Pradhan Mantri Jan Arogya Yojana (PMJAY)

Introduction

Access to affordable healthcare is a fundamental right for every citizen. Recognizing this, the Government of India launched the Pradhan Mantri Jan Arogya Yojana (PMJAY), also known as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), in September 2018. This revolutionary scheme aims to provide comprehensive medical cover to a significant portion of India’s population.

This blog post serves as a one-stop resource for everything you need to know about PMJAY. We’ll delve into the scheme’s eligibility criteria, benefits offered, application process, and how to avail healthcare services under PMJAY.

What is Pradhan Mantri Jan Arogya Yojana (PMJAY)?

PMJAY, also known as Ayushman Bharat PM-JAY, is the world’s largest government-funded health insurance scheme. It targets over 10 crore (100 million) poor and vulnerable families, roughly 50 crore (500 million) beneficiaries, constituting the bottom 40% of India’s population. It offers financial assistance of up to Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization. This scheme aims to mitigate the financial burden of medical treatment, which often pushes families into poverty.

Benefits Covered under Pradhan Mantri Jan Arogya Yojana (PMJAY)

PMJAY offers a wide range of benefits, including:

Hospitalization expenses: Covers room charges, doctor’s fees, medicines, surgical procedures, anesthesia, and diagnostic tests during hospitalization.
Pre and Post hospitalization care: Up to 15 days of pre-hospitalization and 15 days of post-hospitalization expenses are covered.
Maternity benefits: Covers normal or caesarean deliveries along with pre and post-natal care.
Secondary and tertiary care: The scheme covers treatment across various specialties like cardiology, oncology, nephrology, and more.

Who is Eligible for Pradhan Mantri Jan Arogya Yojana (PMJAY)?

PMJAY primarily targets poor families and vulnerable populations identified through the Socio-Economic Caste Census (SECC) data. Here’s a breakdown of the eligibility criteria:

Families listed in SECC data: This includes families classified as “identified as having deprivation” or those holding a Rashtriya Swasthya Bima Yojana (RSBY) card.
Informal workers: Street vendors, construction workers, domestic helpers, rickshaw pullers, and other informal sector workers are eligible.
Farmers and agricultural workers: Small and marginal farmers are covered under the scheme.
Elderly population: Individuals aged 60 and above living in economically weaker sections are included.
Identified professions: PMJAY covers sanitation workers, mine workers, and workers in hazardous occupations.
Women and children: Pregnant women and children are prioritized under the scheme.

Documents Required for PMJAY Application

While applying, you’ll need to have the following documents readily available:

Aadhaar card: This is the primary document for identification and verification under PMJAY.
Ration card: If you don’t have an Aadhaar card, a valid ration card can be used for verification.
Income certificate (optional): While not mandatory in all cases, some states might require an income certificate for specific categories.

How to Apply for PMJAY?

There are multiple ways to check your eligibility and apply for PMJAY:

Ayushman Bharat Website: Visit the official PMJAY website and use the “Am I Eligible” option to enter your details and check your name in the SECC data.
UMANG App: Download the UMANG app from the app store and check your eligibility under the “Ayushman Bharat” section.
CSCs (Common Service Centres): Visit your nearest CSC and enquire about PMJAY eligibility and registration.
Helpline Number: Call the toll-free helpline number 14555 to get assistance with eligibility checks and registration.

How to Apply for PMJAY at official portal?

Online Registration:

Visit the PMJAY Website:Head to the official PMJAY portal at PMJAY website: https://pmjay.gov.in/.
Check Eligibility:Before registering, use the “Am I Eligible” tab to confirm if you or your family qualify for PMJAY benefits. You’ll need details like your name, ration card number, or mobile number.
Register Online:If eligible, proceed to the “Registration” section on the homepage.
Aadhaar Verification:Enter your Aadhaar number and click “Generate OTP.” An OTP will be sent to your registered mobile number.
Fill the Application:Enter the OTP and provide your personal information as requested in the online form.
Document Upload:You may need to upload scanned copies of documents like your Aadhaar card, ration card, or income certificate (depending on your eligibility criteria).
Review and Submit:Carefully review your application details before final submission

Guidelines for Enabling Pradhan Mantri Jan Arogya Yojana (PMJAY)

1. Search a Panelled Health Centre: The PMJAY website (https://nha.gov.in/) or the PMJAY app, can provide you with the list of assigned health centers that are panelled. Hospitals have an emblem representing PMJAY to show their connection to this scheme.

2. Proof Of Eligibility: Take along with you any other documents as requested by the hospital like ration card and valid government ID proof which is necessary for verification in order to get quality services from a hospital.

3. This may include pre-authorization if necessary: Pre-authorization from the insurance company may be required before some procedures can take place. If it does, the hospital will assist you through it.

4. Treatment without cash: All your bills will be settled directly between the hospital and your insurer; therefore, you are not required to make any payments prior treatment for covered procedures.

5. After Discharge: Keep all receipts and discharge summaries provided to you by hospitals safe for future reference purposes.

Conclusion

It has been proved through PMJAY initiative that there is transformation being witnessed on health care accessibility among millions of Indians through different approach empowering people which brings about healthier and safer future of everyone who adopts such kind of thinking in his or her life style choice level priority of health. With time, PMJAY will improve while dealing with its hardships making it among best accessible and affordable healthcare models not only locally but also among the world