Apply for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana
- Author :
- TATA AIG Team
- ●
- Published on :
- 05/07/2023
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is the largest healthcare scheme in the world. As healthcare costs continue to rise, millions in India struggle to afford the medical care they need. However, the Ayushman Bharat scheme allows eligible families to access free healthcare services at government and empanelled private hospitals.
But how do you apply for this life-changing scheme?
This comprehensive blog will show you how to apply for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, from checking your eligibility and registering for the scheme to obtaining your e-card and accessing healthcare services.
It will also answer some of the most commonly asked questions about the medical insurance scheme, such as the coverage it provides, the documents you will need to apply, etc.
So, whether you are a beneficiary looking to enrol in this government health insurance plan or someone who wants to help spread awareness, this guide is for you.
Let's get started on the journey to better healthcare for all.
What is PMJAY - Ayushman Bharat Yojana Scheme?
PMJAY, also known as Ayushman Bharat Yojana or the Pradhan Mantri Jan Arogya Yojana, is a flagship healthcare scheme implemented by the Government of India. Launched in September 2018, it aims to provide accessible and affordable healthcare to economically vulnerable individuals and families nationwide.
The Scheme is a part of the Ayushman Bharat Mission, which envisions the achievement of Universal Health Coverage (UHC) in India. PMJAY provides health insurance coverage of up to ₹5 lakhs per family per year, covering over 50 crore individuals from approximately 10.74 crore vulnerable families identified through the Socio-Economic Caste Census (SECC) data.
The PMJAY scheme primarily targets poor, deprived rural families and identifies occupational categories of urban workers' families. Under this scheme, eligible beneficiaries can avail themselves of cashless and paperless treatment at empanelled public and private hospitals across India.
What Does the PMJAY Scheme Cover?
The coverage of PMJAY Scheme includes various medical services, such as hospitalisation expenses, surgeries, consultations, diagnostic tests, pre- and post-hospitalisation care, and more. The scheme also provides secondary and tertiary healthcare services coverage, ensuring comprehensive medical support. This blog includes a detailed table of PMJAY medical insurance coverage.
To avail of the benefits of PMJAY, individuals need to check their eligibility by visiting the official PMJAY website or contacting the nearest Ayushman Mitra. If eligible, they can then apply and register for the scheme.
Once registered, beneficiaries receive an Ayushman Bharat card and a health insurance e-card. This card allows them to access healthcare services at any empanelled hospital without needing upfront payment.
Eligibility Requirements for PMJAY
The PMJAY (Ayushman Bharat Yojana) Scheme has two categories based on the location of the beneficiaries: PMJAY Urban and PMJAY Rural. Here's a breakdown of each category:
1. PMJAY Urban
Eligibility Criteria: Under PMJAY Urban, individuals and families residing in urban areas can avail of the Scheme benefits.
Occupational Categories: The Scheme includes specific occupational categories of urban workers' families, such as street vendors, ragpickers, domestic workers, construction workers, sanitation workers, mine workers, beedi workers, etc.
Socio-Economic Caste Census (SECC): Eligibility for PMJAY Urban is determined based on the SECC database, which identifies economically vulnerable households in urban areas.
Other Criteria: The same exclusion criteria, such as being a regular government employee, income taxpayer, or holding a constitutional post, also apply to PMJAY Urban.
2. PMJAY Rural
Eligibility Criteria: PMJAY Rural covers individuals and families residing in rural areas of India.
Socio-Economic Caste Census (SECC): Eligibility is determined based on the SECC database, which identifies economically vulnerable rural households.
Priority Categories: PMJAY Rural prioritises specific categories, such as landless labourers, families without an adult male member aged 16 to 59, households with no individuals aged 16 to 59, and destitute individuals living on alms.
Family Definition: The Scheme covers the head of the household, spouse, and dependent children up to 18. In some cases, dependent children up to 23 years studying full-time or married females may also be included.
[Note: The implementation and specific guidelines for PMJAY Urban and PMJAY Rural may vary between states, as the Scheme is administered at the state level. It is advisable to check the guidelines the respective state government provides or visit the official PMJAY website for accurate and up-to-date information regarding eligibility and coverage under each category.]
What is Covered Under the PMJAY Scheme?
