choose the HHD code and mention it to the Common Service Centre (CSC), which would inspect the code and other info.
- Step 5: The CSC representatives will then do the rest.
- Step 6: As a beneficiary, you will need to pay INR 30 to get the Ayushman card.
What is Covered Under Ayushman Bharat Yojana?
Health insurance covers beneficiaries without any premium cost, or treatment cost during and after hospitalization. It provides a coverage of INR 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
There are three different levels of patient care:
- Primary Care- The primary care level includes everyday healthcare given by general doctors and nurses at a physician’s office who act as the first contact with a patient for a non- emergency situation.
- Secondary Care- The secondary care level refers to health services given by medical professionals who are the second contact with a patient, generally referred from the primary care provider.
- Tertiary Care- The tertiary care level is for extremely specialized care involving complicated and advanced equipment, treatment for serving life-threatening conditions.
PMJAY or Pradhan Mantri Jan Arogya Yojana covers pre-hospitalization expenses for 3 days and post-hospitalization for 15 days, along with the below expenses:
2. Food facility
3. Medicine and medical consumables
4. COVID-19 treatment
5. Diagnostic and laboratory facility
6. ICU Services
What is Not Covered Under Ayushman Bharat Yojana?
Ayushman Bharat scheme details might include nearly 1,350 medical packages at empanelled public & private hospitals, but it is important to know about the categories excluded from the PMJAY scheme.
The following are not covered under Ayushman Bharat Yojana :
1. Drug rehabilitation
2. Cosmetic surgery
3. Fertility treatment
4. Organ transplant
5. Government employees
6. People who own a two-wheeler, three-wheeler or a car
7. People whose monthly income is more than 10,000
8. People who hold a Kisan card
9. People living in a properly built house
10. People having farming machinery
11. People having refrigerator and landline phones
Features of Ayushman Bharat Yojana Scheme
The “Ayushman Bharat” scheme aims at providing quality healthcare facilities to those groups of people who cannot afford big hospital expenses or insurance premium costs of health insurances. Below are the key features of Ayushman Bharat Yogana:
1. To ensure a continuous flow of medical treatment facilities in rural and urban areas.
2. To reduce avoidable deaths by providing quality healthcare services for free.
4. Covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses for diagnostic and medicines.
5. There is no constraint on gender, family size and age, all pre-existing conditions are covered from the first day.
6. Service includes approximately 1393 medical procedures.
7. Includes cost for diagnostic service, drugs, room charges, ICU and OT charges.
Benefits of Ayushman Bharat Yojana Scheme
The Ayushman Bharat Yojana card offers a coverage amount of INR 5 lakhs. It offers multiple benefits to the users covered in this scheme in case of medical emergencies. Below are the benefits one can get under the PMJAY scheme:
1. Medical examination, treatment, and consultation
3. Medicine and medical consumables
4. Non-intensive and intensive care services
5. Accommodation benefits and food service
6. Post-hospitalization follow-up care expenses for 15 days
7. Pradhan Mantri Jan Arogya Yojana offers 25 specialty categories, covering a wide range of 1,354 medical and surgical package
Difference Between Arogya Sanjeevani Policy vs Ayushman Bharat Yojana
|Arogya Sanjeevani Policy||Ayushman Bharat Yojana|
|Applicable for any individual between the age of 18 and 65 years.||Applicable only for under-privileged person.|
|Sum insured ranges from INR 3 lakh to INR 2 crore.||Can insure Up to INR 5 lakh.|
|Pre-existing conditions shall be covered after 48 months from the policy's start date.||PM Jan Arogya Yojana covers all the pre-existing conditions from Day 1- this could be one point.|
|Tax benefits are available.||Tax benefits are not available.|
|One can renew this plan online.||Online renewal may or may not be possible.|
|Pre-hospitalization cover for up to 30 days and post-hospitalization up to 60 days.||Pre-hospitalization cover for up to 3 days and post-hospitalization up to 15 days.|
|OPD expenses are not covered.||OPD cover is not available.|
|Home treatment is not covered.||Home treatment is not covered.|
|Premiums start from INR 2.414 per year.||In PMJAY, premiums are paid by the government.|
How to Check Your Name on the Ayushman Bharat Yojana List?
Ayushman Bharat Yojana covers 10 crore families in India and close to 50 crore people who get a free insurance cover of INR 5 lakh, including tertiary and secondary care hospitalization. The eligible members are already identified by the Indian Government. Follow the below-mentioned steps to check your name in the Ayushman Bharat Yojana -:
- Visit the PMJAY official website.
