India’s constitution promises to provide its citizens free and quality healthcare services. However, many people still don’t have access to appropriate medical care because of the monetary crunch. And with the growing number of lifestyle diseases, it has become a matter of grave concern.
To tackle this issue, the government has introduced numerous initiatives, such as Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which is a health protection plan that offers financial coverage to the economically weaker section in case of any medical emergency.
To know about the plan in detail, continue reading!
What is Ayushman Bharat PMJAY Yojana?
The Ayushman Bharat Yojna, which was introduced on September 28, 2018, aims to help India’s poor rural and urban households. It is specially designed for the country’s economically disadvantaged individuals and their family members.
This flagship initiative includes the National Health Protection Scheme (NHPS) and Wellness Centers. Families participating in the NHPS are given yearly health insurance coverage of Rs 5 lakhs (per year per family) to 40% of India’s population who are requiring hospitalization.
Moreover, a total of 1.5 lakh wellness centers will be established as part of the Wellness Centers project to offer a variety of healthcare services, including those for mental illness, pregnancy, non-communicable illnesses, child health, and dental care, among others.
Salient Features & Benefits Of AB-PMJAY
Below are some of the key features and benefits of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana:
- No Restrictions Due To Family Size, Age, Or Gender: One of the scheme’s major benefits is that there are no restrictions on who can receive these benefits based on their gender, age, or family size. However, in order to get Ayushman Bharat benefits in the hospital, one must always have a prescription ID on hand.
- Health Cover Of Rs. 5 Lakhs: With the aim to cater to 5 crore beneficiaries, the scheme provides health coverage of Rs. 5 lakhs per year per person to families who are living below the poverty line.
- Covers 1393 Procedures: The program offers coverage for around 1393 treatments, including physician fees, room charges, diagnostic costs, medical expenses, ICU expenses, operating room costs, and more.
- Priority To Females & Senior Citizens: Though the scheme provides health coverage that is inclusive for all, it lays special emphasis on senior citizens, women, and children, especially girl children.
- Covers PED From Day 1: Unlike most other insurance policies, PMJAY covers pre-existing diseases of the insured from day 1. This simply means that if the insured requires medical care at any time, he/she cannot be turned away.
- Comprises Of Secondary & Tertiary Care: The scheme is also designed in a manner so that the insured can get secondary healthcare treatments offered by specialists like urologists and cardiologists. Moreover, in case the insured requires advanced medical treatment like that for cardiac surgery and cancer, he/she is covered under the scheme.
- Cashless & Paperless Process: The scheme has made the entire registration and administration process cashless and paperless to eliminate the burden of out-of-pocket expenses and make everything seamless and faster. Moreover, healthcare services are free all across India.
Eligibility Criteria Of AB-PMJAY For Rural & Urban People
The eligibility criteria of the scheme for rural and urban people are mentioned in the table below:
|Eligibility Criteria For Rural People||Eligibility Criteria For Urban People|
|Families with no adult male members in the age group of 16-59 years||Beggars|
|Families with no adult members in the age group of 16-59 years||Domestic workers|
|Families living in a household of a single room with a kaccha roof and walls||Ragpickers|
|Families having at least one disabled member and zero abled bodied adult member||Individuals like street vendors, cobblers, and hawkers who are providing services on streets|
|SC and ST households||Transport workers, such as drivers, conductors, cart pullers, rickshaw pullers, and so on|
|Families working as manual scavengers||Sanitation workers, mali, and sweepers|
|Individuals living in extremely poor conditions||Washermen|
|Legally released bonded labor||Chowkidars|
|Primitive tribal groups||Head-load workers, such as welders, painters, masons, plumbers, construction workers, etc.|
|Landless households who are having a major part of their income from manual casual labor||Artisans, tailors, home-based workers, and handicraft workers|
|Mechanics, assemblers, electricians, and repair workers|
|Delivery boys, peons, waiters, shop workers, and attendants|
Who Are Not Eligible For AB-PMJAY?
The scheme does not cover the following individuals:
- Those who use mechanized farming machinery
- Those who own two-, three-, or four-wheeler
- The owners of Kisan cards.
