Ayushman Bharat Yojana(Pradhan Mantri Jan Arogya Yojana)

Pradhan Mantri Jan Arogya Yojana(PMJAY) or Ayushman Bharat Yojana is an initiative to ensure that poor and vulnerable population is provided health cover. This initiative is part of the Government’s vision to ensure that its citizens – especially the poor and vulnerable groups have universal access to good quality hospital services without anyone having to face financial hardship as a consequence of using health services.

Benefits of Ayushman Bharat Yojana(Pradhan Mantri Jan Arogya Yojana)

Ayushman Bharat Scheme provides an insurance cover up to Rs 5 lakh per family, per year for secondary and tertiary hospitalization. All pre-existing conditions are covered from day 1 of implementation of PM-JAY in respective States/UTs.

Benefit cover under various Government-funded health insurance schemes in India have always been structured on an upper ceiling limit ranging from an annual cover of INR30,000 to INR3,00,000 per family across various States which created a fragmented system. PM-JAY provides cashless cover of up to INR5,00,000 to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment.

• Medical examination, treatment and consultation

• Pre-hospitalization

• Medicine and medical consumables

• Non-intensive and intensive care services

• Diagnostic and laboratory investigations

• Medical implantation services (where necessary)

• Accommodation benefits

• Food services

• Complications arising during treatment

• Post-hospitalization follow-up care up to 15 days

The benefits of INR 5,00,000 are on a family floater basis which means that it can be used by one or all members of the family. The RSBY had a family cap of five members. However, based on learnings from those schemes, PM-JAY has been designed in such a way that there is no cap on family size or age of members. In addition, pre-existing diseases are covered from the very first day. This means that any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.

Eligibility Criteria of Ayushman Bharat Yojana(Pradhan Mantri Jan Arogya Yojana)

Ayushman Bharat scheme is entitlement based there is no registration required for it.

Ayushman Bharat scheme will target poor, deprived rural families and identified the occupational category of urban worker's families as per the latest Socio-Economic Caste Census (SECC) 2011 data, both rural and urban. Additionally, all such enrolled families under Rashtriya Swasthaya Bima Yojana (RSBY) that do not feature in the targeted groups as per SECC data will be included as well.

The categories in rural and urban that will be covered under PMJAY are given as follows:

For Rural:

Total deprived Households targeted for PMRSSM who belong to one of the six deprivation criteria amongst D1, D2, D3, D4, D5 and D7:

• Only one room with kucha walls and kucha roof (D1)

• No adult member between ages 16 to 59 (D2)

• Female-headed households with no adult male member between ages 16 to 59 (D3)

• Disabled member and no able-bodied adult member (D4)

• SC/ST households (D5)

• Landless households derive a major part of their income from manual casual labour (D7)

Automatically included:

• Households without shelter

• Destitute/ living on alms

• Manual scavenger families

• Primitive tribal groups

• Legally released bonded labour

For Urban:

• 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 another 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

As per the SECC 2011, the following beneficiaries are automatically excluded:

• Households having motorized 2/3/4 wheeler/fishing boat

• Households having mechanized 3/4 wheeler agricultural equipment

• Households having Kisan Credit Card with a credit limit above Rs. 50,000/-

• A household member is a government employee

• Households with non-agricultural enterprises registered with the government

• Any member of the household earning more than Rs. 10,000/- per month

• Households paying income tax

• Households paying professional tax

• House with three or more rooms with pucca walls and roof

• Owns a refrigerator

• Owns a landline phone

• Owns more than 2.5 acres of irrigated land with 1 irrigation equipment

• Owns 5 acres or more of irrigated land for two or more crop season

• Owning at least 7.5 acres of land or more with at least one irrigation equipment

A dedicated Pradhan Mantri Jan Arogya Yojana family identification number will be allotted to eligible families. Additionally, an e-card will also be given to the beneficiary at the time of hospitalization.

Documents Required for Ayushman Bharat Yojana

• Aadhaar 

• Any other valid government id(s) decided by the State if they do not have an Aadhaar 

• Ration Card or any other family ID from the following:

  • Government certified list of members

  • RSBY Card: Document image (RSBY Card) to be uploaded

  • PM Letter: Document image (PM Letter) to be uploaded

  • State Specific Requirement

• In case of unavailability of either of the abovementioned family IDs, the state can decide to accept an Individual ID mentioning at least father/ mother/ spouse’s name as a family ID. This will be accepted only in such cases where both individual’s name and father/ mother/ spouse’s name match as that in SECC/ RSBY/ State Scheme data.

