Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is a national health insurance scheme especially crafted for the economically weaker sections of society. It is controlled and managed by the Ministry of Health and Family Welfare and is facilitated through all the existing government health and wellness centers.
The speciality of this scheme is that the beneficiaries need not be required to pay the premium and allow hospitalisation coverage for up to INR 5 lakhs. However, you need to fulfill certain specific eligibility criteria to enjoy the benefits of this government-sponsored health insurance scheme.
The primary condition to receive the benefit of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is that the concerned family must be included in the SEC Census of 2011. Depending on the results of this census, families have been segregated into certain specific categories, based on which the benefits of this health scheme are extended. Speaking of the rural areas, every household categorised from D1 to D7 is included in this scheme, except D6.
These categories are determined like this:
Houses with kuchcha walls and roofs belong to the D1 category
D2 denotes families were the members are aged between16 years and 59 years
D3 is any women-led family without any male members
D4 is the family without any able-bodied adult member
SC and ST families belong to the D5 category
D7 is denoted if the major source of income of any landless household comes from manual labor.
Certain families get automatically included under the provisions of this scheme under the following circumstances:
Any household without shelter,
Any destitute family or someone living exclusively on alms,
Primitive tribal families and groups,
Any manual scavenger family or
Any bonded labor who has been legally released.
The occupational criteria that are observed in the urban areas include:
Apart from this, members covered under the erstwhile Rashtriya Swastha Bima Yojana also receive the coverage of AB-PMJAY. Every family included in the Antyodaya Anna Scheme and Annapurna scheme automatically gets included in this beneficiary scheme.
AB-PMJAY scheme follows a simple user-friendly online self-registration procedure:
You can easily check your eligibility for the AB scheme benefits using the following steps:
Login to mera.pmjay.gov.in
Enter your registered mobile number
Complete the OTP verification process
From the drop-down menu, select your state or Union territory.
Add your name/HHD number/ration card number/mobile number
You can approach the government healthcare officials working in health and wellness centers across the country or call 14555 or 1800111565.
Some of the most significant benefits of the AB-PMJAY scheme include the following:
Covering all OUP expenses incurred during hospitalisation.
Exclusive cashless coverage irrespective of whether the hospital is public or an empanelled private one.
Transport allowance incurred during pre- and post-hospitalisation up to a stipulated time limit.
Availability of daycare treatment facilities.
All Pre-Existing Diseases are covered with a few minor exceptions.
Follow-up provisions to ensure complete recovery of the concerned beneficiary.
Healthcare cost coverage of up to INR 5 lakhs per family.
Covering all SECC enlisted families.
Prioritising women, girl children, and senior citizens.
Intensive Care Unit coverage, etc.
| Features and Benefits | Specifications |
|---|---|
| Yearly Coverage | INR 5 lakh/family |
| Cashless Hospitalisation | Available |
| Pre-hospitalisation Costs | Up to 3 days |
| Post-hospitalisation Costs | Up to 15 days |
| Coverage | All public and empanelled private hospitals |
The hospital eligibility to avail of the AB-PMJAY coverage includes:
In-patient hospitalisation capacity of at least 10 beds.
Round-the-clock availability of qualified medical professionals.
Easily accessible washroom facility.
Inter-operable IT system for easy data maintenance.
Easy availability of ambulances and other emergency services.
Availability of a dedicated qualified professional for coordinating AB-NHPS.
Availability of all the necessary technical equipment.
Easy accessibility to blood banks and diagnostic services in the vicinity.
The concerned hospital must be registered with the relevant state health agency.
Controlled and well-managed handling of bio-medical waste, water, and power.
The list of documents that are essential to complete claim settlement under the AB-PMJAY scheme are:
Age-proof documents
Income certificate.
Caste certificate
Special category certificate
Aadhaar card (scanned copy)
Identification details
Contact details
Documents denoting family structure.
Some of the typical services that are covered under the PMJAY scheme include
Treatment costs, diagnostic tests, and medical consultation expenses.
The cost of any surgical intervention is up to the coverage limit.
Hospitalisation costs.
Any medical cost related to critical illnesses.
The list of critical illnesses that get covered under PMJAY includes the following:
Cardiovascular ailments
Parkinson’s disease
Cancer
Neonatal ailments
Mental illness
Kidney issues
Burns
Similar to any standard health insurance policy, PMJAY also maintains certain specific exclusions. Some of the common exclusions under this scheme include treatment costs of cosmetic procedures, dental treatment costs, and organ transplant costs. Apart from these, treatment costs of lifestyle diseases like obesity and infertility are also not covered here.
Launched back in September 2018, PMJAY is the largest government-sponsored public healthcare program in the world. It targets to cover nearly 50 crore countrymen. Easy availability on a PAN India scale has made it all the more user-friendly. This article highlights all the significant aspects related to this exclusive government healthcare scheme.
