Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (PMJAY) | 5 years to This Scheme

Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme is a health insurance scheme launched on the recommendation of National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC). This initiative works to achieve Sustainable Development Goals (SDGs) and its underlying commitment, which is to “leave no one behind.”

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What is Pradhan Mantri Jan Arogya Yojana (PMJAY) ?

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana is a government-sponsored health insurance scheme to provide free healthcare coverage to low-income earners in the country. It was launched by the Prime Minister on September 23, 2018, in Ranchi, Jharkhand with a vision of providing access to healthcare to all eligible citizens of our country.

It should be noted that PMJAY is the largest health assurance scheme in the world.  It provides a health cover of ₹ 5,00,000 per family per year for secondary and tertiary care hospitalization to over 10.74 crores of poor and vulnerable families. For the primary health care service, Health and Wellness Centres (HWCs) or Swaasth Up Kendra are built. We will learn about both of them in detail below. 

S.No          Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana Highlights 
1PMJAY Official Websitehttps://www.pmjay.gov.in/ 
2PMJAY Launched DateSeptember 23, 2018
3PMJAY Health Cover Amount ₹ 5,00,000 per family per year
4Types of care coveredPrimary, Secondary and Tertiary care 
5Limit on number of people in a familyNo limit 
6Is this scheme Cashless?Yes
7Ministry Involved Ministry of Health and Family Welfare

Pradhan Mantri Jan Arogya Yojana in News | Gujrat to double the Insurance cover from 5 Lakh to 10 Lakh

The government of Gujarat has taken a significant step in enhancing healthcare accessibility for its citizens by increasing insurance coverage under the Pradhan Mantri Jan Arogya Yojana (PMJAY). Effective July 11th, beneficiaries of PMJAY in Gujarat will now receive an insurance cover of Rs 10 lakhs, twice the previous coverage of Rs 5 lakhs. This decision by the state government aims to benefit around 1.78 crore Ayushman Bharat cardholders in Gujarat, improving their access to high-quality medical treatment.

Types of Ayushman Bharat- PMJAY Healthcare Cover

Under Ayushman Bharat, the government thought of healthcare by adopting two means. Therefore, Ayushman Bharat comprises two interrelated components of the government where the government will take care of primary, secondary, and tertiary health care services. Those are the following. 

  • Health and Wellness Centres (HWCs) or Swaasth Up Kendra – Primary Health Care
  • Pradhan Mantri Jan Arogya Yojana (PM-JAY) – Secondary and Tertiary Health Care

Health and Wellness Centers (HWCs)

Government made 1,50,000 Health and Wellness Centres (HWCs) in 2018 by transforming the existing Sub Centres and Primary Health Centres. These centres  were made to deliver Comprehensive Primary Health Care (CPHC) to every household making healthcare accessible to all.  HWCs cover both, maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.

They are designed in a way that they deliver a wide range of services to address the primary health care needs of the entire population in their area, expanding access, universality and equity close to the community. 

Pradhan Mantri Jan Arogya Yojana (PM-JAY)

To take care of Secondary and Tertiary health care services, the second component under Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojna. As stated earlier, this scheme was launched on September 23, 2018 in Ranchi, Jharkhand by the Prime Minister of India, Shri Narendra Modi.

PM-JAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened. It subsumed the then-existing Rashtriya Swasthya Bima Yojana (RSBY) which had been launched in 2008. 

Please Note: PM-JAY is fully funded by the Government and cost of implementation is shared between the Central and State Governments.

Key Features of PMJAY

  • PMJAY is the world’s largest health insurance/ assurance scheme in the world. It is fully financed by the government (Centre and State).
  • It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
  • It provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
  • It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
  • No restriction on the family size, age or gender.
  • All pre–existing conditions are covered from day one.
  • Benefits of the scheme are portable across India.

Benefits of the PMJAY 

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana provides Secondary and Tertiary health care to the beneficiaries. Primary health care which means going to the doctor for primary treatment should be born by themselves. It should be noted that AB PM-JAY provides cashless cover of up to ₹ 5,00,000 each to eligible families per year for listed secondary and tertiary care conditions. The cover will consist of the following:  

  • Medical implantation services (where necessary)
  • Accommodation benefits
  • Food services
  • Complications arising during treatment
  • Post-hospitalization follow-up care up to 15 days
  • Medical examination, treatment, and consultation
  • Pre-hospitalization
  • Medicine and medical consumables
  • Non-intensive and intensive care services
  • Diagnostic and laboratory investigations

Who is Eligible for the PMJAY Scheme?

It should be noted that in order to avail the benefit of PMJAY scheme, you must have the listed eligibility of the scheme. The PMJDY eligibility criteria is different for Rural residents and Urban residents. All the eligibility requirement for PMJAY is provided separately in the list below. 

Rural Residents

  • Beggars and those surviving on alms
  • Families with no individuals aged between 16 and 59 years
  • Families having at least one physically challenged member and no able-bodied adult  member
  • Landless households who make a living by working as casual manual laborers
  • Those living in scheduled caste and scheduled tribe households
  • Families with no male member aged 16 to 59 years
  • Primitive tribal communities
  • Legally released bonded laborers
  • Families living in one-room makeshift houses with no proper walls or roof
  • Manual scavenger families.

Urban Residents

  • Plumbers, masons, construction workers, porters, welders, painters, and security guards
  • Transport workers like drivers, conductors, helpers, cart or rickshaw pullers
  • Assistants, peons in small establishments, delivery boys, shopkeepers, and waiters
  • Washerman/ chowkidars
  • Ragpickers
  • Mechanics, electricians, repair workers
  • Domestic help
  • Sanitation workers, gardeners, sweepers
  • Home-based artisans or handicraft workers, tailors
  • Cobblers, hawkers, and other services provided on streets or pavements. 

