A Guide to Ayushman Bharat Yojana

Ayushman Bharat Yojana, also known as Pradhan Mantri Jan Arogya Yojana (PMJAY), is a scheme launched by the Indian Government in 2018. It is also known as Ayushman Bharat National Health Protection Scheme (NHPS) - a national public health insurance fund that offers free healthcare access to low-income bearers in the country. This scheme is best for you if you belong to society's poor and lower sections. It provides you with financial assistance in case of emergency hospitalisation.

A Guide to Ayushman Bharat Yojana
What is Ayushman Bharat Yojana (PMJAY)?

Ayushman Bharat Yojana is one of the largest healthcare schemes rolled out by the GOI. PMJAY is considered the one of best health insurance in India. It provides coverage of up to INR 5 lakhs for each family per year for all hospitalisation expenses, such as medicines, medical treatment, diagnostics, and pre-hospitalisation. It also covers around 1400 surgeries, including knee replacement, skull surgery, and many more.

Ayushman Bharat Yojana also provides cashless hospitalisation through their e-card, which you can use at any network hospital nationwide. Hence, you can avail of medical treatment by showing the e-card. There have been 21,40,17,608 e-cards issued to date.

What are the features and benefits of the Ayushman Bharat Yojana Scheme?

Apart from being a lifesaver for low-income people, it has the following features -

● Ayushman Bharat Yojana is a family floater scheme that offers a sum assured of INR 5 lakhs to each family. You can use this scheme to avail of tertiary and secondary hospitalisation care nationwide.

● The scheme is tailored for people below the poverty line and low incomes bearers.

● PMJAY offers cashless healthcare services to the insured in any public or private network hospital.

● Ayushman Bharat Yojana also covers the transportation costs incurred by the policyholder during the travel pre and post - hospitalisation.

● PMJAY also covers a few pre-existing medical conditions and the daycare expenses incurred.

● The payment is made based on the predetermined package rate by the Government.

● Under this scheme, several health and wellness centres will be established as per the SECC (Socio-Economic Caste Census) data.

● Covers up to 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses, including diagnostics and medicines.

● You can benefit from the scheme regardless of caste, gender, and age.

● Minimises out-of-pocket expenses incurred due to medical conditions.

● You can also avail affordable treatments at private hospitals as they are also now coming into the picture to join hands in the evolution of affordable treatment schemes.

What are the inclusions and exclusions under Ayushman Bharat Yojana?

Inclusion of the scheme are-

● Pre-hospitalisation expenses 
● Non-intensive and intensive care services 
● Medical tests, consultation fees, and other treatments 
● Hospital accommodation charges 
● Medical implantation expenses 
● Food services ● COVID treatments 
● Post-hospitalisation for up to 15 days 
● Costs incurred due to complications during treatment.

Exclusions of the scheme are -

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

How to apply for Ayushman Bharat Yojana?

Below are the steps to apply for Ayushman Bharat Yojana online -

● Visit the PMJAY scheme's official government portal. 
● Click on the Am I Eligible tab. 
● Submit your contact details (phone, email, and resident address) 
● Enter the CAPTCHA, and click on Generate OTP. 
● Enter your state, name, ration card number, household number, and mobile number. 
● You will know if you are eligible for the scheme.

You can also contact the Ayushman Bharat Yojana customer care number (1800-111-565-14555), check your eligibility, and register yourself in the scheme.

You can download the PMJAY card by -

● Visit the PMJAY website and log in with your registered number. 
● Enter the CAPTCHA code and generate OTP. 
● Opt for HDD code and provide the same to the Common Service Centre. 
● The CSC executive, also known as Ayushman Mitra, will complete the procedure. 
● They will charge some amount and get the card downloaded for you.

The documents required to apply for the Ayushman Bharat Yojana are as follows -

● Contact details (mobile number, residential address, and email address) 
● Caste certification 
● Income proof (maximum income must be up to INR 5 lakhs in a year) 
● Document showing your family status (joint or nuclear family) 
● Government issues identity and age proof documents such as - Aadhar cards, PAN cards, ration cards, voter ID cards, etc.

What are the critical diseases and illnesses covered under PMJAY?

The followings are the diseases and conditions covered under the PMJAY scheme -

● Prostate cancer 
● Covid 19 
● Coronary artery bypass graft 
● Double valve replacement 
● Skull surgery 
● Pulmonary valve replacement 
● Knee replacement 
● Carotid angioplasty with stent 
● Anterior spine fixation 
● Tissue expander for disfigurement after third-degree burns.

Who is eligible to enrol for Ayushman Bharat Yojana?

Families covered under Rashtriya Swasthya Bima Yojana, launched in 2008, would be covered under the PMJAY scheme even if they are not listed on SECC. Some other eligibility criteria to apply for the PMJAY scheme -

● People who belong to SC and ST caste 
● Beggar surviving on alms 
● Low-income families with no male member between 16 to 59 years of age 
● Households with one or more physically disabled person 
● Families who do not own land or any other property 
● Casual labourers earning a minimum wage 
● Legally released bonded workers 
● Primitive tribal communities 
● People living in houses with no proper roof or wall.

In the urban areas, the following people can avail the benefit of the PMJAY scheme - 
● Ragpickers 
● Domestic help 
● Security guards/coolie/painters/welder 
● Washermen 
● Sanitation workers 
● electrician/mechanics/repair workers 
● Gardeners 
● Cobblers and hawkers/vendors working on pavements 
● Transport workers/cart pullers/rickshaw pullers 
● Shopkeepers, waiters, and peons working in a small organisation.

Ayushman Bharat Yojana is a welfare scheme to provide financial assistance with quality treatment at registered public and private hospitals nationwide. It is a government-funded scheme that acts like a group health insurance and family floater plan. This is the best health insurance in India for people with low income and scavenger workers.

Disclaimer - The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.