Ayushman Bharat Yojana, also called the Pradhan Mantri Jan Arogya Yojana (PMJAY), is a healthcare scheme aimed at helping economically weaker sections access quality healthcare services. The main purpose of this scheme is to ensure that even those who cannot afford expensive medical treatments can still get essential healthcare.
Launched by the Prime Minister on September 23, 2018, PMJAY has become one of the largest health insurance programs in the world. It provides coverage to nearly 50 crore Indian citizens, offering financial support for medical expenses. Many beneficiaries have already received life-saving treatments through this scheme.
A recent update to the PMJAY scheme allows all senior citizens aged 70 and above, regardless of their financial status, to get Rs. 5 lakh health insurance coverage per year. This helps ensure elderly citizens receive the care they need without financial worries.
In this article, we will explore the key features of Ayushman Bharat Yojana, including its benefits, coverage, eligibility, and exclusions, to give you a clear understanding of how it works and how it can assist those in need.
Ayushman Bharat Card 2024 Benefits
Ayushman Bharat Yojana, one of the largest healthcare initiatives globally, aims to cover over 50 crore Indian citizens, focusing on those from economically weaker sections. Launched in September 2018, this scheme, also known as Pradhan Mantri Jan Arogya Yojana (PMJAY), offers health insurance with a maximum coverage of Rs. 5 lakh per family per year.
The PMJAY scheme covers various medical expenses, including treatments, medications, diagnostic tests, and pre-hospitalisation costs. One key feature is the cashless hospitalisation service, available through the Ayushman health card. Beneficiaries can use this card at any hospital within the empanelled network across India. By showing their PMJAY e-card, they can receive hospital care without paying upfront.
| Name of the Scheme | Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) or Ayushman Bharat National Health Protection Scheme (NHPS) |
| Also Known as | PM Jan Arogya Yojana |
| PMJAY Launch Date | September 23, 2018 |
| Coverage Amount (per family) | ₹5 lakh/year |
| Treatment Covered | 1,400 |
| Pre-hospitalisation fees range | Up to 3 days |
| Post-hospitalisation fees range | Up to 15 days |
| Official Website |
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| Ayushman Bharat Scheme Helpline Numbers | 1800-111-565 or 14555 |
| Ayushman Bharat Scheme Email ID | [email protected] |
Originally called Ayushman Bharat Yojana – National Health Protection Scheme, it was renamed Pradhan Mantri Jan Arogya Yojana (PMJAY). Its main aim is to provide underprivileged citizens cashless secondary and tertiary healthcare. Beneficiaries can access treatment at any empanelled public or private hospital with an Ayushman card, ensuring quality medical services without financial burden.
Eligibility Criteria for Rural and Urban under Ayushman Bharat Scheme
The Pradhan Mantri Jan Arogya Yojana (PMJAY), or Ayushman Bharat Yojana, provides health insurance coverage of Rs. 5 lakh per family each year. It aims to cover 10 crore families, focusing on economically weaker sections. Out of these, 8 crore families are from rural areas, and 2.33 crore are from urban areas, benefiting a total of 50 crore individuals.
Eligibility for Rural Areas:
In rural areas, eligibility is based on economic hardship. Applicants must belong to one of the following categories:
- Scheduled Caste (SC) and Scheduled Tribe (ST) households
- Beggars and those dependent on alms
- Families without working-age members (16-59 years)
- Households with one physically challenged member and no able-bodied adult
- Landless households relying on casual labour
- Primitive tribal communities
- Legally freed bonded labourers
- Families living in one-room houses without solid walls or roof
- Manual scavenger families
- Families already enrolled under the Rashtriya Swasthya Bima Yojana (RSBY)
Eligibility for Urban Areas:
In urban areas, eligibility is based on occupation as identified in the Socio-Economic Caste Census 2011. Eligible categories include:
- Washermen, watchmen, and rag pickers
- Mechanics, electricians, and repair workers
- Domestic help, sanitation workers, and gardeners
- Home-based artisans, tailors, and handicraft workers
- Cobblers, hawkers, and street vendors
- Construction workers, plumbers, and painters
- Transport workers like drivers, conductors, and rickshaw pullers
- Assistants, delivery boys, peons, and small shopkeepers
Expansion for Senior Citizens:
As of September 12, 2024, the PMJAY scheme has been expanded to include all senior citizens above 70 years, regardless of their financial background. They will receive Rs. 5 lakh coverage per year, with costs shared by central and state governments. Senior citizens already covered under AB PM-JAY will get an additional Rs. 5 lakh just for themselves.
