Ayushman Bharat Yojana
  • Eligibility for Urban and Rural Areas
  • People Not Covered under PMJAY
  • Critical Diseases under Ayushman Bharat Yojana

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Introduction About Ayushman Bharat Yojana or PMJAY

Ayushman Bharat Yojana is a flagship scheme launched by the government of India on September-23-2018 as recommended by the National Health Policy. It is one of the biggest healthcare schemes that is sponsored by the Govt. of India. This scheme aims to help those people who need healthcare facilities and people who are economically vulnerable. Prime Minister rolled out Pradhan Mantri Jan Arogya Yojana intending to cover more than 10 crore poor families which is almost equal to around 50 crore Indians, which means around 40% population of the entire country.

PMJAY or Ayushman Bharat Yojana offers Cashless treatment at both government & private hospitals. This scheme covers Pre-Hospitalization costs for a period of 3 days, Hospitalization, Post-Hospitalization expenses for a period of 15 days, and medication related expenses incurred during the treatment.

The policy also covers around 1400 procedures like skull surgery, knee replacement, pediatric surgery, opthamology procedures, etc.

Features of Ayushman Bharat Yojana or PMJAY

Some of the key features of PMJAY or Ayushman Bharat Yojana are as follows:-

Pradhan Mantri Ayushman Bharat Yojana reimburses the transportation cost of the policyholder during the Pre and Post hospitalization.

It is a family floater scheme providing coverage of 500K per family, per year.

Pradhan Mantri Ayushman Bharat Yojana covers Pre-Existing Diseases (PED) from Day 1.

PMJAY or Ayushman Bharat Yojana provides cashless hospitalization in public hospitals and private network hospitals.

Ayushman Bharat Yojana covers Day-Care expenses, that require hospitalization for less than 24 hours.

Benefits of Ayushman Bharat Yojana or PMJAY

Ayushman Bharat yojana or PMJAY provides healthcare services to the vulnerable and needy families in the country. The benefits that can be availed are listed below:

  • There is no restriction based on age, gender, and size of the family.
  • The healthcare facilities and treatments are free of cost across India.
  • There is no waiting period for the coverage of the Pre-Existing Diseases.
  • The treatment of oncology with chemotherapy for 50 different types of cancers has been covered under PMJAY or Ayushman Bharat Yojana.
  • In case of multiple surgeries, the scheme covers the highest package amount of the first surgery and 50% and 25% respectively for the second and third surgery.

Eligibility Criteria for PMJAY or Ayushman Bharat Yojana

There are two different types of eligibility criteria for Rural and Urban people:

Eligibility Criteria For Rural People

   Families with no male members within the age group of 16-59 years

   Families with no adult members within the age group of 16-59 years

   Families with at least 1 physically challenged member and no-able bodied adult member

   Families living in a single-room house with kaccha roofs and walls

   Families living in SC and ST households

   People who are living in alms or extremely poor conditions

   Families who are working as a manual scavenger

   Primitive Tribal Groups

   Legally Released Bonded Labor

   Landless households deriving a major part of their income from manual casual labor

Eligibility Criteria For Urban People

   Domestic workers

   Beggars

   People who are working as service providers on streets like hawkers, Street vendors, Cobblers

   Ragpickers

   Sweepers, Mali, and Sanitation workers

   Transport workers like Conductors, Drivers, Helpers of drivers and conductors, Rickshaw pullers, cart pullers

   Head-load workers like a Construction worker, Coolie with a Security guards, Welders, Painters, Labours, Mason, Plumbers

   Artisan, Home-based workers, Handicraft workers, and Tailors

   Chowkidars and Washer-man

   Shop worker, Delivery boys, Peon in a small establishments, Waiters, Attendants

   Mechanics, Electricians, Repair worker, Assembler

What is Covered Under The PMJAY or Ayushman Bharat Yojana?

The following treatments are covered under the PMJAY:

1 Pre-hospitalization is covered for 15 days.

2 The scheme also offers coverage for medicines and medicinal consumables.

3 The scheme also covers the hospital accommodation charges.

4 The scheme covers doctor consultation charges, medical examination, and treatment charges.

Who is not entitled to avail of the Ayushman Bharat Yojana Scheme?

The following people are not covered under the Ayushman Bharat yojana Scheme:

  • People having a vehicle like a two-wheeler, three-wheeler, and car
  • People having government jobs
  • People with a monthly income of more than 10,000 INR
  • People having farming machines and equipment
  • People living in properly built houses
  • People having Kisan Cards
  • People having motorized fishing boats
  • People who own more than 5 acres of agricultural land
  • People who are working in government-run agricultural enterprises
  • People having landline phones and refrigerators in their houses

Online Registration Process For PMJAY or Ayushman Bharat Yojana

It is a simple process to register for PMJAY or Ayushman Bharat Yojana Scheme. It applies to all beneficiaries who are identified under the list of SECC 2011 and are a part of the RBSY scheme. You can follow these simple steps to register for PMJAY online:

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

List of Critical Diseases covered under PMJAY or Ayushman Bharat Yojana

Ayushman Bharat Yojana or PMJAY covers around 1,350 medical packages at their impaneled public and private hospitals. Below are some of the Critical Illnesses that are covered under the scheme:

  • Skull base surgery
  • Coronary artery bypass grafting
  • Double valve replacement surgery
  • Pulmonary valve surgery
  • Tissue expander for disfigurement following burns
  • Anterior spine fixation
  • Prostate cancer
  • Carotid angioplasty with stent

How To Download Your Ayushman Scheme Card Online?

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".

Hospitalization Process in PMJAY or Ayushman Bharat Yojana

The PMJAY or Ayushman Bharat Yojana provides Health Insurance to needy people without any premium. It covers both Pre and Post-hospitalization costs along with ambulance charges and all the expenses related to medicines and medical consumables.

The Ayushman Mitras are there at the Help Desks of the impaneled hospitals to help the beneficiaries. Ayushman Mitras verify the documents, eligibility criteria and the enrolment process and provide QR codes to the beneficiaries so that they can scan the code and check their eligibility to avail the benefits of the scheme.

COVID-19 Treatment under the Scheme

COVID-19 Testing and Treatment is now available under PMJAY or Ayushman Bharat Yojana. The Scheme provides free testing through private labs and free treatment for COVID-19 in impaneled hospitals. To avail of these benefits, an eligible person has to show his/her e-card and some other documents like an Adhar card, Voter ID, etc.

Contact Information & 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

Written By : Naval Goel

Last Updated : September, 2021

Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.

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