Ayushman Bharat (PM-JAY) Scheme
Ayushman Bharat (PM-JAY) Scheme
Ayushman Bharat (PM-JAY) Scheme
What is PMJAY (Ayushman Bharat Yojana)?
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is India’s flagship health insurance scheme, launched by the Government of India on 23rd September 2018.
Hon’ble Prime Minister Shri Narendra Modi ji rolled out the PMJAY healthcare scheme to provide free healthcare coverage of up to ₹5 lakh per family per year for secondary and tertiary hospitalization.
PMJAY is considered to be the world’s largest government-funded healthcare program, targeting India’s economically weaker sections of society.
Mission of Pradhan Mantri Jan Arogya Yojana (PM-JAY)
PMJAY is also known as the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) Scheme, one of the biggest healthcare schemes that are sponsored by the Government of India. Hon’ble Prime Minister, Shri Narendra Modi rolled out the Pradhan Mantri Jan Arogya Yojana (PM-JAY) healthcare scheme with an aim to reduce the financial burden on poor and vulnerable groups arising out of catastrophic hospital episodes and ensure their access to quality health services.
Key Features of Ayushman Bharat (PM-JAY) Scheme
- Provides hospitalization free coverage of up to Rs. 5,00,000 per family per year in all over India.
- More than 10.74 crore poor and economically deprived families (approximately 50 crore beneficiaries) covered across the country.
- Around 13,000 hospitals in the country have been coordinated for the implementation of the scheme.
- The scheme aims to target poor and vulnerable population of the country, based on the Socio Economic and Caste Census 2011 (SECC) database.
- It will be a cashless and paper less transactions for the beneficiaries.
- The benefit cover will also include pre and post-hospitalisation expenses.
- All pre-existing conditions will be covered from day one of the policy.
- Free treatment available at all public and empanelled private hospitals.
SGVP Holistic Hospital empanelled with Ayushman Bharat (PM-JAY) Scheme with all the following clusters:
To check eligibility, beneficiaries can contact the helpline (14555/1800111565), visit nearest Common Service Centres (CSC) or logon to https://mera.pmjay.gov.in.
Key Features of Ayushman Bharat (PM-JAY) Scheme
The key differences between regular health insurance plans and government health insurance schemes like PMJAY are as follows
Features | Regular Health Insurance Plans | PMJAY (Government Health Insurance Scheme) |
Eligibility | Open to all who can afford premiums | Targeted at economically weaker sections |
Sum Insured | Varies and can be substantial | Up to ₹5 lakh per family per year |
Premiums | Paid by the policyholder | Fully funded by the government |
Network Hospitals | Limited to insurer’s network | Extensive network of empaneled hospitals |
Pre-existing Conditions | May have waiting periods | Covered from the start |
Cashless Treatment | Available in network hospitals | Fully cashless across empaneled hospitals |
Tax Benefits | Available under Section 80D of IT Act | Not applicable |
Benefits of Ayushman Bharat Yojana
Pradhan Mantri Jan Arogya Yojana (PMJAY) provides medical access to approximately 40% of India’s population, covering various segments. The key benefits of this scheme include:
- Free hospitalization for several healthcare procedures.
- Covers pre-existing diseases.
- Offers comprehensive coverage for over 27 medical specialties, including cardiology, oncology, and orthopedics.
- Provides treatment at both public and private hospitals empaneled under PMJAY.
- Covers expenses for surgery, ICU care, diagnostic tests, and post-hospitalization costs.
- Covers critical illnesses such as heart surgery, cancer, organ transplants, and other life-threatening medical conditions.
- Offers financial assistance for multiple surgeries, with subsequent surgeries covered at reduced costs.
- Reduces out-of-pocket medical expenses for economically weaker families.
Eligibility Criteria for PMJAY for Rural and Urban Households
Eligibility criteria for PMJAY are based on data obtained from the Socio-Economic and Caste Census 2011 (SECC-2011). The eligibility criteria for rural and urban households are as follows:
Rural Households
Families that meet one or more of the following criteria are eligible for PMJAY:
- Households without shelter
- Destitute individuals
- Manual scavengers
- Primitive tribal groups
- Legally released bonded laborers
Urban Households
PMJAY coverage extends to people employed in the following occupations:
- Domestic workers
- Construction workers
- Street vendors
- Ragpickers
- Rickshaw pullers and drivers
- Plumbers, masons, and daily wage laborers
Eligibility Criteria for Senior Citizens Above 70 Years of Age
All senior citizens above 70 years of age are eligible for PMJAY coverage of up to INR 5 lakh, irrespective of their Socio-Economic status.
Senior citizens who belong to families already covered under PMJAY will receive an additional top-up coverage of up to INR 5 lakh per year for themselves.
What is Covered Under the Ayushman Bharat Yojana Scheme or PMJAY?
PMJAY provides comprehensive coverage of up to INR 5 lakh per family annually for secondary and tertiary hospitalization care. The following facilities are covered under the scheme:
- Hospitalization expenses, including room charges, ICU care, nursing, and boarding.
- Surgeries, including major and minor procedures.
- Diagnostic tests and laboratory investigations.
- Post-hospitalization expenses for up to 15 days.
- Medical examination and treatment.
What is Not Covered Under the Ayushman Bharat Yojana Scheme or PMJAY?
Like other health insurance policies, PMJAY also has its exclusions. The following costs are not covered under the scheme:
- OPD (Outpatient) consultations.
- Cosmetic surgeries.
- Drug rehabilitation.
- Infertility treatments like IVF, IUI, etc.
- Individual diagnostic tests without hospitalization.
- Organ transplant surgery costs.
How Can You Check Ayushman Bharat Yojana's Eligibility Online?
To check if you qualify for PMJAY online, follow these steps:
- Visit the Official PMJAY Portal at https://pmjay.gov.in.
- Click on ‘Am I Eligible’.
- Enter your mobile number and OTP to access eligibility details.
- If eligible, proceed to register for a PMJAY Ayushman Card.
Alternatively, to check eligibility for PMJAY, beneficiaries can contact the helpline (14555/1800111565) or visit the nearest Common Service Centers (CSC).