How to Apply for Ayushman Bharat Yojana(Pradhan Mantri Jan Arogya Yojana)?

You don't need to apply for the Ayushman Bharat scheme (Pradhan Mantri Jan Arogya Yojana). It is based on entitlement. Your name might or might not be already included in the list.

You can check whether your name is already included in the list by using either or any of your

• Mobile number

• Ration Card Number

• Socio-Economic and Caste Census (SECC) Name

• Rashtriya Swasthya Bima Yojana (RSBY) URN

Please follow the below steps to check your eligibility for Pradhan Mantri Jan Arogya (Ayushman Bharat) scheme

• Visit Pradhan Mantri Jan Arogya website

• Click on "Am I Eligible"

• Enter Mobile Number and Captcha

• Now you can search either by

  • Mobile number

  • Ration Card Number

  • Socio-Economic and Caste Census (SECC) Name

  • Rashtriya Swasthya Bima Yojana (RSBY) URN

Search by mobile number

An Additional Data Collection Drive (ADCD) was conducted on 30th April 2018 at Gram Sabha’s across India to capture the active mobile number and ration card number of a family of the Socio-Economic Caste Census (SECC) database. If the individual got his/her Mobile number or Ration card number captured during this drive, only then it will show results on the portal.

Please follow the below steps to check details by mobile number

• Choose your state

• Select "Search by Mobile Number"

• Enter the mobile number

• Click on the Search  button

Search by Ration Card number

Please follow the below steps to check details by Ration card number

• Choose your state

• Select "Search by Ration card Number"

• Enter the mobile number

• Click on the Search button

If the individual got his details captured during the ADCD drive and still no results are displayed, then the “SECC Name” option should be used for searching.

Search by SECC Name

An individual can search if he/she is eligible for PMJAY using his details as per the SECC database such as Name, Father’s Name, Gender, State etc.  Please follow the below steps to check details by SECC Name

• Choose your state

• Select "Search by Name"

• Enter the name followed by name of your father, mother and  spouse

• Choose your Gender

• Enter your Age

• Select Rural or Urban part

• Enter District, Village, Pincode

• Click on the Search  button

Even now, if no results are displayed, then the user should contact a nearby Ayushmaan Mitra.

Search by RSBY URN

If all active families that are enrolled under Rashtriya Swasthya Bima Yojana (RSBY) (till 31st March 2018) that do not feature in the targeted groups as per SECC data will be included as well and can identify if they are eligible for PMJAY using RSBY URN.

Please follow the below steps to check details by RSBY URN

• Choose your state

• Select "Search by RSBY URN"

• Enter the RSBY URN number

• Click on the Search button

If your name appears in any of these searches, you are a beneficiary of the Ayushman Bharat scheme.

How to Avail this Services?

Please follow the below steps to access care under the Ayushman Bharat scheme (Pradhan Mantri Jan Arogya Yojana)

• Patients approach the empanelled hospital. You can find the list of empanelled hospitals here.

• Arogya Mitras will assist in admission, beneficiary verification, authentication, query management, grievance redressal.

• The hospital will confirm the person is an eligible beneficiary under the Ayushman Bharat scheme by checking the beneficiary's Aadhar or any relevant documents.

• Hospital select packages and checks balance.Submit supporting evidence required for treatment

• Undergo Treatment

• Discharge

• The hospital should submit a discharge summary and post-treatment evidence 

• Electronic payments will be made to Hospital

If the beneficiary has any issues, the beneficiaries can also call the helpline number at 14555. Regular updates will also be provided through ASHAs, ANM and other specific touchpoints.

List of Hospitals

Follow the below steps to find empanelled hospitals under the Ayushman Bharat scheme.

• Visit Pradhan Mantri Jan Arogya website

• Click on "Find Hospitals"

• Now you can search for the hospital by State, District, Name, Type or Speciality.

• Details of the hospital along with the phone number of the contact person will be displayed.

References

While crafting this guide, we have consulted reliable and authoritative sources, including official government directives, user manuals, and pertinent content sourced from government websites.

• NHA Guidelines

• Beneficiary Identification Guidelines

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