What is The Ayushman Bharat Yojana or PMJAY Scheme?
Features of PMJAY : Ayushman Bharat Yojana Scheme
- PM-JAY is that the world’s largest health insurance/ assurance scheme fully financed by the govt .
- It provides a canopy of Rs. 5 lakhs per family per annum for secondary and tertiary care hospitalization across public and personal empanelled hospitals in India.
- Over 10.74 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
- PM-JAY provides cashless access to health care services for the beneficiary at the purpose of service, that is, the hospital.
- PM-JAY envisions to assist mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty annually .
- It covers up to three days of pre-hospitalization and 15 days post-hospitalization expenses like diagnostics and medicines.
- There is 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 the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
- Services include approximately 1,393 procedures covering all the prices associated with treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
- Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
Benefits of Ayushman Bharat Yojana Scheme :
- Medical examination, treatment and consultation
- Medicine and medical consumables
- Non-intensive and medical 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 fifteen days
What is Covered under Ayushman Bharat Yojana Scheme?
PMJAY covers the subsequent expenses during the treatment:
- Ayushman Bharat Yojana Scheme provides coverage for checkup , treatment and consultation fee
- Pre-hospitalization expenses are covered under Ayushman Bharat Yojana policy
- Post-hospitalization expenses are covered for 15 days
- The policy also covers the value of drugs and medical consumables
- Hospital accommodation charges also are covered
- Non-intensive and ICU services
- The expenses incurred on the Diagnostic procedures also are covered
- Medical implantation services are covered where required
- Expenses incurred on complications arising during the medical treatment
- Food services
Eligibility Criteria for Rural and Urban People :
To avail the benefits of Ayushman Bharat Yojana health insurance scheme, it is essential for all the people to check for their names in the Socio-Economic Caste Census-2011 data. This will ensure if their family is eligible to be covered under Ayushman Yojna or not. And only those households whose name is listed in SECC database and active RSBY card holders are entitled to avail PMJAY benefits.
Eligibility Criteria for Rural :
- Household with no adult/male/ earning member within the age group of 16-59 years
- Families living in one room with Kuccha Kuccha walls and roof
- Families with no members within the age group of 16-59 years
- Household without a healthy adult member and one disabled member
- Manual scavenger families
- Landless households earning a major part of their family income from manual labour
Eligibility Criteria for Urban :
- Domestic worker
- Home-based Artisans/ Tailor Sweeper/ Handicrafts worker/ Sanitation worker/ Mali
- Construction worker/ Labour/ Painter/ Welder/ Security guard/ Coolie
- Washer-man/ Plumber/ Mason
- Electrician/ Mechanic/ Assembler/ Repair worker
- Transport worker/ Rickshaw puller/ Conductor/ Cart puller/
- Waiter/Shop worker/ Assistant/ Peon/Delivery assistant
- Street vendors/ hawker / Cobbler
Important Link :
Documents Required :
- Age & Identity Proof (Aadhaar Card/PAN Card)
- Contact details (mobile, address, email)
- Caste certificate
- Income certificate (maximum annual income to be only up to Rs. 5 lakh a year)
- Document proof the current status of the family to be covered (Joint or nuclear)