Who cannot apply for the PMJAY Scheme?

This health scheme called AB PMAJY is launched to cater heath issues of poor people of cour country which is almost 50% of the population. In order to make it clear to the citizens of India, the government has clearly listed certain conditions that are excluded from the Ayushman Bharat PMJAY benefits. Please look below for the AB PMJAY exclusion list. 

  • Those who work in government-managed non-agricultural enterprises.
  • Those earning a monthly income above ₹ 10000.
  • Those owning refrigerators and landlines.
  • Those with decent, solidly built houses.
  • Those owning 5 acres or more of agricultural land.
  • Those who own a two, three, or four-wheeler or a motorized fishing boat.
  • Those who own mechanized farming equipment.
  • Those who have Kisan cards with a credit limit of ₹ 50000.
  • Those employed by the government.

What Documents are required for PMJAY Scheme? 

Before applying for the Ayushman Bharat Card, you should have documents handy with you. Here are the documents that you need to apply for PMJAY.  

  • Proof of Address
  • Contact details (Mobile, e-mail)
  • Caste Certificate
  • Income Certificate
  • Document Proof of the Current Status of the Family (Joint or Nuclear)
  • Aadhaar Card

How to Apply for PMJAY Scheme?

In order to get a PMJAY e-card or Ayushman Card, you have to visit either a hospital or a Community Service Centre (CSC) for identification. After identification, they will scan the valid ID documents and then the  following  steps will take place.  

  • You have to submit the PM letter/ RSBY URN/ RC Number/ Mobile Number to the Arogya Mitra which is the operator that searches the available list of beneficiaries. 
  • He/she can do this by entering details such as name, location, Ration Card number, mobile number, or even RSBY URN of the beneficiary.
  • The Arogya Mitra will search for the potential beneficiary in the entitled SECC, RSBY, State Health Scheme, Additional Data Collection Drive databases.
  • Now the identification process will start (if the name is found in the list). For this, documents like Aadhaar or any government ID and a Ration Card or an alternative family ID are required to validate against the details available in the system. At this stage, scanned documents are uploaded.
  • Your family records will be identified by the Arogya Mitra. This will be done through the ration card and the scanned documents are then uploaded. After this, the Arogya Mitra will submit the individual and family records to the trust/insurance company for approval.
  • At this stage, based on your documents authentication, the Health insurance company or trust may then approve or recommend rejection. The cases that are recommended for rejection will be finally verified for approval or rejection by the State Health Agency (SHA).
  • After approval by SHA/insurance company/trust, an e-card or Ayushman Card will be issued. 

Download Ayushman Card | How to download Ayushman Bharat Card

In order to download the Ayushman Card or eCard, you need to complete all the steps as mentioned above. After the approval by the Insurance company/ trust. You can download your Ayushman Card from the link Provided below 

              Download your Ayushman Card here 

Complete List of PMJAY Empanelled Hospitals 

PMJAY has various Private hospitals under the scheme. You can check the empanelled hospitals in your state just by entering your state and city. To check the PMJAY empanelled hospitals, you can click on the link below

Check Complete List of PMJAY Empanelled Hospitals here

Challenges in PMJAY

While many people are taking advantage of this ambitious scheme, there are people/hospitals who are misusing this scheme by forging cases and making fake surgery. On the other hand people are still unaware of his scheme and are spending hundreds and thousands on taking basic healthcare services. It is extremely important to keep an eye on how the scheme is getting implemented. Also, how efficiently it is giving benefit to the people. Although the government has spent a significant amount in awareness about the scheme, we are still lacking in entering every beneficiary household. A solid plan regarding that should be made. 

Conclusion  

AB PMJAY is a record-breaking scheme launched by the government in 2018. This is the most ambitious scheme in the world that gained international importance from the day of its inception. This scheme is very beneficial to poor people who cannot afford to have a healthcare service in private hospitals. Government is adamant to make this scheme successful by increasing empaneled hospitals in the list and by promoting any way they can. 

FAQs

What is the Pradhan Mantri Jan Arogya Yojana (PMJAY)?

 A  PMJAY is a health insurance scheme initiated by the Government of India to provide financial coverage for secondary and tertiary healthcare to eligible beneficiaries.

Who is eligible for PMJAY?

A PMJAY aims to benefit economically vulnerable families in India. Eligibility is determined based on the Socio-Economic Caste Census (SECC) database, primarily targeting households identified as poor and deprived.

What are the benefits of PMJAY?

 A  PMJAY provides health insurance coverage of up to Rs 5 lakhs per family per year to assist with hospitalization expenses. The coverage includes various medical treatments, surgeries, diagnostics, and follow-up care.

Is there any cost involved in enrolling for PMJAY?

A No, there is no enrollment fee or premium required to avail PMJAY benefits. The scheme is free of cost for eligible beneficiaries.

Does PMJAY cover pre-existing illnesses?

A Yes, PMJAY covers pre-existing illnesses. The scheme provides coverage for hospitalization expenses related to both pre-existing and newly acquired medical conditions.

Can I choose any hospital for treatment under PMJAY?

A No, treatment under PMJAY can only be obtained at empaneled hospitals within the PMJAY network. These hospitals have agreed to provide cashless treatment to eligible beneficiaries.

Is PMJAY applicable only in specific states?

No, PMJAY is a national health insurance scheme applicable across all states and union territories of India.

Can I avail PMJAY benefits multiple times in a year?

PMJAY provides coverage for hospitalization expenses up to Rs 5 lakhs per family per year. Once this limit is exhausted, further benefits can be availed in subsequent years

How can I obtain more information about PMJAY?

You can visit the official website of PMJAY or contact the helpline number provided by the scheme for additional information or assistance regarding PMJAY.

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