PMJAY Scheme (Ayushman Bharat Yojana): Eligibility & Online Registration

Health contingencies do not distinguish between the rich and the poor. Everyone is equally vulnerable to medical exigencies, some more than others. It depends on your daily habits and lifestyle; the foods you consume, your vices and more. Hence, in order to safeguard every citizen of the nation, the government of India has introduced Ayushman Bharat Yojana. This programme was launched with a vision to achieve universal health coverage. The Ayushman Bharat scheme aims for sustainable development with its underlying commitment to “leave no one behind”. Ayushman Bharat Yojana attempts to change sectoral and segmented to a comprehensive need-based approach. There are two components of the Ayushman Bharat Yojana -

• Health and Wellness Centres
• Pradhan Mantri Jan Arogya Yojana (PMJAY)

Health and Wellness Centres

The Government of India transformed the existing sub-centres and primary health centre to Health and Wellness Centres in February of 2018. The primary motive is to bring healthcare closer and more accessible to the poor. The main highlight of these centres is the delivery of maternal as well as childcare services along with free diagnostic services and essential drugs.

Pradhan Mantri Jan Arogya Yojana (PMJAY)

Launched on the 23rd of September by our Honourable Prime Minister, Shri Narendra Modi Pradhan Mantri Jan Arogya Yojana or PMJAY is the second component of the Ayushman Bharat scheme. PMJAY is one of the largest schemes for health insurance around the world. It provides a cover of ₹ 5 lakhs per family per year with coverage for diagnostics tests, pre-hospitalisation costs, and medical treatment expenses. Also, cashless health insurance feature as well as a paperless facility is available under PMJAY. The coverage of PMJAY extends to over 10.74 crore low-income families that constitute around 40% of the Indian population. The people covered under this scheme are based on criteria for deprivation and occupation as counted under the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas. Erstwhile PMJAY was known as the National Health Protection Scheme (NHPS). It subsumes the Rashtriya Swasthya Bima Yojana (RSBY) launched in 2008. Thus, those covered under these erstwhile schemes are automatically included under the PMJAY, thereby expanding its reach to the poor.

Benefits of Ayushman Bharat Yojana Scheme

• PMJAY scheme covers up to 3 days of pre-hospitalisation and up to 15 days of post hospitalisation expenses including the diagnostics and cost of medicines.
• There is no restriction based on the size of family, age or gender.
• Coverage for any pre-existing diseases from day one. No waiting period.
• There is coverage for daycare expenses too.
• Cashless health insurance along with paperless facility available to those enrolled under the scheme.
• Access to the facilities under PMJAY is available across the nation.

PMJAY Eligibility Criteria for Rural and Urban Population

While the Ayushman Bharat scheme aims to benefit over ten crore families which count to over 50 crore individuals, there are different criteria for the urban and rural population.

PMJAY Rural

The primary concern for healthcare facilities in the rural area is accessibility which goes on to increase with the soaring cost of medical healthcare. Often it is observed that people fall into debt traps to repay the hefty medical bills. The PMJAY is available to the following types of people in the rural areas -

1. Families without any male member in the age band of 16 to 59 years.
2. Families without any adult in the age range of 16 to 59 years.
3. Family with a disabled member and no able-bodied adult members.
4. Households belonging in the Scheduled Caste and Scheduled Tribes.
5. Landless households who earn a major part of their income from manual labour.
6. Families living in a single room house with temporary walls and roofs.
7. Families working as manual scavengers.
8. Families not having any household.
9. Primitive tribal groups.
10. Legally released bonded labour.
11. Those living in extreme poverty or living on alms.

PMJAY Urban

With a ₹ 5 lakh insurance cover per family, the Ayushman Bharat scheme shall benefit the following category of people in the urban regions -

1. Rag Pickers
2. Beggars
3. Domestic Workers
4. Street vendors, cobblers or hawkers or other individuals providing services on the pavements.
5. Construction workers, plumber, Labourer, painters, welders, security guards
6. Sweepers and sanitation workers
7. Individuals who offer transport services like drivers, conductors, helpers, cart or rickshaw pullers along with head load workers.
8. Home-based workers, artisans including tailors and handicraft workers.
9. Shopworkers, assistants or peons in small establishments, delivery boys, and waiters.
10. Washer-men or chowkidars.

In addition to above, families included under the Rashtriya Swasthya Bima Yojana (RSBY) shall be covered under this scheme too.

What is Non-Covered Under Ayushman Bharat Yojana Scheme?

The following individuals or households shall be excluded from PMJAY -

1. Any household falling under the bracket and paying income taxes or professional taxes.
2. Those households with a government employee as a member.
3. Those who are employed in non-agricultural enterprises registered with the government.
4. Any member of the family earring more than ₹ 10,000 per month.
5. Those households who have Kisan Cards with a credit limit of ₹ 50,000.
6. Individuals who own a two, three or four-wheeler or a motorised fishing boat.
7. Households that have refrigerators and landline phones.
8. Those who own more than 2.5 acres of land with irrigation equipment.
9. Those who reside in permanent house structures.

PMJAY Enrollment Process

One does not need to follow any special process for Ayushman Bharat Yojana registration. The beneficiaries under PMJAY are identified by the Socio-Economic Caste Census, 2011 (SECC 2011) and RSBY scheme. This is how you can check your eligibility under the PMJAY scheme - There is no special Ayushman Bharat registration procedure of PMJAY since it applies to all beneficiaries as identified by the SECC 2011 and those who are already part of the RSBY scheme. However, here’s how you can check if you are eligible to be a beneficiary of PMJAY.

• Head over to the official website of Pradhan Mantri Jan Arogya Yojana.
• Click on the ‘Am I Eligible’ button.
• Next, enter your mobile number and the security captcha and click on ‘Generate OTP.’
• Proceed with selecting your state and search by your name or HHD number or ration card or mobile number.

The above process will fetch you results whether your family is covered under the PMJAY scheme. Another way to apply is by contacting an Empanelled Health Care Provider (EHCP) for further details. *Standard T&C apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.