Exclusions:
Certain individuals are not eligible for the PMJAY scheme, including:
- Owners of two, three, or four-wheelers or motorized fishing boats
- Those with mechanized farming equipment or Kisan cards with a credit limit above ₹50,000
- Government employees and those in government-managed enterprises
- Individuals earning more than Rs. 10,000 per month
- Owners of refrigerators, landline phones, or solid houses
- Those owning 5 acres or more of agricultural land
For those not eligible under PMJAY, exploring other health insurance options may be necessary. Bajaj Finance offers affordable plans tailored to various financial needs.
Ayushman Bharat Yojana: What is Covered Under PMJAY?
The Ayushman Bharat Yojana Scheme (AB-PMJAY) provides healthcare services to economically disadvantaged families with coverage of up to Rs. 5 lakh per family per year. It focuses on secondary and tertiary hospitalization care, making essential healthcare accessible and affordable.
The scheme covers a wide range of services, including:
- Medical Examination, Consultation, and Treatment: Access to check-ups, doctor consultations, and treatments.
- Pre-Hospitalisation Services: Medical care is needed before hospital admission.
- Non-Intensive and Intensive Care: Coverage for both non-critical and critical care.
- Medications and Medical Consumables: Necessary medicines and consumables during treatment.
- Diagnostic and Laboratory Tests: Coverage for required tests and lab work.
- Hospital Accommodation: Costs for hospital stays during treatment.
- Medical Implants: Coverage for necessary implants like joint replacements or cardiac devices.
- Food Services: Ensuring patients receive meals during their hospital stay.
- Treatment-Related Complications: Coverage for any complications arising from treatment.
- Post-Hospitalisation Expenses: Healthcare services for up to 15 days after discharge.
This extensive coverage helps families access essential medical care without worrying about high costs.
What Treatments Are Not Covered Under PMJAY?
While the scheme offers broad coverage, some services are not included:
- Out-Patient Department (OPD) Expenses: Routine visits and consultations without hospitalization.
- Drug Rehabilitation: Programs for addiction recovery are not covered.
- Cosmetic Surgeries: Procedures for appearance enhancement are excluded unless medically necessary due to an injury.
- Fertility Treatments: Infertility treatments are not covered.
- Individual Diagnostics: Standalone diagnostic tests not tied to a treatment plan.
- Organ Transplant: Costs related to organ transplants are excluded.
Understanding what is covered and excluded helps beneficiaries make informed decisions about their healthcare needs under AB-PMJAY.
Step-by-Step Guide to Check Ayushman Bharat Yojana Eligibility Online
To check your eligibility for the Ayushman Bharat Yojana (PMJAY) scheme online, follow these simple steps. This will help you verify if you and your family qualify for the health benefits under the scheme.
Step 1: Visit the official Ayushman Bharat Yojana website at www.pmjay.gov.in.
Step 2: On the homepage, find and click on the “Am I Eligible” section to go to the eligibility checking page.
Step 3: Enter your mobile number and the captcha code displayed. Then click the “Generate OTP” button.
Step 4: You will receive an OTP on the mobile number you entered. Enter the OTP and click “Verify OTP” to proceed.
Step 5: After verifying your OTP, you will be redirected to a page where you need to provide details such as your name, state, age, family members, and income to determine your eligibility.
