PMJAY (Pradhan Mantri Jan Arogya Yojana): Everything You Need To Know

Pradhan Mantri Jan Arogya Yojana (PMJAY) or Ayushman Bharat Yojana is a health insurance and protection policy that was introduced in 2018. This government initiative aims to provide medical coverage to the economically weaker section of society. 

Following is a discussion on the features, benefits, eligibility criteria, and other details related to this scheme. 

Features and Benefits of PMJAY

Here are some features and benefits of PMJAY:

• Since PMJAY is a government-funded scheme, the Central and State Governments cover all expenses.  
• Ayushman Bharat Yojana provides medical coverage to over 50 crore underprivileged individuals.
• This scheme provides medical insurance coverage of up to Rs. 5 lakh per entitled family for tertiary and secondary healthcare. 
• One can enjoy the benefits of this scheme at empanelled private hospitals or any government hospital. 
• The healthcare expenses borne by the government include the cost incurred during the pre-and post-hospitalisation period.
• The medical coverage includes a cashless hospitalisation facility. 
• The amount of money to be paid for medical expenses will be based on a pre-specified package rate. 
• Beneficiaries can claim compensation for more than 1390 procedures, which include ICU as well as OT expenses. 
• The scheme aims to improve the quality of life in the economically weaker segments of India.
• This scheme prioritises women, girl child as well as senior citizens. There are no restrictions in relation to family size or age. 

Coverage Available under PMJAY

Pradhan Mantri Jan Arogya Yojana offers coverage for the following expenses:

• Medical examination 
• Diagnostic services availed before hospitalisation
• Hospital accommodation along with meal services
• Post-hospitalisation care and medication for a maximum of 15 days
• Doctor consultation 
• Expenditure incurred owing to complications arising during treatment

Here are some treatments that are covered under PMJAY: 

• Paediatric care
• Geriatric care
• Mental health care
• Maternal health care services 
• Non-communicable and communicable diseases 
• Eyecare 
• Pregnancy care
• Health care services for infants

Further, here is a list of diseases that are covered under this scheme: 

• Anterior Lumbar Interbody Fusion
• Skull base surgery
• Prostate cancer
• Pulmonary valve surgery 

Exclusions under PMJAY 

PMJAY health protection scheme does not provide medical coverage for expenses incurred due to the following: 

• Fertility procedures
• Cosmetic surgery procedures
• Drug rehabilitation programme
• Individual diagnostics 
• Organ transplantation
• OPD

PMJAY Eligibility Criteria for Urban Population

Here is a list of individuals who can be beneficiaries under the PMJAY scheme:

• Domestic workers
• Daily wage workers
• Street vendors, hawkers, cobblers
• Peons 
• Repair workers such as electricians, mechanics, etc. 
• Plumbers, welders, security guards, etc.

PMJAY Eligibility Criteria for Rural Population

The following category of individuals are eligible for PMJAY health care coverage:

• Individuals belonging to the SC/ST category
• Families that reside in makeshift homes
• Individuals who belong to primitive tribal segments
• Families that do not have any male members between the age of 16 and 59 years

Who Are Not Eligible for PMJAY Scheme?

These households will not be able to avail benefits of the PMJAY scheme:

• Households that have registered non-agricultural enterprises 
• Any family earning over Rs. 10,000 per month
• Households that have motorised two/three/four-wheeled vehicles 
• Landowners having at least 5 acres of irrigated land for a minimum of two crop seasons
• Households that have a fishing boat or three/4-wheeled mechanised agricultural equipment 
• Households having a refrigerator or a landline
• Income tax or professional tax payees
• Landowners having over 2.5 acres of land and a minimum of 1 irrigation equipment 
• Owners of a pucca house (houses with a roof and permanent walls)

In case an individual is not eligible for this health protection scheme, he or she can opt for a health insurance policy from any leading insurance provider in India. 

Navi Health Insurance offers medical coverage with cashless claims via a network of over 10,000 hospitals across India. Download the Navi app to know more today! 

How Can One Apply for PMJAY Card?

Eligible individuals can gain access to cashless healthcare facilities under the Ayushman Bharat Yojana scheme by using the PMJAY Card. Here’s how they can apply for it:

Step 1: Visit the official PMJAY website

Step 2: Log in to the official portal using your mobile number

Step 3: Enter the captcha code and generate a one-time password, which you will receive on your registered mobile number

Step 4: After logging in, request the Household ID (HHD )code 

Step 5: Submit the HHD code at a Common Service Centre (CSC) 

Step 6: Upon successful verification of all details, the card will be issued to you. You can avail of the card from your nearest CSC or download a digital copy from the official PMJAY website. 

Documents Required for PMJAY Scheme 

Eligible applicants must submit these documents to apply for the Ayushman Bharat Yojana scheme: 

• Proof of Identity
• Address proof
• Caste certificate 
• Document affirming the family’s status that is seeking medical coverage
• Income certificate 

Final Word

Healthcare protection schemes such as PMJAY ensure financial protection against life-threatening illnesses or accidents. The above-mentioned guide about this scheme can help prospective applicants avail of its benefits with ease.  

Frequently Asked Questions

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