Pradhan Mantri Jan Arogya Yojana (PMJAY)
Pradhan Mantri Jan Arogya Yojana (PMJAY) also known as the Ayushman Bharat Yojana, is a plan that aims to assist and help economically vulnerable citizens who are in need of healthcare facilities. The scheme was launched as a second part of the Ayushman Bharat Yojana after its first offering wherein the government announced the construction of Health & Wellness Centres.
PM Modi rolled out this health insurance scheme in the year 2018, on the 23rd of September to cover about 50 crore citizens and already has several success stories to its credit. As per the latest data on PMJAY’s official website, since the launch over 24,000 hospitals have been empaneled, 1.59 crore beneficiaries have been admitted and over 13 crore e-cards have been issued.
Pradhan Mantri Jan Arogya Yojana plans to make secondary and tertiary healthcare completely cashless. The Yojana beneficiaries get an e-card that can be used to avail services at an empanelled hospital, private or public, anywhere across the nation. With it, one can reach a hospital and obtain cashless treatment.
The coverage also includes 3 days of pre-hospitalization and 15 days of post-hospitalization expenses for meeting medical & diagnostic tests. Adding to it, around 1,400 procedures with all related costs like test expenses are taken care of. All in all, the e-card of PMJAY provides a coverage of Rs. 5,00,000 per family, per year, thus helping the economically vulnerable obtain easy access to healthcare services.
To get the benefits of PMJAY, it is mandatory for all the individuals to vouch for their names in the Socio-Economic Caste Census-2011 data. This will ensure if the family of the individual is eligible to be covered under the yojana or not. Only those households who are active RSBY cardholders and are listed in the SECC database are entitled to avail benefits under this yojana.
PMJAY Scheme: Eligibility criteria for Urban
- Domestic Worker
- Construction worker/ labour/ welder/ painter/ coolie/ security guard
- Home-based artisans/ Tailor/ Sweeper/ Handicrafts worker/ Mali/ Sanitation worker
- Plumber/ Mason/ Washer-man
- Assembler/ Repair Worker/ Electrician/ Mechanic
- Trasport worker/ Conductor/ Cart puller/ Rikshaw puller
- Peon/ Delivery Assistant/ Assistaant/ Waiter/Shop Worker
- Cobbler/ Hawker/ Street Vendors
PMJAY Scheme: Eligibility Criteria for Rural
- Families living in one room with Kuccha roofs and walls
- Families with no members within the age group of 16-59 yrs
- Landless families whose major income comes from manual casual labor
- Household with one differently-abled member and without a healthy adult member
- A household with no male/adult/earning member withing the age group of 16-59 yrs.
WHO IS NOT ENTITLED UNDER PMJAY?
- Government Employees
- People who own a vehicle like a 2 wheeler, 3 wheeler, or a car
- Those who have farming equipments and machinery
- People whose monthly income is more than Rs 10,000
- Those who reside in properly build houses
- Those who hold a Kisan card with a limit of Rs.50,000
- Those owing a motorized fishing boat
- Those owing more than 5 acres of agricultural land
- People who have landline phones and refrigerators in their houses
- People employed in government-run non-agricultural enterprises
- PM-JAY is the world’s largest health insurance scheme fully financed by the government of India.
- It provides a cover of Rs. 5,00,000 per family, per annum for tertiary and secondary care hospitalization across private and public empanelled hospitals in India.
- Over 10.74 crore vulnerable and poor families (approximately 50 crore beneficiaries) are eligible for these benefits.
- PM-JAY provides cashless access to health care services for the beneficiary at the hospitals.
- PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore citizens into poverty each year.
- It covers up to 15 days post-hospitalization and 3 days of pre-hospitalization expenses such as medicines and diagnostics.
- There is no restriction on the family size, gender, or age.
- All conditions (pre-existing) are covered from day one.
- Benefits of the scheme are portable across the nation i.e. a beneficiary can visit any empanelled private or public hospital in India to avail cashless diagnosis and treatment.
- Services include approximately over 1400 procedures covering all the costs related to diagnosis and treatment, including but not limited to supplies, drugs, diagnostic services, physician's fees, surgeon charges, room charges, OT and ICU charges etc.
- Public hospitals are reimbursed for the healthcare services at par along with the private hospitals.
COVERAGE & BENEFITS UNDER PMJAY
Benefit cover under various Government health insurance schemes in the country has always been structured on an upper ceiling limit ranging from a yearly coverage of Rs 30,000 to Rs 3 lakh per family across various States which created a fragmented structure. PM-JAY provides cashless cover of up to Rs 5 lakh to each eligible family per year for listed secondary and tertiary care conditions. The cover under the yojana includes all expenses incurred on the following aspect of the treatment:
- Medical examination, treatment, and consultation
- Medicine and medical consumables
- Non-intensive and intensive care services
- Diagnostic and laboratory investigations
- Medical implantation services (where necessary)
- Accommodation benefits
- Food services
- Complications arising during treatment
- Post-hospitalization follow-up care up to 15 days
The benefits of Rs 5 lakh are on a family floater basis which means that it can be used by all or one member of the family. PM-JAY has been structured in such a way that there is no cap on the age of members or family size. Adding to it, pre-existing diseases are covered from the very first day. This means that any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those diseases as well under this scheme right from the day they initiated the yojana.
REGISTRATION FOR PMJAY SCHEME ONLINE
It is quite convenient to initiate for PMJAY scheme. An individual can follow these steps:
- Visit the official govt site for PMJAY scheme
- Find the ‘Am I eligible’ tab and click on it
- Submit the captcha code, mobile number, and click on generate OTP button
- Now enter name & state, and search by entering ration card number, mobile number, or telephone number
- If the family is covered under the PMJAY, then the name shall appear in the results.
- Identity proof & Age (PAN card/Aadhar Card)
- Contact Details (Email, mobile, address)
- Caste Certification
- Income Certification (Maximum annual income to be only up to Rs 5,00,000 per annum)
- Document proof of the current status of the family to be covered (nuclear or joint)
LIST OF CRITICAL DISEASES COVERED UNDER PMJAY
Some of the critical illnesses covered under the PMJAY scheme are mentioned below:
- Coronary Artery Bypass grafting
- Carotid Angioplasty with stent
- Skull base surgery
- Pulmonary valve surgery
- Anterior spine fixation
- Double value replacement surgery