The PMJAY (Ayushman Bharat Yojana) Scheme provides coverage for a wide range of medical services and treatments. Here's an overview of what is covered and not covered under the PMJAY Scheme:
| Things Covered Under the PMJAY Scheme | Things Not Covered Under the PMJAY Scheme |
|---|---|
| Hospitalisation Expenses: PMJAY covers expenses related to hospitalisation, including room charges, nursing charges, and intensive care unit (ICU) charges. | Outpatient Care: PMJAY primarily focuses on providing coverage for inpatient hospitalisation expenses. Outpatient care, including routine consultations, medications, and diagnostic tests conducted on an outpatient basis, is not covered under the Scheme. |
| Surgical Procedures: The Scheme covers the cost of various minor and major surgical procedures, including pre-surgery and post-surgery expenses. | Fertility Treatments: PMJAY does not cover fertility treatments, including assisted reproductive technologies like in vitro fertilisation (IVF) and related procedures. |
| Medical Consultations: PMJAY provides coverage for consultations with doctors and specialists, enabling beneficiaries to seek medical advice for their conditions. | Aesthetic and Cosmetic Procedures: Procedures and treatments that are purely aesthetic or cosmetic, such as plastic surgery for non-medical reasons, are not covered under PMJAY. |
| Diagnostic Tests: The Scheme covers a range of diagnostic tests, including laboratory investigations, imaging studies (like X-rays, ultrasounds, and MRI scans), and other necessary tests for diagnosis and treatment. | Organ Transplants: The Scheme does not cover the costs associated with organ transplantation, including the procurement of organs, surgeries, and post-transplant care. |
| Medications: The cost of essential medicines and drugs required for treatment during hospitalisation is covered by PMJAY. | Non-Medical Expenses: Expenses that are not directly related to medical treatment, such as transportation costs, attendant charges, food expenses, and phone bills, are not covered by PMJAY. |
| Pre & Post-Hospitalisation Expenses and Follow-up Care: The Scheme covers expenses related to medical investigations and consultations conducted before and after hospitalisation. PMJAY extends coverage to post-hospitalisation care and follow-up consultations, ensuring continued support for beneficiaries after discharge. | Experimental and Unproven Treatments: PMJAY does not cover experimental or unproven treatments not supported by scientific evidence or approved medical guidelines. |
| Maternity and Newborn Care: PMJAY provides coverage for antenatal care, delivery expenses, and postnatal care for expectant mothers. It also includes the cost of neonatal intensive care unit (NICU) services for newborns requiring specialised care. | Pre-Existing Conditions: The Scheme does not cover pre-existing medical conditions known to the beneficiary before enrolling. |
| Secondary and Tertiary Care: PMJAY covers secondary and tertiary healthcare services, including specialised treatments and procedures like chemotherapy, dialysis, cardiac surgeries, joint replacements, etc. | Injuries Resulting from Hazardous Activities: Expenses incurred to treat injuries resulting from participation in hazardous activities, such as adventure sports or criminal activities, are not covered. |
Features of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana
Here are a few of the key features of the PMJAY (Ayushman Bharat Yojana) Scheme that you should know before you apply for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana:
- Health Insurance Coverage: PMJAY provides health insurance plan coverage of up to ₹5 lakhs per family per year, ensuring financial protection against high medical expenses.
- Cashless and Paperless: The Scheme enables beneficiaries to receive cashless and paperless treatment at empanelled public and private hospitals across India, reducing the burden of upfront payments.
- Large Beneficiary Base: PMJAY aims to cover over 50 crore individuals from approximately 10.74 crore vulnerable families identified through the Socio-Economic Caste Census (SECC) data, making it one of the largest healthcare schemes in the world.
- Coverage for a Wide Range of Medical Services: PMJAY covers a comprehensive set of medical services, including hospitalisation expenses, surgeries, consultations, diagnostic tests, pre- and post-hospitalisation care, and more.
- Empanelled Hospitals: Beneficiaries can access healthcare services at both government hospitals and empanelled private hospitals, ensuring a wide network of healthcare providers for treatment.
- Portability: PMJAY offers portability, allowing beneficiaries to avail treatment in any empanelled hospital across India, irrespective of their residence.
- Beneficiary Identification: Eligible beneficiaries receive an Ayushman Bharat card, a health insurance e-card that helps in easy identification and verification at healthcare facilities.
- Beneficiary Empowerment: PMJAY promotes beneficiary empowerment by providing access to information through the Ayushman Bharat website and helpline, allowing beneficiaries to make informed healthcare decisions.
- Technology-Driven Implementation: The scheme leverages technology for efficient implementation, including IT systems for beneficiary identification, e-card generation, and seamless claims processing.
- Fraud Control and Monitoring: PMJAY incorporates robust fraud control and monitoring mechanisms to ensure the scheme's resources are utilised appropriately and maintain transparency in the implementation process.
PMJAY Apply Online: Detailed Steps to Apply for the Scheme
For Ayushman Bharat Pradhan Mantri Jan Arogya Yojana online apply, you can follow these steps:
- Visit the Official Website: Visit the official PMJAY website.
- Find the "Am I Eligible?" Section: To proceed, click on the "Am I Eligible?" section on the website's homepage.
- Enter the Required Information: Provide the necessary details as prompted on the eligibility check page. This may include your mobile number, ration card number, SECC database-related information, or any other details required for eligibility verification. Fill in the information accurately.
- Verify Your Mobile Number: After entering the required information, you will receive an OTP (One-Time Password) on your provided mobile number. Enter the OTP to verify your mobile number.