Step 6: Once you have filled in all the details, click on “Submit” to complete the process. Your eligibility status for Ayushman Bharat Yojana will be displayed.
By following these steps, you can easily check if you or your family are eligible for the Ayushman Bharat Yojana (PMJAY) scheme and access its health coverage benefits.
How to Create Your PMJAY Patient Card Under Ayushman Bharat Yojana?
Once you have confirmed your eligibility for the Pradhan Mantri Jan Arogya Yojana (PMJAY), the next step is to generate your PMJAY e-card, which allows you to access healthcare services under the scheme. The process is simple and can be done through the official website, pmjay.gov.in.
Follow these steps to generate your card:
1. Verification at the PMJAY Kiosk:
Visit an authorized PMJAY kiosk to verify your Aadhaar card or ration card. These documents confirm your identity and eligibility for the scheme.
2. Family Identification Proofs:
Provide additional proof of your family’s identity, such as a government-certified family list, PM letter, or RSBY card. This ensures all eligible family members can benefit from the scheme.
3. Issuing the PMJAY e-Card:
Once your details are verified, the PMJAY e-card will be generated. This card contains your unique AB-PMJAY ID, which serves as proof of eligibility for healthcare services.
4. Using the e-Card:
Present your PMJAY e-card at any empanelled hospital to access cashless treatment. The card proves your eligibility for healthcare under the Ayushman Bharat Yojana.
Keep your e-card safe, as it will be needed for future medical treatments under the PMJAY scheme.
Ayushman Bharat Card: FAQs
1. What is the Ayushman Bharat Yojana (PMJAY) scheme?
Ayushman Bharat Yojana, also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY), is a government initiative aimed at providing health insurance coverage to economically disadvantaged families. It offers financial protection for secondary and tertiary healthcare services.
2. Who is eligible to benefit from the PMJAY scheme?
Eligibility for PMJAY is determined based on specific criteria from the Socio-Economic Caste Census (SECC) of 2011. Beneficiaries must belong to vulnerable or marginalized groups, such as families in rural areas, those without a proper house, or workers in unorganized sectors.
3. How can I check if I am eligible for PMJAY?
To check eligibility, individuals can visit the official PMJAY website and use their mobile number or ration card number to verify. Alternatively, you can visit a nearby Common Service Center (CSC) or a designated Ayushman Mitra to check your status.
4. What kind of medical treatments are covered under the PMJAY scheme?
PMJAY provides coverage for a wide range of medical treatments, including surgeries, hospitalization, and specialized care for conditions like cancer, heart disease, and kidney ailments. Both secondary and tertiary healthcare services are included.
5. Is there a limit to how much coverage PMJAY offers?
Yes, each family is entitled to coverage of up to ₹5 lakh per year for hospitalization and medical treatments under the scheme. This amount covers a variety of medical procedures and treatments.
6. Are there any enrollment fees to apply for PMJAY?
No, the PMJAY scheme is completely free for eligible beneficiaries. You do not need to pay any fees for enrollment or to receive benefits.
7. Can I use PMJAY at private hospitals?
Yes, PMJAY can be used at empanelled private hospitals, in addition to public hospitals. However, the hospital must be registered and recognized under the PMJAY scheme to provide cashless treatments.
8. What documents are needed to apply for PMJAY benefits?
You generally need your Aadhaar card, ration card, and mobile number to apply for PMJAY benefits. These documents will be used to verify your eligibility in the system.
9. How do I claim benefits under the PMJAY scheme?
Claiming benefits is a cashless process at empanelled hospitals. You just need to present your Ayushman card or provide your identification details at the hospital. The hospital will verify your eligibility and process the treatment without requiring upfront payment.
10. Can urban households benefit from the PMJAY scheme?
Yes, urban households that meet the eligibility criteria, particularly those in vulnerable conditions or working in informal sectors, can also benefit from the PMJAY scheme. Urban eligibility is also based on SECC 2011 data.
