Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana: What you need to know

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana aims to provide cashless health insurance to 50 crore Indians. Here’s a look at what it covers and how you can check if you are eligible

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana: What you need to know

The world is facing an unprecedented healthcare crisis. The prompt lockdown measures enforced by the Indian government has ensured that the Coronavirus pandemic does not spiral out of hand. Yet given our population and the high rate of transmission, our healthcare systems are already overwhelmed especially in high density localities. Luckily, the cost of testing and treating Covid-19 is free via public and private facilities for all citizens.

Government health insurance schemes like the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is offering free services for Covid care to over 53 crore citizens.  This comes as a great boon in times of financial distress especially for the marginalised sections of society.

PMJAY is amongst the biggest state-sponsored government health insurance schemes in the world that provides cashless and paperless access to services for the beneficiaries at the point of service. 

In this article, we shall discuss in detail the benefits and the eligibility criteria for this health program. But first, let’s understand why the need was felt for such government health insurance schemes.

India did not have any comprehensive government health insurance schemes until PM Modi announced the launch of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) in September 2018. In the event of sickness or hospitalisation, most citizens end up paying more than three-fourths of their healthcare cost out of their own pockets. Getting proper medical care can be really tough for those living below the poverty line. Ayushman Bharat has been designed to help such families. 

Related: Health Insurance 101 

Who is covered under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana?

The AB-PMJAY covers about 10.74 crore families. The scheme provides a Rs 5 lakh cashless family floater insurance cover for all members of the household for one year. Members can be added to the insurance with the government’s approval.

There is no cap on family size, age, or gender. All members of eligible families as present in the latest Socio Economic Caste Census (SECC) database are automatically covered by this scheme. Existing Rashtriya Swasthya Bima Yojana (RSBY) beneficiaries and even those who are a part of similar schemes in other states will be included.

To ensure that the underprivileged people of the society benefit from the initiative, the eligibility has been divided as PMJAY-Rural and PMJAY-Urban. 

Eligibility under PMJAY-Rural

  • Landless households and destitute, manual scavenger families, living through alms, primitive tribal group, bonded labourers
  • Households with only one room with Kucha walls and roof.
  • No adult member between the ages of 16 and 59 years.
  • Disabled member and no-abled bodied member in the household.
  • Scheduled Castes and Scheduled Tribes

Eligibility under PMJAY-Urban

  • Domestic workers/ tailor/ handicraft workers
  • Beggars/ ragpickers
  • Sweeper/ Sanitation Workers
  • Construction workers/ security staff/ plumber/ electrician/ mechanic
  • Driver/ hawker/ cobbler, etc.

What is covered under the PMJAY scheme?

Families insured under Ayushman Bharat will be covered for up to 1578 medical and surgical packages that have been categorised under 25 separate specialties – which include cardiology, neurosurgery, oncology (chemotherapy for 50 types of cancers), burns, etc. Patients can avail of any one package – either surgical or medical – at one time.

So as to deal with the Covid-19 pandemic on a war footing, the government has actively involved the private sector as a key partner and stakeholder. Over 20,000 public and private hospitals have been empaneled across the country to provide inpatient services to the beneficiaries for Coronavirus treatment.

Be sure to check if the private laboratory is approved/registered by the Indian Council for Medical Research (ICMR). Information on symptoms, testing and treatment for COVID-19 can be accessed from the website of the MoHFW and by calling the national COVID-19 helpline 1075.

Related: 6 Simple ways to cut down expenses on doctors and healthcare article

What are the key benefits of Ayushman Pradhan Mantri Jan Arogya Yojana?

While the biggest benefit is the Rs 5 lakh cashless cover that families enjoy, there are other benefits that make the program appealing to the common man.

  1. Ayushman Bharat covers all pre-existing conditions from the day the policy comes into effect.
  2. Insured families can visit a public or empaneled private hospital anywhere in the country and get free treatment.
  3. Hospitalisation expenses – including registration, nursing, and boarding charges in a general ward – are all covered by the insurance policy.
  4. The scheme also takes care of surgical equipment, consultation fees, and procedure charges, as well as cost of implants, medicines, diagnostic tests, and food for patients during their hospital stay.
  5. All follow-up care, including pre- and post-hospitalisation expenses, will be taken care of.
  6. The insured family pays no money towards treatment in case of hospitalisation.
  7. In the event the insured individual requires multiple surgeries, the highest package rate will be waived for the first treatment; and 50% and 25% of the expense will be provided for the second and third treatment respectively.
  8. To receive treatment at any registered hospital, the injured family member must carry the prescribed ID.

Related: Healthcare rates could be 20% lower than CGHS under modicare 

How to check your eligibility for Ayushman Bharat Yojana online?

1) Go to the Ayushman Pradhan Mantri Jan Arogya Yojana website. Enter an active mobile number (to get an OTP) and then the captcha letters displayed on the screen. Then click on the ‘Generate OTP’ button. You will receive an OTP as a text message at the mobile number entered. Enter this and click on ‘Verify OTP,’ which takes you to a page where you can enter search details.

2) An individual can search whether he/she is an eligible beneficiary for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana using any of the following:

Mobile number/Ration card Number: An Additional Data Collection Drive (ADCD) was conducted on 30th April 2018 at all Gram Sabhas across India to capture active mobile numbers and ration card numbers of families in the SECC database. Only if the individual got their mobile number or ration card number captured during this drive will it show up on the portal. If despite doing this no results are displayed, search using the ‘SECC Name’ option.

SECC Name: Individuals can search if they are eligible for Pradhan Mantri Jan Arogya Yojana using the details as per the SECC database – name, father’s name, gender, state, etc. If no results are displayed even now, contact a nearby Ayushman Mitra.

RSBY URN: Additionally, all active families that are enrolled under RSBY (till 31st March 2018) that do not feature in the targeted groups as per SECC data will be included; they can identify if they are eligible for Ayushman Pradhan Mantri Jan Arogya Yojana using their RSBY URN.

3) If the search is successful, the individual has an option to receive a text message with the HHID number/ RSBY URN in future on their phone by clicking the ‘Get SMS’ button and entering the mobile number. Note: This mobile number can be different from the one used in the first step for OTP generation.

Related: Here's how getting healthy today can save you additional costs later 

How to check your eligibility for Ayushman Bharat offline?

You can also check your eligibility for Ayushman Bharat by calling the helpline number 14555 / 1800111565.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is an ambitious project by the Government of India that aims to offer a comprehensive health insurance plan to its citizens, thereby making healthcare affordable and accessible to the country's economically weaker sections.  

Since its launch in September 2018, the scheme has provided treatments at more than 95 lakh hospitals, totaling nearly Rs. 13,000 Cr.  Till date more than 12 crore e-cards have been issued across the 32 States and UTs implementing the government health insurance schemes, and will be our best bet on ensuring that the masses can be protected and treated against this healthcare crisis.


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