The Pradhan Mantri Jan Arogya Yojana (PMJAY), often known as the Ayushman Bharat Yojana Scheme, is the government of India’s flagship scheme. It is essentially a health insurance programme aimed at the poor, lower-income, and vulnerable members of society.
The plan provides financial assistance in the event of hospitalisation due to a medical emergency. This page provides a comprehensive overview of the government’s health insurance program’s eligibility requirements, features, benefits, and application procedure.
Ayushman Bharat Golden Card Download
What is the PMJAY (Pradhan Mantri Ayushman Bharat Yojana)?
Ayushman Bharat Scheme, considered one of the world’s largest healthcare programmes, seeks to cover more than 50 crores, of Indian residents. It is aimed mostly at the country’s economically disadvantaged areas. In September 2018, PMJAY was introduced, offering health insurance with a maximum sum covered of Rs.5 lakh.
The majority of medical treatment expenditures, medications, diagnostics, and pre-hospitalization charges are covered by the government’s health insurance programme. In addition, the plan provides cashless hospitalisation services through the Ayushman Bharat Yojana e-card, which may be used to get healthcare at any of the country’s empanelled institutions. By presenting their PMJAY e-card, beneficiaries of the plan can receive hospitalisation for the required treatment.
What is the scope of the Pradhan Mantri Jan Arogya Yojana?
The Ayushman Bharat Scheme, which aims to provide affordable healthcare to the poor and needy, provides coverage of up to Rs.5 lakh per family per year for secondary and tertiary hospitalisation treatment.
The AB-PMJAY health insurance covers policyholders’ hospitalisation bills and comprises the following components:
- Examination, consultation, and treatment by a physician.
- Pre-hospitalisation.
- Services for non-intensive and intensive care.
- Medical supplies and consumables.
- Laboratory and diagnostic services.
- Accommodation.
- Wherever possible, medical implant services.
- Provisioning of food.
- A complication that develops during therapy.
- Up to 15 days of post-hospitalization expenditures
- Treatment for COVID-19 (Coronavirus).
What Is Not Included in the Ayushman Bharat Yojana?
The Ayushman Bharat Yojana Scheme, like other forms of health insurance coverage, has specific exclusions. The following items are not covered under the plan:
- Expenses for the Out-Patient Department (OPD).
- Drug and alcohol treatment.
- Cosmetic procedures.
- Treatments for infertility.
- Diagnostics for individuals.
- Transplantation of an organ
Ayushman Bharat Yojana Scheme Details
The PMJAY plan has several essential elements, which are listed below:
- It is funded by the Indian government and is one of the world’s largest health insurance systems.
- Secondary and tertiary care coverage of Rs.5 lakh per family each year in both public and private facilities.
- The plan is expected to benefit over 50 million people (approximately 10 million poor and disadvantaged households).
- Hospitalization without the use of cash.
- Pre-hospitalization expenditures like medications and tests are covered for up to three days.
- Up to 15 days of post-hospitalization expenditures, including medications and diagnostics, are covered.
- There are no restrictions on the size, gender, or age of the family.
- Can get services at any of the country’s empanelled public and private hospitals.
- From the start, all pre-existing conditions are covered.
- There are 1,393 medical treatments included in the plan.
- Costs for diagnostics, medicines, hotel charges, physician’s fees, surgeon’s fees, supplies, ICU and OT expenses are all included.
- Public hospitals receive the same reimbursement as private hospitals.
Ayushman Bharat Beneficiary List
The programme is aimed at the most vulnerable and impoverished members of society. The PMJAY offers the following incentives to cater to them:
- It covers all hospitalisation costs for beneficiaries through cashless transactions.
- A place to stay while you are in the hospital.
- Pre-hospitalization and post-hospitalization expenses.
- Any problems that arise as a result of the therapy.
- Everyone in the family may use it.
- There are no restrictions on family size, age, or gender.
- Pre-existing problems are taken into account from the start.
List of Critical Illnesses or Diseases Covered by the Ayushman Bharat Yojana:
More than 1300 medical packages were covered under the medical care plan at empanelled public and private institutions around the country. Some of the critical ailments covered by the Ayushman Bharat Yojana are listed below:
- Prostate cancer is an illness that affects men.
- Replacement of two valves.
- Bypass transplant of the coronary arteries.
- COVID-19.
- Replacement of the pulmonary valve.
- Surgery on the base of the skull.
- Fixation of the anterior spine.
- Gastric pull-up with laryngopharynx ectomy
- Tissue expander to help with deformity from burns.
- Stent-assisted carotid angioplasty.
