Ayushman Bharat Pradhan Mantri Jan Arogya Yojana
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana
What is Ayushman Bharat Pradhan Mantri Jan Arogya Yojana ( (AB PM-JAY) ?
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a flagship health insurance scheme of the Government of India aimed at providing free quality healthcare services to the poor and vulnerable sections of the country. This scheme is one of the largest health insurance schemes in the world.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a cashless treatment scheme. This means that beneficiaries do not need to pay any money out of pocket for covered treatments. All expenses are directly settled between the healthcare provider and the insurance company.
This cashless facility makes it easier for beneficiaries to access quality healthcare without worrying about the financial burden of treatment.
Key Objectives:
Reduce financial burden of serious illnesses
Make healthcare accessible to all
Provide quality healthcare services in government and private hospitals
Provide social security and reduce poverty
Key Benefits:
Free treatment up to ₹5 lakh
Comprehensive coverage for almost all serious illnesses
Portability across India
Cashless treatment
Quality healthcare services in government and private hospitals
Who is eligible for the scheme ?
Families belonging to the bottom 40% as per Socio-Economic Caste Census (SECC) database are eligible to join the scheme . There is no age limit to join the scheme
Update dated 11.09.2024 : The Union Cabinet, chaired by the Prime Minister Shri Narendra Modi, has approved the health coverage the scheme to all the senior citizens aged 70 years and above irrespective of income . The eligible senior citizens would be issued a new distinct card under AB PM-JAY. The senior citizens of the age 70 years and above belonging to families already covered under AB PM-JAY will get an additional top-up cover upto ₹5 lakh per year for themselves (which they do not have to share with the other members of the family who are below the age of 70 years). All other senior citizens of the age 70 years and above will get a cover upto ₹5 lakh per year on a family basis. Senior citizens of the age 70 years and above who are already availing benefits of other public health insurance schemes such as Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), Ayushman Central Armed Police Force (CAPF) may either choose their existing scheme or opt for AB PMJAY. It has been clarified that senior citizens of 70 years and above who are under private health insurance policies or Employees’ State Insurance scheme will be eligible to avail benefits under AB PM-JAY.
How to join the ABPM-JAY scheme?
Obtain an Ayushman card
Register at a nearby government hospital or Common Service Center (CSC)
HOW TO GET AYUSHMAN CARD ?
Ayushman card is a unique identification number that provides access to the benefits of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). Here's a step-by-step guide on how to obtain an Ayushman card:
1. Check Eligibility:
SECC Database: Ensure your family is listed in the Socio-Economic Caste Census (SECC) database as part of the bottom 40% of the population. You can check your eligibility status online or through government offices.
2. Gather Required Documents:
Address proof: Aadhaar card, ration card, or voter ID card.
Identity proof: Aadhaar card, passport, or driving license.
Mobile number: A valid mobile number for registration.
3. Visit a Common Service Center (CSC) or Government Hospital:
Locate a nearby CSC or government hospital that offers Ayushman card registration services.
Take the required documents with you.
To locate a Common service Centre near you, click here
4. Provide Information:
Fill out the necessary registration form with accurate information.
Provide your family details, including names, ages, and relationships.
5. Biometric Verification:
Your biometric information, such as fingerprints and iris scan, will be collected.
6. Document Verification:
The registration officials will verify the authenticity of your documents.
7. Card Generation:
Once your information is verified, an Ayushman card will be generated for your family.
8. Receive Ayushman Card:
You will receive your Ayushman card either immediately or within a few days.
Note:
The process might vary slightly depending on the location and specific procedures followed by the CSC or government hospital.
If you face any difficulties or have questions, you can contact the National Health Authority (NHA) helpline or visit their official website for assistance.
For more information, you can visit the National Health Authority website: https://nha.gov.in/
The eligible senior citizens would be issued a new distinct card under AB PM-JAY
Whether all hospitals in India entertain the scheme beneficiaries ?
Not all hospitals in India entertain Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) beneficiaries.
While the government has been working to expand the network of empanelled hospitals, there are still some that may not be participating in the scheme.
To find out if a specific hospital is empanelled under AB PM-JAY, you can:
Check the National Health Authority (NHA) website: The NHA website provides a list of empanelled hospitals.
Contact the hospital directly: Inquire with the hospital's administration if they accept AB PM-JAY beneficiaries.
Call the AB PM-JAY helpline: The helpline can provide information on empanelled hospitals in your area.
It's recommended to verify the hospital's participation before seeking treatment under the scheme to avoid any inconvenience.
BENEFITS UNDER PM -JAY SCHEME
PM-JAY provides cashless cover of up to INR5,00,000 to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment.
1, Medical examination, treatment and consultation
Pre-hospitalization
3. Medicine and medical consumables
4 . Non-intensive and intensive care services
Diagnostic and laboratory investigations
6. Medical implantation services (where necessary)
7. Accommodation benefits
8 . Food services
Complications arising during treatment
10 . Post-hospitalization follow-up care up to 15 days
The benefits of INR 5,00,000 are on a family floater basis which means that it can be used by one or all members of the family. The RSBY had a family cap of five members. However, based on learnings from those schemes, PM-JAY has been designed in such a way that there is no cap on family size or age of members. In addition, pre-existing diseases are covered from the very first day. This means that any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.
CO-PAY : Ayushman Bharat (AB-PMJAY) generally does not require any co-payment from beneficiaries . This means that eligible individuals can avail of the scheme's benefits without paying any out-of-pocket expenses for covered treatments. However check with the hospital or healthcare provider while seeking treatment under Ayushman Bharat and confirm directly with the facility if any co-payment is applicable.
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