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.

What is PMJAY (Ayushman Bharat Yojana Scheme)?

Ayushman Bharat, also known as Pradhan Mantri Jan Arogya Yojana (PMJAY), is India’s flagship healthcare scheme launched by Prime Minister Narendra Modi on September 23, 2018. Recognised as the world’s largest government-funded health insurance program, it targets over 50 crore citizens from economically disadvantaged backgrounds. Ayushman health insurance offers coverage of up to INR 5 lakh per family per year for secondary and tertiary care, ensuring access to both private and public hospitals. The scheme covers hospitalisation expenses and ensures a cashless, paperless experience for beneficiaries. Aimed at providing financial protection against high medical costs, Pradhan Mantri health insurance is a key initiative to improve healthcare access for the underprivileged, transforming India’s healthcare landscape.

Features of Ayushman Bharat Yojana Scheme

The Ayushman Bharat Yojana comes with several features that set it apart from traditional healthcare programs. Some of the prominent features include:

1. Cashless hospitalisation across government and private hospitals.
2. Comprehensive coverage for pre-hospitalisation, hospitalisation, and post-hospitalisation costs.
3. Coverage for approx. 1,929 procedures
4. No restrictions based on family size, gender, or age.
5. Pre-existing conditions are covered from day one.
6. The Ayushman Bharat health insurance scheme is aimed at families from vulnerable sections of society, providing them with access to quality healthcare without worrying about out-of-pocket expenses.

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.

Regular Health Insurance Plans vs Government Health Insurance Scheme

While regular health insurance plans are designed to cater to a wide range of individuals, Pradhan Mantri health insurance specifically targets the economically weaker sections of society. Traditional health insurance plans often require policyholders to pay premiums, have exclusions for pre-existing conditions, and may involve long waiting periods for claims. In contrast, PMJAY is a government-funded scheme with no premiums and immediate coverage for pre-existing conditions. Additionally, health insurance Ayushman Bharat has a higher coverage amount for families, providing up to INR 5 lakh per year for healthcare needs, including surgery, diagnostics, and critical care.

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. Also read: Government Insurance Schemes in India

Who is Not Eligible for the Ayushman Bharat Yojana?

While Ayushman Bharat Yojana aims to provide health insurance coverage to the most vulnerable sections of society, individuals from higher-income households or those who do not meet the specific eligibility criteria may not qualify for the scheme. For instance, families that own luxury goods, have higher annual income levels or belong to the wealthier categories of society might not be eligible.

What is Covered Under the Ayushman Bharat Yojana Scheme?

Ayushman Bharat Yojana covers a wide range of healthcare services, including:

1. Medical consultation and treatment.
2. Surgical procedures, including critical surgeries.
3. Pre-hospitalisation and post-hospitalisation expenses.
4. Medicines and diagnostic tests.
5. Room charges, ICU fees, and other medical consumables.
6. COVID-19 treatment.
7. Maternity services and neonatal care.

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.

List of Critical Diseases or Illnesses Covered Under Ayushman Bharat Yojana Scheme

Prime minister's health insurance scheme includes a broad list of critical illnesses, such as:

1. Prostate cancer.
2. Coronary artery bypass graft(CABG).
3. Pulmonary valve replacement.
4. Organ transplants, including kidney and liver transplants.
5. Burn-related injuries.

PMJAY Enrollment Process

The enrollment process for the Ayushman Bharat insurance registration is simple and straightforward. There is no need for a formal application. Eligible beneficiaries are selected through a government database based on socio-economic status. To check eligibility:

1. Visit the official website of PMJAY
2. Click on the “Am I Eligible” section.
3. Enter details such as your name, mobile number, or ration card number.
4. A result will display whether you are eligible for the scheme.

Documents Required to Apply For Ayushman Bharat Yojana Scheme

To apply for Pradhan Mantri medical insurance, you will need to provide the following documents:

1. Identity proof (Aadhaar card, PAN card).
2. Address proof.
3. Income certificate.
4. Caste certificate (if applicable).
5. Ration card or Household Identification Number (HHD).

How To Apply Online For Ayushman Bharat Yojana?

Ayushman Bharat health insurance apply online by following these steps:

1. Visit the official PMJAY website.
2. Select the “Am I Eligible” section.
3. Provide your contact details and generate OTP.
4. Check the results for eligibility.

How To Download Ayushman Bharat Yojana Card Online?

To download your Ayushman Bharat health insurance card online:

1. Visit the PMJAY website.
2. Enter your registered mobile number and OTP.
3. Provide Household ID or Ration card number.
4. Pay a nominal fee of INR 30 at the Common Service Centre to get your card.

How to Check Ayushman Bharat Yojana Eligibility Online

To check your eligibility for the Ayushman Bharat Yojana:

1. Visit the official PMJAY website.
2. Enter your personal details, such as name or ration card number.
3. Verify eligibility results online.

