Pradhan Mantri Jan Arogya Yojana (PMJAY) popularly known as ‘Ayushman Bharat’ is a flagship national health protection scheme of the Government of India, the main objective of which is to provide free health insurance coverage to the lower income groups of the country. This scheme provides financial protection in case of hospitalization due to emergency treatment.
High cost of treatment has always been a major barrier to access to better healthcare for the poor. In addition, they are uninsured, consuming much of their medical savings and staying below the poverty line.
Ayushman Bharat Yojana has made it possible to change this condition of people to a large extent. The Government of India and the State Governments will jointly pay the premiums of this health insurance so that the people of lower income groups can get the necessary healthcare completely free of charge.
But Ayushman Bharat Yojana provides coverage not only to the poor but also to the rural families, which is why it is particularly economically beneficial for the poor and helpless families in rural and urban areas.
What is Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana?
Ayushman Bharat-Prime Minister Jan Arogya Yojana (AB-PMJAY) is the largest healthcare scheme of the Government of India which was launched on 23rd September 2018.
The scheme has provided insurance coverage of ₹5 lakh annually to over 50 crore Indian citizens i.e. about 10-12 crore underprivileged families, making it the largest government sponsored healthcare program in the world.
Ayushman Bharat Yojana offers cashless admission services in government hospitals and private hospitals belonging to the Yojana panel. Under this health insurance, pre-hospitalization consultation, diagnostics, hospitalization expenses, medicines and post-hospitalization treatment period expenses are covered.
There are more than 1,400 treatment facilities under this scheme for kidney, heart, liver, burns and even cancer.
Ayushman Bharat Yojana Details
Scheme Name | Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) |
Type of plan | Health insurance |
Start Time | 23rd September 2018 |
Authority | Ministry of Health and Family Welfare |
Insurance coverage | ₹5 lakh |
Official website | pmjay.gov.in |
Helpline number | 14555 |
webmaster-pmjay@nha.gov.in |
Features of Ayushman Bharat Yojana
The salient features of Ayushman Bharat Yojana are listed below:
- This scheme is one of the largest health insurance schemes in the world.
- There is no restriction on size, gender or age of beneficiary family under this scheme.
- A coverage of ₹5 lakh per family per annum is provided for secondary and tertiary care in government and private hospitals.
- Services are available at any government and private hospital enrolled in this scheme across the country.
- This scheme is specially designed for people living below poverty line.
- Approximately 50 crore beneficiaries i.e. more than 10 crore poor families are eligible for the benefits of this scheme.
- Ayushman Bharat Yojana provides cashless healthcare services to the beneficiaries of any government hospital and private hospitals belonging to the panel.
- This plan provides coverage for certain pre-existing diseases like thyroid, high blood pressure, diabetes, asthma, cholesterol etc. However the list of pre-existing coverage diseases may vary from state to state.
- Generally, pre-hospitalization expenses are covered for a specified number of days of the patient before hospitalization. The exact number of days may vary depending on the medical condition and the specific treatment required.
- Diagnostic services, medicines, room charges, doctor fees, surgeon charges, OT charges and ICU are covered under this scheme.
Ayushman Bharat Yojana Eligibility Criteria
Ayushman Bharat Yojana was launched to empower the 40% poor and economically weaker sections of the country. To identify the actual disadvantaged and needy households based on the report of Socio-Economic Caste Census 2011 and the criteria for rural and urban areas are kept separate.
Now let’s see who is eligible for this scheme according to the criteria:
Eligibility criteria for rural households
There are 6 deprivation criteria to identify rural households eligible for this scheme.
- Households with no earning adult members between the ages of 16 and 59.
- Household headed by female members with no adult male members aged 16 to 59 years.
- A single room family with temporary walls and roof.
- Families belonging to Scheduled Castes and Scheduled Tribes category.
- Families with disabled members but no able-bodied members.
- Landless families whose main source of income is manual labour.
- Destitute family dependent on alms.
- Only manual labor without machines is the household.
- Poor families without proper shelter.
- Bonded labor families.
- Specially vulnerable tribal groups.
Also, the following families are automatically eligible:
Eligibility criteria for urban households
Urban households are classified on the basis of occupation and there are 11 eligibility criteria for Ayushman Bharat Yojana.
- The beggar
- A scavenger
- Cobblers, street vendors, hawkers, other street service providers
- A housekeeper or housekeeper
- Construction site workers, plumbers, masons, painters, welders, security guards and porters
- Sweepers, sanitation workers and gardeners
- Artisans, domestic workers, artisans and tailors
- Transport workers such as drivers, conductors, transport workers, cart or rickshaw drivers, assistants to drivers or conductors
- Dhopa and Chowkidar
- Electricians, mechanics, repairmen and assemblers
- Peons, helpers, shop workers, delivery assistants, attendants and waiters
Benefits of Ayushman Bharat Yojana
Ayushman Bharat Yojana provides healthcare services to vulnerable and poor families in the country.
The benefits of this plan are listed below:
- There are no restrictions based on age, gender and family size.
- There are pre-existing disease coverage benefits.
- Any type of cancer treatment is covered under this scheme.
- These healthcare facilities and treatment are available free of cost all over India.
Who is not eligible for Ayushman Bharat Yojana?
No person or family shall be entitled to Ayushman Bharat Yojana in case of the following conditions.
