Ayushman Bharat Scheme

Ayushman Bharat Scheme is the largest health assurance scheme in the world. Ayushman Bharat Scheme is the flagship scheme by the Government of India. Ayushman Bharat Scheme aims at providing a health cover of Rs. 5 lakhs per family per year.

Ayushman Bharat Scheme provides health cover for secondary and tertiary care hospitalization to over 10.74 crores of needy and vulnerable families. The Pradhan Mantri Jan Arogya Yojana (PMJAY) is popularly known as Ayushman Bharat Yojana Scheme. This scheme has approximately 50 crore beneficiaries.

Ayushman Bharat scheme delivers financial safeness in case of hospitalization due to medical crises. Let’s check out the eligibility criteria, benefits, and other details about Ayushman Bharat Yojana.

What is Ayushman Bharat Scheme (PMJAY)?

Ayushman Bharat Scheme aspires to cover more than 50 crore Indian citizens. PMJAY is considered the biggest healthcare scheme in the world. Ayushman Bharat Scheme is specially designed for the economically weaker section of the country.

Prime Minister Narendra Modi launched Ayushman Bharat Scheme on 23rd September 2018. Ayushman Bharat Scheme is also known as the Pradhan Mantri Jan Arogya Abhiyaan, Ayushman Bharat Yojana, or the National Health Protection Mission (AB-NHPM) or Medicare.

The government health insurance scheme covers most of the medical treatment costs, medicines, diagnostics, and pre-hospitalization expenditures. Further, the scheme offers cashless hospitalization services through the Ayushman Bharat Yojana e-card.

An e-card can be used to get healthcare services at any of the impaneled hospitals across the country. Beneficiaries of the scheme can get the benefit of hospitalization for necessary treatment by showing their Ayushman Bharat Yojana e-card.

Ayushman Bharat Scheme Features:

Features of the Ayushman Bharat Scheme are as follows-

  1. Ayushman Bharat Scheme is one of the world’s largest health insurance schemes sponsored by the Indian Government
  2. Coverage of Rs.5 lakh per family per annum for secondary and tertiary care across public and private hospitals
  3. Approximately 50 crore beneficiaries are eligible for this scheme
  4. The scheme gives access to cashless hospitalisation
  5. 3 days of Pre-hospitalisation expenses such as medicines and diagnostics covers up under this scheme
  6. 15 days of post-hospitalisation expenses contain medicines and diagnostics covers up under this scheme
  7. No regulation on the family size, gender or age
  8. Can avail services across the country at any of the empanelled public and private hospitals
  9. All pre-existing conditions were covered from day one
  10. About 1,393 medical procedures were comprised in the scheme
  11. Includes costs for diagnostic services, drugs, room charges, physician’s fees, surgeon charges, supplies, ICU and OT charges
  12. Public hospitals are compensated with private hospitals

What is Covered Under Ayushman Bharat Scheme?

The health insurance under Ayushman Bharat Scheme (PMJAY) includes hospitalization costs of individuals and contains the elements such as-

  • Medical examination, consultation and treatment
  • Pre-hospitalisation
  • Non-intensive and intensive care services
  • Medicine and medical consumables
  • Diagnostic and laboratory services
  • Accommodation
  • Medical implant services, wherever possible
  • Food services
  • Complication arising during treatment
  • Post-hospitalisation expenses for up to 15 days
  • COVID-19 (Coronavirus) treatment

What is Not Covered Under Ayushman Bharat Scheme?

The health insurance under Ayushman Bharat Scheme (PMJAY) excludes some of the elements from the coverage such as-

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

Ayushman Bharat Scheme Benefits:

Ayushman Bharat Scheme intent to help the weak sections of the society. The benefits of the PMJAY are as follows-

  • PMJAY covers all hospitalisation expenditures with cashless trades to individual
  • PMJAY also covers accommodation during the hospitalisation period
  • Pre and post-hospitalisation expenses
  • This scheme can be used by all family members
  • No restrictions on family size, age or gender
  • Pre-existing conditions are included from day one

Ayushman Bharat Scheme Eligibility Criteria:

