Ayushman Bharat : Pradhan Mantri Jan Arogya Yojana Review, Features and benefits

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a health insurance scheme launched by the Government of India. It is the flagship program comes under the Ayushman Bharat initiative. It provides financial protection of up to Rs 5 lakh per family per year for hospitalisation due to medical emergencies. It is for the poor and vulnerable sections of society.

Ayushman Bharat (PM-JAY) Pradhan Mantri Jan Arogya Yojana Review
Ayushman Bharat (PM-JAY) Pradhan Mantri Jan Arogya Yojana Review

What is Pradhan Mantri Jan Arogya Yojana

  • Ayushman Bharat Yojana, launched by the Government of India, is one of the world’s largest healthcare schemes that aims to provide health insurance to over 50 crore Indians from economically weaker sections.
  • This flagship initiative offers a maximum sum insured amount of Rs. 5 lakh per family per year, covering most medical treatment costs, diagnostics, medicines, and pre-hospitalization expenses.
  • Beneficiaries can use the Ayushman Bharat Yojana e-card to avail cashless hospitalization services at any of the empaneled hospitals across the country.
  • PMJAY, as the scheme is now called, is an ambitious health sector programme that covers all secondary and most tertiary care expenditures, including pre-existing conditions, with no cap on family size or age.
  • It also includes medical consultation, treatment, consumables, intensive care, lab investigations, transport allowance, and accommodation benefits.
  • With the PMJAY, eligible families can access quality healthcare services at both public and private hospitals without any financial burden.

Overview of Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Scheme NameAyushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) or
Ayushman Bharat National Health Protection Scheme (NHPS)
Type of InsuranceHealth Insurance
MinistryMinistry of Health and Family Welfare
Launching Date
23 September 2018
Coverage AmountRs. 5 Lakhs
Official Websitehttps://www.pmjay.gov.in/
AddressNational Health Authority of India, 3rd, 7th and 9th Floor, Tower-L, Jeevan Bharati Building, Connaught Place, New Delhi – 110001
Helpline Numbers1800-111-565 or 14555

How Pradhan Mantra Jan Arogya Yojana Works?

Under PMJAY, eligible low-income families gets automatically enrolled by the government. A health card has been issued to the eligible families and they get cashless treatment up to INR 5 lakhs per year for secondary (which doesn’t involve a super specialist) and tertiary care (which involves a super specialist) at any empaneled public or private hospital.

For example:
Suppose there is a family of 5 members belonging to a low-income group and are eligible under this scheme. If any of the family members require hospitalization due to an illness or accident, they can go to the nearby empaneled hospital, present the health card and avail the benefits.

As this is a family floater plan, if the first family member has exhausted the INR 2 lakhs amount, then the remaining INR 3 lakhs can be utilized by the other 4 members.

Features and Benefits of Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Below are the key features of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana:

  • Fully government-funded health insurance/assurance scheme.
  • Provides coverage of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization.
  • Covers over 12 crore poor and vulnerable families (approximately 55 crore beneficiaries).
  • Offers cashless access to healthcare services at empanelled hospitals.
  • Aims to prevent medical expenses from pushing people into poverty.
  • Covers pre-hospitalization (up to 3 days) and post-hospitalization (up to 15 days) expenses.
  • No restrictions based on family size, age, or gender.
  • Covers all pre-existing conditions from day one.
  • Benefits are portable across the country, allowing treatment at any empanelled hospitals.
  • Includes approximately 1,929 procedures, covering all treatment costs.
  • Public hospitals receive reimbursement at par with private hospitals.

Coverage under Pradhan Mantri Jan Arogya Yojana (PMJAY)

Following components are covered under PM-JAY

  • Hospitalization costs
  • Medical examination, consultation, and treatment
  • Pre-hospitalization expenses
  • Non-intensive and intensive care services
  • Medicine and medical consumables
  • Diagnostic and laboratory services
  • Accommodation
  • Medical implant services
  • Food services
  • Complications arising during treatment
  • Post-hospitalization expenses (up to 15 days)
  • COVID-19 (Coronavirus) treatment

Exclusions under Pradhan Mantri Jan Arogya Yojana (PMJAY)

Following components are not covered under PM-JAY

  • Out-Patient Department (OPD) expenses
  • Drug rehabilitation
  • Cosmetic surgeries
  • Fertility treatments
  • Individual diagnostics
  • Organ transplant

Eligibility Criteria under Pradhan Mantri Jan Arogya Yojana (PMJAY)

PM-JAY aims to provide health insurance coverage to the poorest and most vulnerable populations, including those who cannot afford to pay premiums and may have limited literacy levels. Here is the list of eligible rural and urban beneficiaries.

Eligible criteria for rural beneficiaries:

All those families are eligible who have,

  • Only one room with kucha walls and kucha roof
  • No adult member between ages 16 to 59
  • Households with no adult male member between ages 16 to 59
  • Disabled member and no able-bodied adult member
  • SC/ST households
  • Landless households deriving a major part of their income from manual casual labour

Eligibility Criteria for Urban Beneficiaries:

All those families are eligible who are,

  • Ragpicker
  • Beggar
  • Domestic worker
  • Street vendor/ Cobbler/ Hawker/ Other service provider working on streets
  • Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and other head-load worker
  • Sweeper/ Sanitation worker/ Mali
  • Home-based worker/ Artisan/ Handicrafts worker/ Tailor
  • Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller
  • Shop worker/ Assistant/ Peon in small establishment/ Helper/ Delivery assistant/ Attendant/ Waiter
  • Electrician/ Mechanic/ Assembler/ Repair worker
  • Washer-man/ Chowkidar

List of Critical Illnesses covered under Ayushman Bharat Yojana (PM-JAY)

Some of the critical illnesses which are covered are listed below,

  • Prostate cancer.
  • Double valve replacement.
  • Anterior spine fixation.
  • Coronary artery bypass graft.
  • Pulmonary valve replacement.
  • Skull base surgery.
  • Laryngopharyngectomy with gastric pull-up
  • Tissue expander for disfigurement following burns.
  • Carotid angioplasty with stent.
  • COVID-19.

