Ayushman Bharat Yojana
  • What is the Ayushman Urban Bharat Yojana?
  • Who is eligible for the plan?
  • How to apply for PMJAY?
Ayushman Bharat Yojana
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Ayushman Bharat Yojana- A Government Scheme

The Pradhan Mantri Jan Arogya Yojana (PMJAY), also known as Ayushman Bharat Yojana (AB-PMJAY), is the national scheme launched by the government of India in 2018. The largest government-funded scheme and healthcare program aims to provide coverage for the bottom 40% of the Indian population.

Under the scheme Ayushman Bharat Yojana, you can get health insurance coverage of up to Rs 5 Lakhs per year for secondary and tertiary hospitalisation.

Let us understand this with an example

Raju is the auto-driver and sole breadwinner in a family of 5 people and his family falls below the poverty line (BPL). Sometimes, they are not able to afford a proper 3-times diet. Raju works hard every day for 13 to 14 hours to earn money. Due to this hard work and restlessness, he developed a heart problem. Now doctors have told him that he requires heart bypass surgery. This procedure typically incurs high costs.

Fortunately, one of his regular passengers registered him on time for the Ayushman Bharat scheme. He got the assistance of Rs. 5 Lakhs which reduced the financial burden on the family. Now, he can go to any empanelled hospital and get the surgery done, without paying any cost with the help of PMJAY.

Understanding PMJAY

This is the scheme launched by our current Prime Minister intending to cover more than 10 crore poor families. PMJAY or Ayushman Bharat Yojana offers cashless treatment at government and private hospitals. This scheme typically covers the cost of pre-hospitalisation for 3 days, hospitalisation, post-hospitalisation for 15 days, and medicines costs incurred during the treatment.

Some Key Features of Ayushman Bharat Yojana or PMJAY

  • Ayushman Bharat Yojana is the largest health insurance scheme backed by the government.
  • Provides coverage of Rs 5 Lakhs per family for secondary and tertiary care.
  • Around 12 crore families who are vulnerable are eligible for these benefits.
  • The National Health Authority of India has implemented the plan.
  • No co-payment or deductibles will be applied to the hospital bill.
  • Up to 3 days of pre-hospitalisation and 15 days of post-hospitalisation are covered.
  • Covers up to 1400+ packages of treatment.

What are the Benefits of PMJAY?

  • It has Rs.5 Lakhs coverage per family yearly.
  • Reduced out-of-pocket expenses and helps prevent families from falling into debt due to unexpected healthcare costs.
  • Wide network of hospitals at any empanelled public or private hospital across India.
  • Pre and post-hospitalisation coverage.
  • Free medical facility up to Rs 5 Lakhs.
  • All pre-existing conditions are covered from day one.
  • No extra capping on the family size, age or gender.
  • The sum insured can be used by all the family members.

Who's Eligible for the Plan?

The eligibility of the Pradhan Mantri Jan Arogya Yojana (PMJAY) is determined solely based on socio-economic factors. These are given below for your reference.

Rural Families Urban Families
Families living in homes with makeshift walls and roofs. Employed in any specific occupation.
People depend on alms. People who are not able to meet the sole criterion of income.
Families who are dependent on manual labour as their primary income source. Family size exceeds the annual income.
Landless families. Domestic workers, ragpickers, and beggars.
Households headed by a female with no adult members between 16 to 59 years old. Cobbler, street vendor, hawker and watchman.
Families with disabled members. Drivers, transport workers, conductors, rickshaw pullers and helpers.
Households belonging to the SC or ST category. Mechanic, electrician, repair worker and sanitation worker.

Know What is Covered- Inclusion

Hospitalisation Charges

Medical Examination

Consultation by an expert doctor

Pre and post-hospitalisation

Non-intensive and intensive care services

Complications arising during the treatment

Surgeries

Diagnostic and laboratory charges

Pre-existing diseases

What are the Exclusions?

Cosmetic Surgery

OPD Expenses

Drug rehabilitation

Fertility treatments

Individual diagnostics

Organ transplant

Critical Illness Covered in PMJAY

  • Brain Tumor
  • Prostate Cancer
  • Coronary artery bypass graft
  • Carotid angioplasty with stent
  • Tissue expander for disfigurement due to burns
  • Anterior spine fixation

How to Apply for PMJAY?

You need to follow the steps to apply for Ayushman Bharat Yojana:

Visit the official website of PMJAY and then click on "Am I eligible".

Enter your mobile number, CAPTCHA code, and click on the "Generate OTP button".

Enter your name, household number, ration card number, and select your state.

You can verify your registration based on the search results.

Required Documents To Apply For PMJAY or Ayushman Bharat Yojana

Required Documents To Apply For PMJAY or Ayushman Bharat Yojana

How to Download Your Ayushman Scheme Card?

Below are the steps by which you can apply or download your Ayushman card online:

Visit the official website of the Ayushman Bharat Yojana or PMJAY.

Sign up with your Email ID and generate a password.

To proceed further, Aaadhar number needs to be entered.

Then, click on "approved beneficiary".

It will redirect you to the Help Center.

Enter your password in CSC and PIN.

Now, it will redirect you to the home page.

Now you can see the download option by which you can download your "Ayushman Bharat Golden Card".

Who is not Eligible for PMJAY?

You cannot avail of the benefits of PMJAY or Ayushman Bharat Yojana if you are:

  • The person has a vehicle like a two-wheeler, three-wheeler, or car.
  • People who have government jobs.
  • Drawing more than INR 10,000 as salary.
  • Have a 'Kisan' card.
  • The owner of farming machines and equipment.
  • Living in properly built houses.
  • The owner of more than 5 acres of agricultural land.
  • Having landline phones and refrigerators in the house.

Contact Information and Address

Address: 9th Floor, Tower-l, Jeevan Bharati Building, Connaught Place, New Delhi - 110001

Toll-Free No. - 14555

Email Address - pmjay[at]nha[dot]gov[dot]in

Bottom Line

The Ayushman Bharat Yojana is a significant initiative done by the Indian government to address the healthcare accessibility of low-income families. But remember, this scheme is not for everyone, it is only for the people who are living below the poverty line. So, if you know someone who needs this scheme, please enlighten them.

If you need any kind of assistance, reach out to us at PolicyX.

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Ayushman Bharat Yojana : FAQ's

1. Who is eligible for an Ayushman Bharat Card?

If your annual income is below INR 2.5 Lakh, or you belong to the SC/ST community or are employed in specific occupations or live in homes with poor construction, then you can apply for an Ayushman Bharat Yojana card.

2. How much coverage does PMJAY offer?

PMJAY provides coverage of INR 5 Lakhs per family for health insurance.

3. What hospitals are covered under the PMJAY Scheme?

You can avail the benefit of cashless treatment from any public or private hospital across India.

4. Do I need to pay in the hospital if I have an Ayushman Bharat Yojana card?

No, you do not need to pay anything, just show your card at the billing counter and you will receive cashless treatment.

5. How can I download the Ayushman Bharat Yojana card?

You can download the e-card from the PMJAY website or through the Ayushman Bharat Health Account (ABHA) app.

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