Pradhan Mantri Jan Arogya Yojana: Benefits, eligibility, how to apply

In 2018, Prime Minister Narendra Modi launched the Ayushman Bharat National Protection Scheme, aiming to provide affordable healthcare services to financially vulnerable sections of society. Many individuals, due to the high costs of medical services, were unable to seek timely treatment. The Ayushman Bharat initiative, also known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), emerged as a solution to address this critical issue.

Understanding Pradhan Mantri Jan Arogya Yojana

1. Overview of PM-JAY

• PM-JAY, India’s second-largest PM-JAY, focuses on providing health insurance coverage to people at affordable rates.
• The scheme offers a health insurance cover of ₹5 lakhs annually to economically weaker sections based on the Socio-Economic Caste Census 2011 (SECC 2011) and commercial criteria.

2. Evolution from RSBY to PM-JAY

• PM-JAY can be seen as a step forward from the National Health Insurance Scheme (RSBY) initiated in 2008.
• Families previously covered under RSBY but absent from the SECC 2011 database are now included in PM-JAY.

3. Government-backed Financing

• PM-JAY is entirely funded by the government, with implementation occurring at both central and state levels.

Unraveling the Impact of PM-JAY

4. World’s Largest Health Insurance Scheme

• PM-JAY stands as the world’s most extensive health insurance and assurance program.
• Every family benefits from ₹5 lakhs health coverage annually, applicable in both public and private healthcare facilities.

5. Wide-Ranging Benefits

• Pre-hospitalization bookings
• Tests and lab examinations
• Preventive healthcare services
• Comfortable accommodations
• Meal provisions
• Resolution of issues arising during treatment
• Post-discharge follow-up for up to 15 days
• Coverage for pre-existing conditions

6. Cashless Health Coverage

• The scheme offers cashless coverage of up to ₹5,00,000, ensuring that eligible families can avail themselves of all-inclusive healthcare services without financial constraints.

Purpose and Eligibility Criteria

7. Objective of PM-JAY

• PM-JAY aims to alleviate the financial burden on economically weaker families grappling with major illnesses.
• The scheme ensures that those facing financial hardships receive health insurance coverage of up to ₹5 lakhs, facilitating cost-free hospitalization and reducing mortality rates due to illnesses.

8. Eligibility Criteria

• Rural residents belonging to marginalized communities
• Families with members aged between 16 to 59 years
• Beggars or those subsisting on alms
• Families without any individual aged between 16 to 59 years
• Families with at least one physically disabled member or an economically active adult
• Landless families earning a livelihood through manual scavenging
• Traditional tribal communities
• Legally released bonded laborers
• Families residing in one-room makeshift houses without proper walls and roofs
• Families of manual scavengers

9. Urban Residents Eligible Under PM-JAY

• Laundrymen, security guards
• Ragpickers
• Mechanics, electricians, maintenance workers
• Domestic helpers
• Sanitation workers, gardeners, sweepers
• Home-based artisans or handicraft workers, tailors
• Cobblers, street vendors, and services provided on roads or pavements
• Plumbers, masons, construction laborers, porters, welders, painters, and security guards
• Drivers, conductors, helpers, and those engaged in transporting goods or passengers

Achieving Healthcare Equality

10. Impact on Rural Dwellers

• Addressing financial barriers for medical treatment
• Empowering marginalized communities
• Ensuring timely access to quality healthcare

11. Transformation for Urban Workers

• Elevating the status of various occupations
• Enhancing the overall health and well-being of urban workers
• Recognizing the contribution of informal sector workers to the economy

The Pradhan Mantri Jan Arogya Yojana covered ailments include:

1. Bypass surgery for changes in coronary arteries
2. Prostate cancer
3. Carotid angioplasty surgery
4. Skull base surgery
5. Double valve replacement
6. Pulmonary valve replacement
7. Anterior spine fixation
8. Laryngopharyngectomy
9. Organ transplant

Conditions not encompassed by the Pradhan Mantri Jan Arogya Yojana:

1. Drug rehabilitation
2. Outpatient procedures (Operations)
3. Procedures related to fertility
4. Procedures related to beauty enhancements
5. Limb prosthetics
6. Personal diagnostics

Documents required for enrollment under the Pradhan Mantri Jan Arogya Yojana:

1. Proof of age and identity (Aadhar card/PAN card)
2. Address verification document
3. Contact details (mobile, email)
4. Caste certificate
5. Income certificate
6. Documentation of the current status of the family (joint or nuclear)
7. Aadhar card

How to apply for registration in the Pradhan Mantri Jan Arogya Yojana?

Individuals aspiring to avail the benefits of the Pradhan Mantri Jan Arogya Yojana should carefully follow our registration process and make use of this facility.

1. Firstly, visit the Common Service Center (CSC) to apply for Pradhan Mantri Jan Arogya Yojana and submit photocopies of all required documents.
2. Subsequently, after the Common Service Center (CSC) agent verifies all documents, your registration will be completed, and a registration certificate will be provided.
3. Within 10 to 15 days, you will receive your Ayushman Bharat golden card from the Common Service Center.
4. your registration process will be deemed successful after receiving the golden card.

Procedure for Hospital Empanelment Module:

1. Visit the official website of Pradhan Mantri Jan Arogya Yojana.
2. On the home page, click on the menu tab.
3. Select the “Hospital Empanelment Module” option.
4. A new page will open where you must enter the hospital reference number, password, and captcha code.
5. Click on the login option.
6. The Hospital Empanelment Module will be displayed on your computer screen.

Procedure for Finding Empaneled Hospitals:

1. Visit the official website of Pradhan Mantri Jan Arogya Yojana.
2. On the home page, click on the menu tab.
3. Click on the “Find Hospital” link.
4. Select the following categories:

• State
• District
• Hospital Type
• Specialty
• Hospital Name

1. Enter the captcha code.
2. After these steps, click on the search button.
3. Relevant information will be displayed on your computer screen.

FAQs:

1. Will people have to pay for treatments covered under the scheme?

• No. All eligible beneficiaries under PM-JAY can receive free services for selected packages in public and empanelled private hospitals.

1. Can one avail of benefits under this scheme without an Aadhar card?

• An Aadhar card is not mandatory to avail of services under this scheme.

1. Are pre-existing conditions covered under this scheme?

• Yes, all pre-existing medical conditions are covered under this scheme.