Coverage Exclusions under PMJAY Scheme

The following individuals will not receive coverage under the PMJAY scheme,

  • Individuals who own vehicles such as three-wheelers, two-wheelers, or cars.
  • Individuals with a monthly income exceeding Rs. 10,000.
  • Government employees.
  • People who possess farming equipment, machinery, motorized fishing boats, and a kisan card.
  • Individuals living in proper houses or owning agricultural land larger than 5 acres.
  • Individuals employed in non-agricultural enterprises operated by the government.
  • Individuals who do not fall within the identified socio-economic criteria specified by the scheme.
  • Non-Indian citizens or foreigners residing in India.
  • People involved in professional vocations such as doctors, lawyers, chartered accountants, etc.
  • Individuals engaged in managerial positions.
  • Members of families holding constitutional posts, serving or retired government employees, and current or former Members of Parliament or Members of Legislative Assembly.

How to Apply / Check eligibility for Ayushman Bharat Yojana (PM-JAY)

You can enroll in this Scheme or check your eligibility via two modes, online as well as offline.

How to apply / check eligibility of PM-JAY via online?
  • Step 1 : Just go to the official website of PM-JAY https://pmjay.gov.in/ and click on Am I Eligible tab.
  • Step 2 : Enter your mobile number, enter the Captcha code and hit Generate OTP. 6 digit OTP will be sent to your registered mobile number. Just enter the OTP, give your consent and hit Submit.
  • Step 3 : Select your state from dropdown and then search by name/HHD/ration card number/mobile number.
  • Step 4: Enter your details and your name will be displayed if you are covered under this scheme.

How to apply PM-JAY via offline?

  • Step 1 : Visit any nearby PM-JAY enrollment center or contact toll-free helpline 15444 to get information on enrollment centers.
  • Step 2 : Gather all the necessary documents such as Aadhaar card, ratio card for each member of your family.
  • Step 3 : Visit enrollment center and provide all the required information about yourself and family to the staff.
  • Step 4 : Submit the application and get the enrollment slip.
  • Step 5 : The authorities will process your application which will take some time.
  • Step 6 : Once your application is approved, you will receive the PMJBY card via mail ot at distribution center.

How to get Ayushman Bharat Yojana (PM-JAY) health card?

Follow below process to get your PMJAY health card.

  • Step 1 : Just go to the official website of PM-JAY https://mera.pmjay.gov.in/search/login and log in with your registred mobile number.
  • Step 2 : Enter your mobile number, enter the Captcha code to generate the OTP and opt for HHD code.
  • Step 3 : you will provide this HHD code to your nearby Common Service Centre (CSC). They will check this and complete rest of the process for you.
  • Step 4 : You will get your Ayushman Bharat (PMJAY) Health card for which you have to pay Rs. 30.

How to Get PMJAY Empaneled Hospital List?

Follow the steps below to find the PMJAY empaneled hospital in your area.

  • Step 1 : Go to the official website of PMJAY Find Hospital Sectio.
  • Step 2 : Select Your State, District, hospital type (Public/Private – not for profit/Private – for profit) and the medical specialty you are looking for.
  • Step 3 : Select the hospital name and empanelment type.
  • Step 4 : Enter Captcha Code and click on search.

Ayushman Bharat : Pradhan Mantri Jan Arogya Yojana FAQs?

What is Ayushman Bharat (PMJAY) Yojana ?

PMJAY is India’s health insurance scheme for economically weaker individuals and families.

What benefits does PMJAY provide?

PMJAY covers hospitalization expenses for various treatments and procedures, offering financial protection against high medical costs.

Who is eligible for PMJAY?

Eligibility for PMJAY is based on socio-economic factors and deprivation criteria, targeting the economically vulnerable population.

How can I check if my family is covered under PMJAY?

Check your family’s PMJAY coverage by visiting the official website or contacting the helpline, providing necessary identification details.

Is PMJAY applicable across all states in India?

Yes, PMJAY is applicable nationwide, although implementation may vary by state.

Can I avail PMJAY benefits at any hospital?

PMJAY benefits can be availed at public and empaneled private hospitals, ensuring the chosen hospital is empaneled.

Are pre-existing conditions covered under PMJAY?

Yes, PMJAY covers pre-existing conditions.

How can I apply for PMJAY?

Apply for PMJAY at the nearest enrollment center, providing required documents and information.

What documents are required for PMJAY application?

Required documents may include Aadhaar card, ration card, or other government-issued identification proofs.

Is PMJAY applicable to non-Indian citizens or foreigners residing in India?

No, PMJAY is exclusively for Indian citizens.

Can I use my PMJAY card across different states in India?

Yes, PMJAY cardholders can use their card at any empaneled hospital nationwide.

This covers all the points on Pradhan Mantri Jan Arogya Yojana (PM-JAY). In case you have any suggestions or questions, please write in the comment box and we will get back to you.

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