All You Need To Know About PMJAY: Eligibility, Coverage And Benefits

Health Insurance

Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched in 2018 to give health insurance coverage to the poor and vulnerable citizens of India. This flagship program under the Ayushman Bharat scheme has already covered the treatment costs of over 1 crore hospital admissions. 

PMJAY aims to protect more than 40% of Indian families with lower incomes. With this health scheme, eligible citizens can get cash-free medical treatment in the secondary and tertiary healthcare sectors.

Low-income households from both the rural and urban areas are eligible to get the benefits of PMJAY. It will cover the benefits of cashless treatment for up to Rs. 5 lakhs per family in a financial year.

Read on to know more about the coverage, benefits and eligibility criteria of the PMJAY scheme!

Benefits of the PMJAY Scheme 

The PMJAY health scheme covers the following medical treatment expenses:

• Pre hospitalisation benefits include doctor’s consultation and medical check-ups 
• Surgeries of patients
• Follow up consultations with doctors
• Medicines
• All intensive and non-intensive care services
• Foods services
• Diagnostics
• Patients’ accommodations
• Post hospitalisation benefits till the 15^th day

Categories Under PMJAY Scheme

Two categories of this scheme are – 

• PMJAY Rural
• PMJAY Urban

Out of more than ten crore beneficiary families, eight crores are from rural areas, and the rest are from urban areas. Hence, the scheme will cater to around 50 crore individuals approximately. 

The list of eligible households for the rural area is based on housing needs, low income and other deprivations. At the same time, the list of urban beneficiaries is decided only by their occupations. Both these lists are currently based on the Socio-economic Caste Census 2011 (SECC-2011).

Also Read – https://navi.com/blog/pmjay-ayushman-bharat-yojana/ 

Treatments Under PMJAY Scheme

This health scheme has a provision for almost 1393 treatment procedures. These are – 

• Poly-trauma
• Treatments of bones and muscles
• Neuroradiology
• Surgery of the brain, spine and nerves
• Surgery and treatments for urinary tracts 
• Other packages of surgery
• Emergency Room packages
• Medicines
• Treatments of cancer diagnosed in childhood
• Check-ups and treatment of heart ailments
• Burns Management
• Obstetrics and Gynaecology
• Medical Oncology
• Vascular Surgery
• Paediatric Surgery
• Plastic Surgery

Eligibility Criteria for PMJAY

Pradhan Mantri Jan Arogya Yojana eligibility is different for rural and urban areas. These are as follows –

Eligibility for Rural Families

The eligibility criteria of Pradhan Mantri Jan Arogya Yojana for the rural families are –

• Families having no male member in the age group of 16-59 years
• Beggars
• Scheduled caste and scheduled tribe families
• Bonded labourers
• Tribal communities
• Families with no adult earning members 
• Those who have houses without any proper roof or walls
• Manual scavenger families

Eligibility for Urban Families

The eligibility criteria of PMJAY for urban families are –

• Ragpickers
• Security workers and chowkidars
• Gardeners
• Sweepers and sanitation workers
• Hawkers, cobblers and others working on streets
• Electricians
• Mechanics and repair workers
• Delivery workers, waiters
• Assistants in small shops
• Construction workers
• Welders and porters
• Tailors, artisans and handicraft workers

Areas Covered Under PMJAY

Facilities and benefits of this scheme are available in every state of India. People can search empanelled Pradhan Mantri Jan Arogya Yojana hospital list from the government website. They need to select district names, types of hospitals, districts and specialities to get a list of available hospitals.

What is the Process of Enrolment Under PMJAY?

There is no need for enrolment in this government scheme. It is an entitlement based scheme. Government checks occupation and the basis of deprivation under the SECC list while giving the benefits to the families. Additionally, all the families under Rashtriya Swasthya Bima Yojana (RSBY) are included in the Pradhan Mantri Jan Arogya list.

What Information Can You Get from the PMJAY Mobile Application?

The National Health Authority has launched a mobile application. One can easily get this application named Ayushman Bharat (PMJAY) in the Google play store. With this app, people can get information regarding –

• Eligibility – One can check whether the health scheme covers his family or not.
• List of the hospitals – Even one can search out one listed hospital.
• It also includes other related information about the services.

Also Read –  https://navi.com/blog/all-about-pmjay-golden-card/ 

Final Word

Pradhan Mantri Jan Arogya Yojana has given many vulnerable citizens a scope to get quality health care facilities. With cashless treatment in listed hospitals, even the middle class and poor families get easy access to medical check-ups and treatments. Thus, with the help of this scheme, the Indian government has fulfilled its promise to improve the healthcare facility for all.

If you want to consider other health insurance providers like Navi, then download the Navi app from the play store today. Navi provides insurance in a paperless way and has connections with over 10,000 hospitals spread across 400 locations in India, their premiums start as low as Rs.241 per month. 

Frequently Asked Questions

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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.