- Click on PMJAY ‘am I eligible’ option.
- Enter your mobile number and captcha code in the image. Click on Generate OTP.
- Enter the OTP received and submit.
- Select your state and search by name/ration card no/mobile no.
- Post filling in the details, you can check your name on the list and see whether your family is covered under Pradhan Mantri Jan Arogya Yojana.
List of Critical Diseases Covered Under PM Jan Arogya Yojana
Serious medical disorders like cancer, kidney failure, coronary artery surgery, heart attack are considered critical illnesses. If diagnosed, they drain a lot of funds from anyone’s pocket. People prefer taking critical illness covers to avoid a big medical expense and these are then taken care of by the company covering the critical illness. There are many critical illnesses, out of which the PMJAY(Pradhan Mantri Jan Arogya Yojana) scheme covers most of it. Below is the Ayushman Bharat Yojana list of critical diseases covered-:
- Pulmonary valve surgery
- Prostate cancer
- Tissue expander for disfigurement following burns.
- Skull base surgery
- Double valve replacement surgery
- Coronary artery bypass graft.
- Carotid angioplasty with stent
- Anterior spine fixation
- Laryngopharyngectomy with gastric pull-up
Apart from the critical illnesses mentioned above, the PM Ayushman Yojana scheme covers about 29 specialties, including: -
|Burns, plastic & reconstructive surgery||Genitourinary surgery||Ophthalmology|
|Cardio thoracic surgery||Medical oncology||Paediatric cancer|
|Chest diseases and respiratory medicine(pulmonology)||Neonatology||Paediatrics|
|Critical care||Nephrology||Paediatric surgery|
|General medicine||Gynaecology||Surgical gastroenterology|
|General surgery||OPD diagnostic|
How to Download Your Ayushman Card Online?
To avail the benefits of Ayushman Bharat Yojana or the PMJAY scheme, you should possess an Ayushman card. Without this card, recognizing people falling under the scheme might become difficult for the authorities. The people who fall under the scheme or are eligible for the benefits related to the Ayushman Bharat scheme may not receive the benefits attached to it. Follow the below mentioned steps to successfully download your Ayushman card-:
- Go to the PMJAY's official website, and enter your personal details.
- Enter your Aadhaar card number and click on the ‘approve beneficiary’ option.
- Now, enter the password in the CSC wallet with the pin number.
- It will redirect you to the website homepage.
- You can see the download option. Click on it in front of your golden card.
- Your Ayushman card is downloaded.
With the Ayushman card, you can seamlessly get insurance facilities at all the empanelled public or private hospitals.
Ayushman Bharat Scheme Hospitalization Process
If you are a part of Ayushman Bharat Yojana and you or any member of your family requires hospitalization, PM Ayushman Yojana covers all your pre and post hospitalization charges in addition to in-patient charges. The process is totally cashless, and there’s no need to pay anything as there is a 60:40 split between the centre and state.
Ayushman Bharat scheme offers PAN-India coverage with cashless hospitalization benefits to all the families enrolled in the PMJAY scheme at the empanelled public and private hospitals.
Various Ayushman mitras are appointed at these empanelled hospitals to help the patient during the hospitalization process. They will verify the documents and eligibility criteria and provide a letter and QR code. This QR code is scanned and verified to check whether the beneficiary is eligible for the PMJAY scheme benefits.
The government has taken a lot of steps to cover the needy, who are unable to manage their hospital bills, by letting them avail of hospitalization benefits at no cost under the PMJAY scheme.
How to Check Nearby Hospitals Covered Under PMJAY on Paytm App?
- Open Paytm App and search PMJAY or click on https://m.paytm.me/pmjay to enter the PMJAY app.
- Click on find hospitals & select the location where you want to search for hospitals.
- By default all speciality is selected, you can select a particular speciality as well.
- Click on the ‘search’ button.
- Select the hospital from the list and all the details related to the hospital will be available.
PMJAY Patient Card Generation
Once eligible for the PMJAY scheme, you can get yourself an e-card through BIS PMJAY. or even at the PMJAY kiosk. BIS stands for Beneficiary Identification System. It will take your Aadhaar or ration card verification to get this PMJAY card. For family identification proof, you can present a list of members certified by the government, an RSBY card and a PM letter. Post verification, the e-card will be printed with your unique PMJAY ID and the card could be used as a proof in future.