The scheme has been launched to cover the bottom 40% of poor and economically weaker sections of the country. This was based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 for rural and urban areas. Eligibility criteria for the rural and urban areas for Ayushman Bharat Yojana are as follows-

PMJAY Rural:

  • Households with only one room with Kucha walls and roof
  • No adult member in the age group between 16 and 59 years
  • No adult male member in the age group between 16 and 59 years
  • Disabled member and no-abled bodied member in the household
  • SC and ST
  • Landless households and major sources of income are through manual casual labour

PMJAY Urban:

  • Beggar
  • Domestic worker
  • Ragpicker
  • Cobbler/Street Vendor/Hawker/Other service providers on the street
  • Plumber/Construction Worker/Mason/Painter/Labour/Welder/Security Guard/Coolie
  • Sweeper/Mali/Sanitation Worker
  • Artisan/Handicrafts Worker/Tailor/Home-based Worker
  • Driver/Transport Worker/Conductor/Cart or Rickshaw Pullers/Helper to Drivers or Conductors
  • Shop Workers/Peon in Small Establishment/Assistant/Helper/Attendant/Delivery Assistant/Waiter
  • Mechanic/Electrician/Repair Worker/Assembler
  • Chowkidar/Washer-man

Ayushman Bharat Yojana Scheme Non-eligible Criteria:

  • Individuals who have mechanised farming equipment
  • Individuals who own a two, three or four-wheeler
  • Individuals who hold a Kisan card
  • Government employees
  • Individuals who own a motorised fishing boat
  • Individuals who are earning more than Rs.10,000 per month
  • Individuals who are working in government-run non-agricultural enterprises
  • Individuals who own more than 5 acres of agricultural land
  • Individuals who own landline phones or refrigerators
  • Individuals who live indecently built houses

Diseases Covered Under Ayushman Bharat Scheme:

The medical care scheme expanded coverage

The medical care scheme extended coverage for more than 1300 medical packages at empanelled public and private hospitals in the country. The list of critical illnesses covered under Ayushman Bharat Yojana are as follows-

  1. Prostate cancer
  2. Double valve replacement
  3. Coronary artery bypass graft
  4. COVID-19
  5. Pulmonary valve replacement
  6. Skull base surgery
  7. Anterior spine fixation
  8. Laryngopharyngectomy with gastric pull-up
  9. Tissue expander for disfigurement following burns
  10. Carotid angioplasty with stent

Ayushman Bharat Yojana Apply Online:

Step 1: Visit the Ayushman Bharat Yojana Government official website and click on the “Am I Eligible” icon
Step 2: Enter your contact details and generate OTP
Step 3: Select your state
Step 4: Now, search either by your name, mobile number, HHD number, or ration card number
Step 5: The result will let you know if you are eligible for the PMJAY scheme or not

Documents Required For Ayushman Bharat Scheme:

The documents required to apply for the PMJAY scheme are as follows-

  • Identity and Age Proof (Aadhaar Card/PAN Card)
  • Details of your mobile number, email address and residential address.
  • Caste certificate
  • Income certificate
  • Documents stating your current family status.

How To Download Ayushman Bharat Yojana Card Online?

To confirm cashless, paperless, and portable transactions through the PMJAY scheme, the Ayushman Bharat Yojana Golden Card will be allocated to the individuals. This PMJAY e-card contains all the essential information of the patient and it is important to present the card while availing of the treatment.

Steps to download PMJAY card online are as follows-

Step 1: Visit the PMJAY official website and log in with your registered mobile number
Step 2: Enter the ‘Captcha Code’ to generate the OTP
Step 3: Wait for the HHD code
Step 4: Provide the HHD code to the Common Service Centre (CSC), where they would check the HHD code and other details
Step 5: The CSC representatives who are known as Ayushman Mitra will complete the rest of the process
Step 6: You will have to pay Rs.30 to get the Ayushman Bharat card

Pradhan Mantri Jan Arogya Yojana Toll-free Helpline Number: 14555/ 1800-111-565
Address: National Health Authority of India, 3rd, 7th and 9th Floor, Tower-L, Jeevan Bharati Building, Connaught Place, New Delhi – 110001

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