Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Ayushman Bharat PM-JAY stands as the world's most extensive health insurance program, extending its reach to more than 12 million impoverished and vulnerable families, equivalent to approximately 55 million beneficiaries. This initiative is designed to offer annual health insurance coverage of Rs 50,000 per family for secondary and tertiary care hospitalizations. The intended recipients of this scheme constitute the lower 40% of India's population. The selection of eligible households is based on the Socio-Economic Caste Census 2011 (SECC 2011) criteria, both in rural and urban areas, which consider poverty and occupation.
PM-JAY was initially known as the National Health Protection Scheme (NHPS) before its name was changed. This renaming also encompassed the incorporation of the previously existing Rastriya Swasthya Bima Yojana (RSBY), which was launched in 2008. Consequently, the coverage offered by PM-JAY encompasses families that were covered by RSBY but may not have been included in the SECC 2011 database. Importantly, PM-JAY is entirely financed by the government, with the implementation costs shared between the central and state governments.
Key Features
PM-JAY holds the distinction of being the world's largest, fully government-funded health insurance scheme.
It provides coverage of Rs 500,000 per family annually for secondary and tertiary hospitalization, encompassing both public and private hospitals in India.
The program extends its reach to more than 12 million impoverished and vulnerable families, benefiting approximately 55 million individuals.
PM-JAY ensures cashless access to healthcare services directly within the hospital, simplifying the process for beneficiaries.
One of its primary objectives is to alleviate the burden of exorbitant healthcare costs that push nearly 6 million Indians into poverty every year.
PM-JAY includes coverage for diagnostic and medication expenses for three days before admission and up to 15 days after admission.
Family size, age, and gender are not restricted under the program, and it covers all pre-existing conditions from the very beginning.
The program's benefits are transferable nationwide, allowing beneficiaries to seek cashless treatment at any relevant public or private hospital in India.
Services provided encompass all costs associated with treatment, which includes but is not limited to medications, supplies, diagnostic services, physician fees, room charges, surgeon fees, operating room and intensive care costs, among others. This coverage includes approximately 1,929 medical procedures.
Public hospitals receive the same fees for medical services as private hospitals, ensuring equal access to quality care.
Benefit Cover Under PM-JAY
India's government-funded health insurance schemes have historically placed caps on benefits, ranging from INR 30,000 to INR 3,00,000 per family per year, depending on the state. This has resulted in a fragmented system. PM-JAY, on the other hand, offers a comprehensive solution by providing cashless coverage of up to INR 5,00,000 annually to each eligible family for a wide range of specified secondary and tertiary medical conditions. The coverage encompasses all expenses related to the following aspects of treatment:
Health check-ups, treatment, and medical advice.
Pre-hospitalization expenses.
Pharmaceuticals and medical supplies.
Non-intensive care and intensive care nursing services.
Diagnosis and laboratory tests.
Medical implant services, if deemed necessary.
Accommodation benefits.
Food services.
Coverage for complications that may arise during treatment.
Follow-up care following hospitalization for a duration of up to 15 days.
In summary, PM-JAY offers more inclusive and extensive healthcare coverage to eligible families, addressing the shortcomings of previous schemes with its generous benefits package.
The benefits totaling INR 5,00,000 are provided under a family floater arrangement, allowing their utilization by one or all family members. Previously, the RSBY program imposed a limit of five members per family, but PM-JAY has been designed with insights from past schemes. In PM-JAY, there are no restrictions on the size of the family or the age of its members. Moreover, pre-existing medical conditions are included in the coverage from day one. Consequently, individuals eligible for PM-JAY can now receive treatment for all pre-existing medical conditions from the moment they enroll in the program.
Steps to find Ayushman Card hospitals list under the PMJAY scheme
The comprehensive list of Ayushman hospitals can be accessed on the official PMJAY website. To check the Ayushman Card list, follow these steps:
Visit the official PMJAY website by going to https://pmjay.gov.in/.
Navigate to the section dedicated to the Ayushman Card list.
Provide your state and district information.
Select the type of hospital you are seeking, which includes options like public, private and for-profit, or private and non-profit.
Specify the medical specialty you require, such as general, pediatric, neurosurgery, cancer, gynecology, and more.
Verify that you are not a robot by entering the captcha code displayed in the provided box.