Common Treatments Covered Under PMJAY

Some of the most common treatments covered under the Ayushman Bharat health insurance scheme include:

1. Maternity services
2. Cancer treatments
3. Cardiac surgeries
4. Orthopaedic treatments

Hospitalisation Process in Ayushman Bharat Scheme (PMJAY)

Once a beneficiary is enrolled in Pradhan Mantri Jan Arogya Yojana (PMJAY), they can avail cashless treatment at any of the empanelled public or private hospitals. The beneficiary needs to present their PMJAY card at the time of hospitalisation, and the treatment costs will be covered under the scheme. No payment is required from the beneficiary at the time of admission or discharge, as the scheme ensures seamless reimbursement.

How to Find PMJAY Hospital List?

To find the list of empanelled hospitals under Ayushman Bharat Yojana, visit the official website of PMJAY:

1. Select your state and district.
2. Choose the type of hospital (public or private).
3. Enter the Captcha code and search for hospitals near you.

FAQs

What is the income limit for the Ayushman card?

There is no specific income limit set for Ayushman Bharat beneficiaries. The scheme is aimed at providing health coverage to economically weaker sections of society. Families are selected based on socio-economic data gathered by the Socio-Economic Caste Census (SECC) and other eligibility criteria rather than income thresholds.

What is the income proof for the Ayushman card?

Ayushman Bharat health insurance card apply online includes proof of income can be provided through various documents that validate the economic status of the family. Common documents include an income certificate issued by government authorities, a ration card that specifies family details, or other documents such as landholding papers, which indicate socio-economic status.

Is the Ayushman card valid for all family members?

Yes, the Ayushman Bharat card is valid for all family members listed in the application. Once registered, the entire family can avail the benefits of the Ayushman Bharat health insurance scheme, which covers secondary and tertiary care for each eligible member. It ensures comprehensive healthcare coverage for everyone in the family.

Is Ayushman card can be used in private hospitals?

Yes, the Ayushman Bharat health insurance card can be used in empanelled private hospitals for cashless treatment. The scheme provides beneficiaries with access to both public and private healthcare facilities that are part of the PMJAY network, ensuring that beneficiaries can receive treatment at high-quality hospitals without any financial burden.

Is Ayushman Bharat free for everyone?

No, Ayushman Bharat is not free for everyone. The scheme is specifically designed to assist economically weaker sections of society. It provides free health insurance to families identified under the Socio-Economic Caste Census (SECC). It is aimed at providing financial protection to underprivileged families who struggle to afford quality healthcare services.

Can I apply for PMJAY offline?

Yes, Pradhan Mantri Jan Arogya Yojana (PMJAY) applications can be processed offline. Eligible individuals can visit Common Service Centres (CSCs) or approach empanelled hospitals for offline registration. The process involves submitting the necessary documents, such as an Aadhaar card and income certificate, and receiving assistance in filling out the forms for eligibility determination.

Is there any premium for PMJAY?

No, there is no premium required for participating in the Ayushman Bharat health insurance scheme. Since PMJAY is a government-funded scheme, beneficiaries do not need to pay any premium fees. The scheme is financed by the Government of India and provides free healthcare coverage for eligible families, ensuring that financial constraints do not hinder access to medical treatment.

How to update data in PMJAY?

To update your data in PMJAY, you can visit your nearest Common Service Centre (CSC). These centres can assist with updating personal details like address, mobile number, or family information. Alternatively, you can also contact the PMJAY helpline at 1800-111-565 or 14555 for guidance on updating your details through official channels.

Does PMJAY cover people above the age of 80 years?

Yes, Ayushman Bharat covers individuals above the age of 80 years. There are no age restrictions for eligibility under the PMJAY scheme. It provides coverage for senior citizens, irrespective of their age, ensuring that the elderly also have access to medical services, including secondary and tertiary care, at empanelled hospitals nationwide.

Does Ayushman Bharat cover orthopaedics treatment?

Yes, Ayushman Bharat health insurance covers a wide range of orthopaedic treatments, including surgical procedures. This includes treatments for fractures, joint replacements, and other orthopaedic conditions. Beneficiaries can avail of cashless treatment for orthopaedic surgeries at empanelled private and public hospitals under the PMJAY scheme.

Does PMJAY cover pre-existing diseases?

Yes, PMJAY covers pre-existing diseases from day one of enrollment. The scheme ensures that beneficiaries with pre-existing medical conditions are eligible for treatment. Whether it’s diabetes, hypertension, or any other chronic illness, Ayushman Bharat health insurance covers the cost of treatment for these conditions from the moment you join the scheme, with no waiting period.

How can I find my Household ID number for PMJAY?

To find your Household ID number (HHD) for PMJAY, you can check your ration card or refer to the PMJAY website. The HHD number is a unique 25-character code that identifies households eligible for the scheme. You can also visit Common Service Centres (CSCs) to get assistance in retrieving your Household ID number for registering or checking eligibility. *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. ***Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.