- Those who have mechanized agricultural machinery
- People who have two-wheelers, three-wheelers
- Those who have Kisan card
- Government employee
- Those who are working in government non-agricultural institutions
- A person earning more than ₹10,000 per month
- Who has a motorized fishing boat
- Those who have more than 5 acres of agricultural land
- Who has a landline phone or a refrigerator
- Those who have a suitable home
What are the diseases excluded under Ayushman Bharat Yojana?
About 1400 diseases are covered under Ayushman Bharat Yojana but some diseases are excluded from the scheme, they are:
- Out Patient Department (OPD) consultation and procedures
- Fertility-related treatments such as in-vitro fertilization (IVF)
- Cosmetic surgery
- Dental treatment
- HIV or AIDS treatment
- Drug and alcohol rehabilitation
Ayushman Bharat Online Registration
Ayushman Bharat Yojana is already applicable to beneficiaries identified by ‘Socio-Economic Cast Census 2011’ and to participants of ‘Rashtriya Swasthya Bima Yojana’.
You can check beneficiary name list and download Ayushman Bharat Card by following the following procedure:
- First you need to visit the official portal of National Health, Authority.
- On the right side of the home page login as beneficiary has to login by filling mobile number and OTP verification and captcha.
- After login, the beneficiary has to ‘search’ by mentioning any of the state name, scheme name, district name and Aadhaar number or ration number etc.
- After that you will see the list of beneficiary name and if the Ayushman card has been generated then you can download it after Aadhaar authentication by clicking on the download button next to it.
Ayushman Bharat Card Online Application
Ayushman Bharat card is available only to those whose name is in the beneficiary list. The procedure for viewing the list of beneficiaries of this scheme is discussed above.
Now let’s see what to do for those beneficiaries who have name but not Ayushman Bharat Card.
- You have to login to ‘Ayushman Bharat Pradhan Mantri Jan Argya Yojana’ Beneficiary Portal and come to Beneficiary Name List page (Procedure mentioned above).
- Beneficiaries whose Ayushman Bharat Card has not been generated will have ‘Not Generated’ in ‘Card Status’.
- You need to click on the card icon in the side ‘Action’ column.
- You can do e-KYC through ‘Aadhaar OTP’, ‘Finger Print’ or ‘IRIS Scan’ on the e-KYC page.
- You can easily do e-KYC verification with the help of ‘Aadhaar OTP’. Here you can see all details of e-KYC. You need to upload a current photo and fill some additional information like ‘Relation’, ‘Pincode’, ‘Village’ etc. and click on ‘Submit’.
- After a few days of doing e-KYC beneficiary will see ‘Approved’ or ‘Pending’ in ‘Card Status’. After getting ‘Approved’, you can download the card by clicking on the download button in the ‘Action’ column next to it.
Required Documents for Ayushman Bharat Yojana Application
Below is the list of documents required to apply for Ayushman Bharat Pradhan Mantri Jan Argya Yojana:
- Identity and Age Proof (Aadhaar Card/PAN Card)
- Mobile number, email and residential address details
- SC/ST Certificate
- Cast Certificate
- Income certificate
How to use Ayushman Card
All hospitals enrolled under the Pradhan Mantri Ayushman Bharat Yojana have a center called ‘Ayushman Mitra’ where insured families are assisted to get cashless treatment.
The Ayushman Mitra representative will scan your Ayushman card’s ‘QR’ code to verify your eligibility.
You will be issued a golden card for cashless hospital admission and treatment facility with a fee of ₹30. You can get cashless treatment at any government hospital and scheme listed private hospital with this card.
Ayushman Bharat Pradhan Mantri Jan Argya Yojana toll-free number and address
Below are the toll-free numbers and addresses of Ayushman Bharat Yojana:
Toll free number: 14555
Address:9th Floor, Tower-L, Jeevan Bharti Building, Connaught Place, New Delhi – 110001
Ayushman Bharat Yojana related Queries (FAQs):
How are beneficiaries identified in Ayushman Bharat Yojana?
The scheme is based on the ‘Socio-Economic Caste Census 2011’ to identify beneficiaries in rural areas and 11 occupational criteria for urban areas. Besides, beneficiaries of ‘State Health Insurance Scheme’ are also included.
Do the beneficiaries have to pay anything to get benefits under Ayushman Bharat Yojana?
No, the beneficiaries of this scheme can get free secondary and tertiary treatment up to ₹5 lakh in government and listed private hospitals.
Are any existing diseases covered under this plan?
Yes. All pre-existing diseases are covered under this scheme.
What services are provided under the Ayushman Bharat scheme?
Diagnostics, pre-hospitalization, pre-hospitalization and post-hospitalization services, medicines etc. are provided under this scheme.
Does Ayushman Bharat Yojana treat cancer?
Yes, cancer is also treated under this scheme, and the treatment varies according to the type of cancer.
Who is Ayushman Mitra?
An Ayushman Mitra is a healthcare professional who is present at each of the ‘Enrolled Healthcare Providers’ (EHCP) to assist the beneficiaries. They will assist beneficiaries in verifying information and document processing as well as complete processing of beneficiary claims.
Can families who are not named in Ayushman Bharat Yojana benefit?
No, those whose name is not in the list of ‘Ayushman Bharat Pradhan Mantri Jan Argya Yojana’ will not get the Ayushman card, so they can’t even avail the benefits under this scheme.