Ayushman Bharat Card Yojana Eligibility Criteria for Rural and Urban Population
The programme was created to help the country’s bottom 40% of poor and economically disadvantaged people. This was based on the Socio-Economic Caste Census 2011’s deprivation and occupational criteria for rural and urban regions. Pre-conditions are included in the Ayushman Bharat Yojana Eligibility so that only the poorest members of society benefit from the project.
Rural PMJAY:
The SECC 2011 (Socio-Economic Caste Census) includes rating households based on their socio-economic status. The status of seven deprivation factors is used to rank rural households. The method automatically includes impoverished, manual scavenger families, those living on alms, primitive tribal groups, and bonded labourers who fit into at least one of the following six deprivation categories:
- Kucha walls and roofs in households with only one room.
- No adult between the ages of 16 and 59 years old.
- There is no adult male member between the ages of 16 and 59.
- Household members who are disabled and those who are not able-bodied.
- S.C. and S.T.
- Manual casual labour is a key source of income for landless households.
Urban: PMJAY
The concept divides urban families into groups depending on their employment. The Ayushman Bharat Yojana Scheme is available to 11 occupational groups of workers:
- Beggar
- Housewife or housekeeper
- Ragpicker
- On-the-street Cobbler/Street Vendor/Hawker/Other service providers
- Plumber/Construction Worker/Mason/Painter/Labour/Welder/Security Guard/Coolie
- Sweeper/Mali/Sanitation Technician
- Tailor/Home-based Worker/Artisan/Handicrafts Worker
- Driver/Transport Worker/Conductor/Cart or Rickshaw Pullers/Driver or Conductor’s Assistant
- Shop Workers/Peon in a Small Establishment/Assistant/Helper/Attendant/Delivery
- Assembler/Mechanic/Electrician/Repair Worker
- Chowkidar/Washer-man
Who Is Not Eligible For The Ayushman Bharat Yojana Program?
The following is a list of persons who are not eligible to use the scheme’s healthcare services:
- Those who own mechanised farming machinery.
- Who owns a two-wheeler, three-wheeler, or four-wheeler
- Those in possession of a Kisan card.
- Employees of the government
- Those who possess a fishing boat with a motor.
- Those with a monthly income of greater than Rs.10,000.
- Those employed in non-agricultural government-run businesses.
- People who possess more than 5 acres of farmland.
- People who have landlines or refrigerators.
- Those who live in well-constructed homes.
The PMJAY Enrollment Process is as follows:
The plan is an entitlement-based effort initiated by the Indian government for the impoverished and venerable sectors of society. As a result, there is no enrolling procedure. Beneficiaries are chosen using the SECC 2011 and are enrolled in the RSBY plan. If you want to see if you qualify for the programme, take these steps:
- Step 1: Go to the government’s PMJAY website (https://pmjay.gov.in/) and click on the “Am I Eligible” icon.
- Step 2: Fill up your contact information and generate an OTP.
- Step 3: Select a state.
- Step 4: Enter your name, cellphone number, HHD number, or ration card number in the search box.
- Step 5: If you are eligible for the PMJAY plan, the outcome will tell you.
You may also reach out to any of the Empanelled Health Care Providers or call the Ayushman Bharat Yojana customer service at 1800-111-565 or 14555. (EHCP).
Documents Required for Ayushman Bharat Yojana Application:
The following are the papers needed to apply for the PMJAY scheme:
- Aadhaar Card/PAN Card as proof of identity and age
- Your contact information, including your phone number, email address, and home address.
- A certificate of caste
- A certificate of income
- Proof of your existing family situation.
Ayushman Card Online Apply
The plan was created by the Indian government to meet the healthcare requirements of the country’s most disadvantaged citizens. It does not have an enrolling process in accordance with the scheme’s fundamental standards. To apply for the Ayushman Bharat Yojana Plan online, you must first determine if you are a beneficiary of the scheme. To see if you are qualified for the Ayushman Bharat Yojana, follow the steps below:
- Step 1: Go to PMJAY’s official website (https://pmjay.gov.in/) and click the “Am I Eligible” icon.
- Step 2: Enter your contact information and click “Generate OTP.”
- Step 3: Next, choose your state and search for yourself using your name, cellphone number, HHD number, or ration card number.
- Step 4: Check to see whether you qualify for the government healthcare plan.
How Do I Get My Ayushman Bharat Card?
The Ayushman Bharat Yojana Golden Card will be provided to beneficiaries of the PNJAY plan to facilitate cashless, paperless, and portable transactions. The PMJAY e-card provides all of the patient’s necessary information. It is required that you produce this card while seeking treatment at an empanelled hospital.
Follow the steps below to obtain this PMJAY Golden Card:
- Step 1: Log in with your registered mobile number on the PMJAY website (https://mera.pmjay.gov.in/search/login).
