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Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY)

  • Author :
  • TATA AIG Team
  • Last Updated On :
  • 02/08/2024

A health insurance plan is an integral requirement of every individual. The rising medical cost and top-notch medical care during emergencies are reasons why individuals invest in critical illness insurance or other health plans. However, only some individuals can afford a health insurance policy.

Availing benefits of health insurance plans is not possible for certain sections of society, such as economically backward people.

This is the reason why the Government of India has started a health insurance plan for individuals who face financial challenges in accessing medical services.

Ayushman Bharat or Pradhan Mantri Jan Arogya Yojana is a scheme launched by the Indian government to offer benefits of health insurance to beneficiaries. But there are a lot of intricacies attached to Ayushman Bharat Yojana, which we will discuss in this blog.

What is The Ayushman Bharat Yojana?

The Ayushman Bharat Yojana is the flagship health insurance scheme the Indian government launched based on the recommendations made under the National Health Policy 2017. As of 31 March 2022, as many as 18 crore Ayushman Bharat e-cards were issued.

An individual holding the Ayushman Bharat card can avail of completely cashless secondary and tertiary healthcare services. This e-card can be used to get healthcare services at a public or private empanelled hospital across India.

PMJAY Features Details
Per Family Coverage ₹5 lakh per year
Pre Hospitalisation Expenses Up to 3 days
Post Hospitalisation Expenses Up to 15 Days
Number of Medical Procedures Included 1393

Critical Disease Covered Under Ayushman Bharat Scheme – Pradhan Mantri Jan Arogya Yojana

The PMJAY scheme offers benefits to eligible candidates for pre-existing or critical conditions, too. Below are some of the critical diseases covered under AB-PMJAY.

  • Prostate Cancer

  • Skull Base Surgery

  • Double Valve Replacement

  • Anterior Spine Fixation

  • Pulmonary Valve Replacement

PMJAY Scheme Covid-19 Coverage

  • According to the IRDAI regulation, all the general and insurance providers, including the government-backed Ayushman Bharat Yojana, provide coverage Covid -19.

  • As per the guidelines, the PMJAY beneficiary can avail of the scheme benefit for free in government or private empanelled hospitals for COVID- 19 including quarantine and isolation expenses.

  • As per the policy, the hospital should be well equipped to conduct testing, treatment and other Coviod-related medical expenses.

PMJAY Scheme Hospitalisation Process

Under the Ayushman Bharat scheme, eligible households with Ayushman cards or any of their family members who require hospitalisation can avail of cashless services in the listed government and private hospitals.

Ayushman Bharat Eligibility Criteria For Urban And Rural

To get the Ayushman Bharat Yojana benefits, eligibility criteria need to be met. All the individuals who are part of the Socio-Economic Caste Census database and have an active Rashtriya Swasthya Bima Yojana can be PMJAY beneficiaries.

Other than this, the PMJAY scheme is categorised for urban and rural individuals based on their eligibility criteria which have been listed below.

PMJAY Rural Eligibility Criteria

  • Households with age group between 16 to 59 with no male or adult earning member.

  • Individuals belong to scheduled caste and tribe households.

  • Households with no land and income depend on manual labour.

  • Household with disabled family members.

  • Households and families with no members in the age group of 16 to 59.

  • Households or families living in houses with no roofs and walls.

  • Individuals who are beggars and surviving on alms.

PMJAY Urban Eligibility Criteria

  • Ragpicker and beggar.

  • Domestic help or worker.

  • Individuals who are construction workers, labourers, painters, etc.

  • Individuals who are washerman, plumber and mason.

  • Individuals who are electricians, repair workers, assemblers, etc.

  • Those who are street vendors, cobblers and hawkers.

  • Individuals who are rickshaw pullers, transport workers, cart pullers, etc.

  • Those who work in small establishments, such as delivery boys, servers, etc.

How to Know or Check the Ayushman Bharat Eligibility Online?

All the candidates seeking PMJAY benefits need to check if they are eligible for the scheme or not. Below are the steps needed to verify the Ayushman Bharat Yojana eligibility criteria.

Step 1: To check the eligibility, open the official PMJAY website.

Step 2: Next, click on the "Am I Eligible" option on the top menu bar.

Step 3: Further, enter the mobile number, select auth mode and then click on the "Generate OTP" button.

Step 4: Now, enter the received OTP and click on the "Verify OTP" option.

Step 5: After that, add the asked details such as name, state, income details, etc.

Step 6: After entering all the details, click the "Submit" button.

Documents Required for Ayushman Bharat Yojana

For a seamless registration process, it is always advised to keep all the necessary documents handy. Here are the documents required for an Ayushman Bharat card:

  • Proof of your age and identity, such as your PAN card or your Aadhar card

  • Contact details, including your mobile number, email ID, address, etc.