This PMJAY card can then act as proof that you and your family are covered under the PMJAY scheme and can avail of the benefits attached with it at all the public and private empanelled hospitals.
COVID-19 Treatment Covered Under Ayushman Bharat Scheme (PMJAY)
The Insurance Regulatory and Development Authority (IRDAI) has issued an advisory to all general and health insurance companies to cover COVID19 treatment and hospitalization.
PMJAY scheme also covers COVID-19 treatment and hospitalization. Beneficiary patients can avail free treatment and medical test facilities at the empanelled public and private hospitals. This scheme also covers quarantine and isolation charges incurred by patients.
Ayushman Bharat scheme is specially devised for people below the poverty line who are facing issues and are unable to cope with the heavy expenses involved in treating deadly COVID-19. So, benefit from this great initiative and check your eligibility under the PMJAY scheme.
PMJAY Toll-free Number and Address
For any information, doubts or issues related to the PMJAY scheme, you can either visit the office address:-
|Address||National Health Authority of India, 3rd, 7th and 9th Floor, Tower-L, Jeevan Bharati Building, Connaught Place, New Delhi – 110001|
Ayushman Bharat Yojana Scheme, Eligibility, Registration Online FAQs
1. What is Pradhan Mantri Jan Arogya Yojana?
An initiative by the Government of India to ensure poor and vulnerable get access to good health quality services with health insurance cover for free.
2. What are the benefits available under PMJAY?
PMJAY provides an insurance cover of upto INR 5 lakh per family per year for secondary and tertiary hospitalization. The cover under the scheme includes all expenses incurred on the following components of the treatment.
- Medical examination, treatment and consultation
- Medicine and medical consumables
- Non-intensive and intensive care services
- Diagnostic and laboratory investigations
- Medical implantation services (where necessary)
- Accommodation benefits
- Food services
- Complications arising during treatment
- Post-hospitalization follow-up care up to 15 days
3. Who is eligible for PMJAY?
Families identified as the deprived rural families and occupational categories of urban worker’s families as per the Socio-Economic Caste Census (CESS) data. Families with an active RSBY card are also covered.
4. What is the minimum or maximum age required to be a part of the PMJAY scheme?
There is no age limit or the number of people in a family that can be covered in this scheme.
5. Can the hospitals charge any money from beneficiaries for treatment under PMJAY?
No, hospitals cannot charge until INR 5 lakhs is completely exhausted by the beneficiary.
6. Can families whose names are not on the list of beneficiaries avail of the benefits under PMJAY?
In this phase, no additional new families can be added under the PMJAY scheme. However, names of family members can be added for those families who are already present on the SECC list created by the government.
7. How are beneficiaries identified under this scheme?
The beneficiaries are identified based on the deprivation categories identified under the SECC database for rural areas and 11 occupational criteria for urban areas. In addition, RSBY beneficiaries with an active card as of 28th February 2018 are covered.
8. How to change your mobile number in the PMJAY scheme?
You can contact your State Health Agency(SHA) to change your mobile number.
9. Where can beneficiaries avail of the PMJAY scheme benefits?
Services under the PMJAY scheme can be availed at empanelled public and private hospitals. Beneficiaries can access the list of these hospitals through the ‘find hospital’ option available in this scheme. Beneficiaries can also call the helpline number at 14555.
10. Do beneficiaries need to pay anything to get covered under this scheme?
No, all Ayushman Bharat eligible beneficiaries can avail free services for secondary and tertiary healthcare facilities. PMJAY offers cashless and paperless access to health services.
11. How to update data in PMJAY scheme?
You can call Ayushman Bharat helpline 14555 or 1800-111-565 or visit the common service centre (CSC) near you.
12. Is organ transplant or cosmetic surgeries covered under PMJAY?
No, OPD expenses, drug rehabilitation, cosmetic surgeries, fertility treatments, individual diagnostics and organ transplants are not covered under the PMJAY scheme.
13. How many cards will be issued to a family?
Only one Ayushman card will be issued per family to all eligible families.
14. Does PMJAY cover COVID-19 expenses?
Yes, both treatment and test for coronavirus are covered under the scheme.
15. Are pre-existing diseases covered under PMJAY?
Yes, pre-existing diseases have no waiting period and are covered from Day 1 under PMJAY scheme.
16. What is the enrollment process to avail benefits under this scheme?
Families identified by the government based on deprivation and occupational criteria using the SECC database are entitled to PMJAY benefits.
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