- Step 2: To create the OTP, enter the ‘Captcha Code.’
- Step 3: Select the HHD option.
- Step 4: Take the HHD code to the Common Service Centre (CSC), where it will be checked together with other information.
- Step 5: The remaining steps will be completed by CSC representatives known as Ayushman Mitra.
- Step 6: To obtain the Ayushman Bharat card, you must pay Rs.30.
COVID-19 Coverage under the PMJAY Scheme
The Insurance Regulatory and Development Authority (IRDAI) has issued advice to all health and general insurance firms to pay COVID-19 (Coronavirus) hospitalisation and treatment charges in order for beneficiaries to benefit from the COVID-19 coverage. COVID-19 therapy and hospitalisation are covered by the PMJAY or Ayushman Bharat Yojana Scheme.
The PMJAY initiative allows COVID-19 patients to get free treatment at empanelled facilities. Ascertain if you are eligible for the Ayushman Bharat Scheme, which is financed by the government.
How can I find out if my name is on the PMJAY Ayushman Card List 2020?
You may verify if your name is on the PMJAY list 2020 using a variety of techniques. They are as follows:
- Common Service Centre (CSC): To see if you are eligible for the healthcare programme, go to your local CSC or any of the empanelled hospitals.
- PMJAY Hotline Numbers: You can call the PMJAY helpline to find out if you are eligible for the plan. You may reach us by dialling 14555 or 1800-111-565.
- Check if you are qualified for the plan on the official website (https://www.pmjay.gov.in/).
Packages for Medical Care:
Families and individuals who are beneficiaries of the plan have access to over 25 specialities, including:
- Cardiology
- Oncology
- Neurology
- Paediatrics
- Orthopaedics
- COVID-19
Please keep in mind that medical and surgical costs cannot be paid at the same time. In addition, if there are several procedures, the surgery with the greatest cost will be paid first. For the second, you will be given 50%, and for the third, you will be given 25%.
Because it is part of the government of India’s large programme, the PMJAY scheme does not take pre-existing diseases into account.
Ayushman Bharat Scheme (PMJAY) Hospitalization Process:
If you or a member of your family needs hospitalisation, you are not required to pay anything under the PMJAY programme as long as you are admitted to one of the empanelled public or private hospitals. The whole hospitalisation and treatment procedure is cashless, thanks to a 60:40 cost-sharing arrangement between the centre and the state.
You will obtain the Ayushman health card as a beneficiary, which will allow you to access cashless treatment and hospitalisation. The golden card entitles you to the scheme’s advantages at any of the empanelled public and private hospitals.
Hospitals on the PMJAY list:
Follow the procedures below to find the PMJAY hospital list and the Ayushman Bharat hospital list:
- Step 1: Go to PMJAY’s official website and look under the Hospitals area.
- Step 2: Choose a state and a district.
- Step 3: Select the hospital type (public, private-for-profit, or private and not-for-profit).
- Step 4: Decide on the medical speciality you want to pursue.
- Step 5: Type in the “Captcha Code” and hit “Search.”
You will be sent to a list of Ayushman Bharat Yojana hospitals, complete with addresses, websites, and phone numbers. You may also look for the ‘Suspended Hospital List’ using the same URL.
Toll-free number and address for PMJAY:
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana’s toll-free number and location are shown below:
- Toll-free telephone number: 14555/1800-111-565
- Address: National Health Authority of India, Tower-L, Jeevan Bharati Building, Connaught Place, New Delhi – 110001, 3rd, 7th, and 9th Floors
Grievance Portal: If you have a grievance, you may go to the PMJAY Grievance area and file a complaint. On the same website, you may monitor the status of your complaint.
What is the best way to update data in PMJAY?
The Coronavirus epidemic caused a huge number of employees who were reliant on daily pay to lose their employment. It is much worse if you are hit with a medical emergency in this circumstance. Such employees would be enrolled as beneficiaries under the Central Government’s main health insurance plan, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, to help alleviate their suffering. The National Health Authority (NHA) is in charge of finding and enrolling AB-PMJAY participants.
The agency is working closely with state governments to identify migrant workers and enrol them in the programme. Diagnostics, hospitalizations, patient meals, post-hospitalization expenses, and other health-related contingencies are covered by the AB-PMJAY programme, which includes COVID-19. This health insurance plan’s annual sum covered is Rs. 5 lakh per qualifying household. Migrant employees may not have to worry about significant documentation or complicated claim procedures because this is a card-based health insurance scheme.
What services does the Ayushman Bharat Scheme provide?
Medical care services such as pre-and post-hospitalization, daycare surgeries, newborn child services, and so on are included under the plan.