- Government employees
- Those who possess a fishing boat with a motor
- Those with monthly incomes exceeding Rs. 10,000
- Those who are employed by non-agricultural government-run businesses
- Those who possess agricultural land that is larger than 5 acres
- Those who have refrigerators or landlines
- Those who reside in properly constructed homes
Inclusions & Exclusions Of AB-PMJAY
The Ayushman Bharat Yojana Scheme has the objective of providing affordable healthcare to underprivileged and needy people. Hospitalization expenses for beneficiaries are covered by the insurance, which contains the following elements:
- Medical examination, medical treatment, and consultation
- Pre-hospitalization expenses
- Post-hospitalization expenses for 15 days
- Non-intensive and intensive care services
- Diagnostic and laboratory services
- Medicine and medical consumables
- Medical implant services
- Accommodation charges
- Food services
- Complications during treatment
- COVID-19 treatment
The Ayushman Bharat Yojana Scheme contains several exclusions, just like other kinds of health insurance policies. The following elements are not protected by the plan:
- Out-Patient Department (OPD) expenses.
- Fertility treatments
- Individual diagnostics
- Drug rehabilitation
- Cosmetic surgeries
- Organ transplant
How To Register For AB-PMJAY?
The registration process for the PMJAY is quite simple. To enroll in PMJAY online, simply follow these easy steps:
- Pay a visit to the official and government website dedicated to the PMJAY plan (https://pmjay.gov.in/).
- Now click on the “Am I Eligible” icon at the top bar of the homepage.
- Provide your contact information and create an OTP.
- After that, choose your state and conduct a search using your name, phone number, HHD number, or ration card number.
- Then the page will verify your eligibility for the PMJAY program as well as your registration based on the search results.
You can also approach any of the Empanelled Health Care Providers (EHCP) or the Ayushman Bharat Yojana customer service at 14555.
Documents Required To Apply For AB-PMJAY
Below are some of the most important documents required for applying for AB-PMJAY:
- Age and identity proof
- Caste certificate
- Income certificate
- Details like mobile number, residential address, and email address
- Documents indicating the applicant’s current family status
What Is An Ayushman Card?
Once an individual determines his/her eligibility for the Ayushman Bharat Yojana, he/she can submit an application for an e-card, which is also known as Ayushman Card or AB-PMJAY ID. However, in order to receive this e-card, he/she must first undergo verification of his/her identity using his/her credentials, like an Aadhaar card or ration card, at a PMJAY kiosk.
This card can be used as identification in the future to get healthcare benefits. Even your family’s identity, such as the RSBY card, government-certified list of members, or PM letter can be provided. Once the verification is done, the Ayushman Card will be printed along with a unique AB-PMJAY ID.
How To Apply For & Download Ayushman Card?
Applying for the Ayushman Card is crucial since it includes a unique family identification number. Every family that is a recipient receives AB-NHPM. The process to apply for and download your Ayushman Card online is listed below:
- Go to the PMJAY plan website, which is the official government website (https://pmjay.gov.in/).
- Next, select the “Am I Eligible” icon from the homepage’s top bar.
- Enter your contact details and generate an OTP.
- Next, select your state and run a search using any of your personal information—your name, phone number, HHD number, or ration card number.
- Based on the search results, the page will then confirm your registration and eligibility for the PMJAY program.
- If you are qualified to use this link, the online application link for the Ayushman Card will appear on the following page.
- Fill up the application form and attach all the necessary documents as asked on the page.
- Now the application will be assessed by the relevant authorities.
- After approval, your screen will display the ABHA Card Number and your dashboard will then display the Ayushman Bharat Card, which you can download in the pdf form.
Frequently Asked Questions
Here is a list of some of the critical illnesses that are covered under the Ayushman Bharat Yojana:
- Prostate cancer
- Coronary artery bypass graft
- Double valve replacement
- Skull base surgery
- Pulmonary valve replacement
- Laryngopharyngectomy with gastric pull-up
- Anterior spine fixation
- Carotid angioplasty with stent
- Tissue expander for disfigurement following burns
Yes. People beyond the age of 80 can also register for Ayushman Yojana and take advantage of this program since there are no specified age restrictions.
Beneficiaries can contact PMJAY officials or Ayushman Mitra at the accredited hospital at any time to receive medical services covered by the PMJAY program.
Yes. At the time of hospitalization, a PMJAY ecard and a special ID card will be handed to eligible family members.
No. The policyholders of the Ayushman Bharat Yojana will not receive any death benefit.
You can make a complaint about it on the official website of PMJAY. An expert grievance redressal committee that is constituted at the national, state, and district levels will resolve the complaint within 30 days of the complaint’s filing.
All program beneficiaries may update their data by calling the government’s designated helpline number (14555), going online, or going to the Common Service Centre (CSC).