Click the 'Search' button to retrieve the relevant information.
List of Critical Diseases or illnesses covered under Ayushman Bharat Yojana Schemes
The healthcare scheme under Ayushman Bharat has expanded its coverage to include over 1300 medical packages offered at affiliated public and private hospitals across the country. Here are some of the significant illnesses and medical procedures covered by the Ayushman Bharat Yojana:
Prostate cancer.
Double valve replacement.
Coronary artery bypass graft.
COVID-19.
Pulmonary valve replacement.
Skull base surgery.
Anterior spine fixation.
Laryngopharyngectomy with gastric pull-up.
Tissue expander for disfigurement following burns.
Carotid angioplasty with stent.
These are just a few examples of the wide range of medical conditions and treatments that fall under the coverage of Ayushman Bharat, ensuring access to essential healthcare services for those in need.
Documents Required to Apply for Ayushman Bharat Yojana Scheme
To apply for the PMJAY (Pradhan Mantri Jan Arogya Yojana) scheme, you will need to provide the following documents:
Identity and Age Proof: Aadhaar Card, PAN Card
Contact Information: Details of your mobile number, Email address and Residential address
Caste Certificate: To establish your caste status, which may be relevant for eligibility and benefits determination.
Income Certificate: This document is important for assessing your financial eligibility for the scheme. It helps in determining whether you fall within the income criteria for PMJAY.
Family Status Documents: These documents are necessary to establish your current family status, including the number of family members and their relationship. This information is crucial for determining the coverage and benefits applicable to your family.
Please note that specific documentation requirements and procedures may vary by state and region, so it's advisable to check with your local PMJAY center or government healthcare authority for the most accurate and up-to-date information on the application process.
PM-JAY (Ayushman Bharat Yojana Scheme) Eligibility Criteria for Rural and Urban Population
The PM-JAY scheme was introduced with the aim of providing healthcare coverage to the most economically disadvantaged individuals in the country, specifically targeting the bottom 40% of the population who are considered poor and economically weaker. The eligibility criteria for Ayushman Bharat Yojana are established based on the deprivation and occupational criteria outlined in the Socio-Economic Caste Census of 2011, which applies to both rural and urban areas. These pre-conditions are put in place to ensure that the benefits of the initiative are directed towards those in society who are most in need of healthcare support and financial assistance.
PMJAY Rural
The Socio-Economic Caste Census 2011 (SECC 2011) involves the categorization of households based on their socio-economic status. In rural areas, households are ranked based on seven deprivation criteria. However, for the purposes of the scheme, Ayushman Bharat PM-JAY covers all beneficiaries who fall under at least one of the following six deprivation categories, and it also automatically includes specific vulnerable groups such as destitute individuals, manual scavenger families, those dependent on alms, members of primitive tribal groups, and bonded laborers:
Households with only one room with Kucha walls and roof.
Households with no adult members in the age group between 16 and 59 years.
Households with no adult male member in the age group between 16 and 59 years.
Households with a disabled member and no other able-bodied member in the household.
Households belonging to Scheduled Castes (SC) and Scheduled Tribes (ST).
Landless households whose primary sources of income are derived from manual casual labor.
These criteria are used to identify and prioritize individuals and families who are most in need of healthcare support and financial assistance under the Ayushman Bharat PM-JAY scheme.
PMJAY Urban
Under the Ayushman Bharat Yojana Scheme in urban areas, households are categorized based on occupation. Eligibility for the scheme is extended to workers falling within the following 11 occupational categories:
Beggar
Domestic worker
Ragpicker
Cobbler/Street Vendor/Hawker/Other service providers on the street.
Plumber/Construction Worker/Mason/Painter/Labor/Welder/Security Guard/Coolie
Sweeper/Mali/Sanitation Worker
Artisan/Handicrafts Worker/Tailor/Home-based Worker
Driver/Transport Worker/Conductor/Cart or Rickshaw Pullers/Helper to Drivers or Conductors
Shop Workers/Peon in Small Establishment/Assistant/Helper/Attendant/Delivery Assistant/Waiter
Mechanic/Electrician/Repair Worker/Assembler
Chowkidar/Washerman
These occupational categories help identify and provide healthcare benefits to urban workers in vulnerable occupations, ensuring that they receive the necessary medical support under the Ayushman Bharat PM-JAY scheme.
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