- Check Eligibility: Once the mobile number is verified, the website will verify your eligibility based on the information provided and the SECC data. It will indicate whether you are eligible for the PMJAY scheme or not.
- Apply Online: If you are eligible, you can proceed with the online application process. Follow the instructions provided on the website to complete the application form. Accurately enter the required personal details, family information, and other necessary information.
- Upload Documents: You will be prompted to upload scanned or digital copies of the required documents. These may include identification proof, address proof, income certificate, and other supporting documents. Ensure that the documents are clear and legible.
- Review and Submit: Review all the entered information and uploaded documents before applying. Make sure everything is accurate and complete. Submit the application form.
- Track Application Status: After submitting the application, you will receive an application reference number or an acknowledgement. Note it down, or keep it for future reference. You can use this reference number to track the status of your application online.
Documents Required to Apply for the PMJAY Scheme
Now that you know how to apply for PMJAY, you should also know about the necessary documents you’d need to apply for PMJAY. Here is the detailed list:
- Identification Proof: Any government-issued identification document can be submitted. This can include an Aadhaar card, Voter ID card, PAN card, Passport, or Driving License.
- Address Proof: Proof of address is required to verify your residential address. You can submit documents such as an Aadhaar card, Voter ID card, Passport, Driving License, or any other government-issued address proof document.
- Income Certificate: An income certificate or proof of income is usually required to establish your economic status and eligibility for the scheme. This can include salary slips, income tax returns, BPL (Below Poverty Line) certificate, or any other document that verifies your income.
- Caste Certificate (if applicable): In certain cases, a caste certificate may be required to establish your eligibility under specific categories or reservation criteria. This document certifies your caste or community.
- Family Details: You may need to provide details of your family members, including their names, ages, and any relevant identification documents for each family member.
- SECC Details: Socio-Economic Caste Census (SECC) data is used to determine eligibility for PMJAY. You may be required to provide information related to your SECC data, such as your ration card number or any other details mentioned in the SECC database.
Steps to Download the PMJAY Card Online
Once you know that you are eligible for PMJAY apply, you must also be aware of how to download the PMJAY card online as a document proof. Beneficiaries are issued this card to transact through the scheme while availing of cashless, portable or paperless treatment at any of the empanelled hospitals.
This is how you can download the card online:
Go to the official PMJAY website.
Look for the "Download" or "Print Your Card" section on the website's homepage. Click on that section to proceed.
Select the identification mode you would like to use to download your card. You will typically have two options: Aadhaar Number or Mobile Number.
Based on the mode of identification you selected, enter the corresponding information. If you choose your Aadhaar Number, enter your Aadhaar Number and the Captcha code. If you choose Mobile Number, enter your registered Mobile Number and the Captcha code.
After entering the required information, you will receive an OTP on the mobile number linked to your Aadhaar or your provided mobile number. Enter the OTP to verify your identity.
Once your identity is verified, you can download or print your Ayushman Bharat Yojana card. Click on the appropriate option provided on the screen to download the card as a PDF file.
Save the downloaded PDF file to your computer or mobile device. You can print the card using a printer if you prefer a physical copy.
Does PMJAY Scheme Cover COVID-19?
Since the outbreak of the COVID-19 pandemic, the Government of India has included COVID-19 testing and treatment under the PMJAY scheme. Beneficiaries can avail of cashless treatment for COVID-19 at empanelled public and private hospitals across India.
The scheme covers the expenses related to hospitalisation, including room charges, ICU charges, consultation fees, diagnostics, medicines, and more. It provides financial protection to eligible individuals and families, ensuring access to quality healthcare during these challenging times.
What is the Process of Hospitalisation Under the PMJAY Scheme?
Now that you know how to apply Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, you need to know about the hospitalisation process under the scheme. If you or a family member needs hospitalisation, you are not required to pay anything under the PMJAY scheme as long as you are admitted to one of the authorised public or private hospitals. Due to a 60:40 cost-sharing structure between the centre and the state, the entire hospitalisation and treatment process is cashless.
You will receive the Ayushman health card as a beneficiary, allowing you to access cashless medical care and hospitalisation. If you have a golden card, you can take advantage of the scheme's benefits at any accredited public or private hospital.
To find the empanelled hospital list, visit the official PMJAY website and click the “Find Hospital” section.
Conclusion
The PMJAY (Ayushman Bharat Yojana) scheme has emerged as a significant step towards providing affordable and accessible healthcare to millions of vulnerable individuals and families in India. By offering cashless treatment and coverage for a wide range of medical procedures, it has alleviated the financial burden of healthcare expenses for many.
However, it is important to recognise that the PMJAY scheme has certain limitations. It has an eligibility threshold. So, for those who are not eligible for PMJAY scheme, should purchase health insurance coverage from elsewhere.
A robust insurance plan can offer unmatched health insurance tax benefits as well. A Tata AIG medical insurance can complement the PMJAY scheme by providing extended coverage, personalised benefits, and a wider network of hospitals.
Disclaimer / TnC
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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