  • Caste certificate

  • Income certificate (you are only eligible if your maximum annual income does not exceed ₹5 lakhs a year)

  • Document proof of the family status – whether they are nuclear or joint – that you are seeking coverage for

How to Apply for the Ayushman Bharat Scheme or PMJAY Online?

Ayushman card online registration is both simple and convenient. The PMJAY is applicable to every beneficiary identified as the SECC 2011, as well as those who are already a part of the RSBY scheme. Here is how you can check your Ayushman card eligibility:

Step 1: Visit the official website of the PMJAY

Step 2: Enter your mobile number along with the captcha code displayed in the small box and click on the tab that says "Generate OTP".

Step 3: Fill in the OTP that you will receive on your registered mobile number, after which you will be directed to the PMJAY login screen.

Step 4: From the drop-down, select the state from which you are doing your Ayushman Bharat Yojana registration.

Step 5: From the options provided, choose how you will want to verify your Ayushman card eligibility. The options include mobile number, name, Ration Card number, or your RSBY URN number.

Step 6: Once you have correctly added the above information, your name will reflect on the right-hand side of the web page if you are eligible for Ayushman card online registration.

Step 7: At the time of your Ayushman Bharat yojana registration, you can also check who the beneficiaries of the policies are by clicking on the 'Family Members' tab.

Aside from those above, you can also check your eligibility for the PMJAY by visiting any Empanelled Health Care Provider (EHCP). Alternatively, you can also check your eligibility to apply for an Ayushman card by calling the call centre number: 1800-111-565 or 14555.

The process to Include Name in AB - PMJAY

The Ayushman Bharat Yojana registration is made simple so every individual can avail of the benefits of a medical insurance plan. Here is how you can add your name to the PMJAY:

Step 1: Once you log into the official website of the healthcare scheme, you will have to click on the tab that displays 'Add Family Details'.

Step 2: Enter your Ration Card number in the relevant section and click on 'Check Document Details'.

Step 3: If your Ration Card is attached to that of your family, then the screen will display your name.

How to Download the Ayushmann Card or PMJAY Card?

All the eligible candidates or PMJAY beneficiaries can avail of the cashless and paperless transactions using the scheme if they have an Ayushman card. The Ayusmhan or PMJAY card has the detailed information of the beneficiaries. By showing this card at listed government and private hospitals, they can avail of the scheme benefits. Below are the steps to issue a PMJAY Golden or Ayushman card.

Step 1: To get the card, visit the official PMJAY website.

Step 2: Next, log into the account using a registered mobile number.

Step 3: Further, add the captcha code to generate OTP.

Step 4: Next, choose the HHD code option.

Step 5: Following that, provide the HHD code to the representative in the Common Service Centre (CSC) of Ayushman Bharat Yojana.

Step 6: A CSC representative will complete the rest of the process of downloading an Ayushman card.

Step 7: Lastly, after completing the process, the CSC representative will charge 30 rs and provide the downloaded Ayushman card.

How to Find PMJAY Empanelled Hospital List?

Individuals, by following these steps, can easily find the PMJAY hospital list.

Step 1: To check the hospital list, go to the official PMJAY hospital list tab.

Step 2: Next, enter the "State" and "District".

Step 3: Now, select the hospital preference, private or government hospital.

Step 4: Further, look for the medical specialty.

Step 5: After entering the captcha code, click on the search icon to know the hospital listed under the PMJAY scheme in your area.

Conclusion

Health insurance is not a luxury but a necessity. With the soaring hospitalisation expenses and rise in illnesses owing to insufficient nutrition and exercise, the underprivileged strata of society find it difficult to access safe medical treatment.

The scheme offered benefits of health insurance to beneficiaries. With the Ayushman Bharat Yojana, healthcare has become accessible and affordable to every Indian.

The comprehensive health insurance plan by Tata AIG includes a host of convenient services, such as paperless policies and cashless treatments. It accommodates the changing lifestyle as well as the rising medical costs.

FAQS

How to get an Ayushman card?

Individuals who need an Ayushaman card can quickly get it by visiting the Common Service Centre (CSC) of Ayushman Bharat Yojana.

Is the Pradhan Mantri Jan Arogya Yojana or scheme applicable to all Indian states?

The PMJAY scheme is applicable in all the states of India. However, only the eligible candidate can avail the benefits of schemes.

How to know the Ayushman Bharat scheme card validity?

To know the validity of the Ayushman Bharat card, visit the nearest CSC centre or contact an Ayushman representative or Mitra.

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Your policy is subjected to terms and conditions & inclusions and exclusions mentioned in your policy wording. Please go through the documents carefully.

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