A Brief Overview

The Ayushman Bharat Yojana which is also known as  Pradhan Mantri Jan Arogya Yojana (PM-JAY) was launched in the month of September 2018 by The Ministry of Health and Family Welfare, Government of India. It is a part of the National Health Policy and its administrative authority has been given to the National Health Authority. This initiative was taken by the Union Government for redressal of healthcare issues of deprived and underprivileged sections of the society in the country. It aims to provide health care insurance and free cashless services to the poor in urban and rural areas.

Eligibility criterion

This scheme can be availed by marginalized sections of society. The criteria are different for rural and urban area residents. It is mainly based on socio-economic factors in rural areas and certain types of occupations in urban areas. The following list mentions the inclusions:-

Urban area resident inclusion list: 

Domestic help, rag pickers, security guards, sweepers, cobbler, street vendor, hawker, shop workers, peon, plumbers, masons, construction workers, transport workers, home-based worker, handicrafts workers, repair workers, beggars, coolie, sanitation workers, mason, plumbers, tailors, delivery assistant, waiter, washerman, and a few others.

Rural area resident inclusion list: 

Residents living in one room ‘Kutcha’ houses; Families with no adult in the age group of 16 to 59 years and also families with no adult male member in the age group of 16 to 59yrs; Households with no land, working as manual labourers; Households with disabled members; Scheduled caste and tribe as well as primitive tribal communities; Beggars, manual scavengers and former bonded labourers.

Exclusion criterion from the Scheme

Just like the PM-JAY sets pre-conditions for availing the scheme, similarly, it also etches out the exclusions very clearly. This has been done to direct the benefits of the scheme to the deserving people who are poor and do not have access to healthcare facilities.

Hence the following includes the exclusions list:-

  • Government employees and people working in non-agricultural setups managed by the Government.
  • People having Kisan cards, refrigerators, two-wheelers, four-wheelers, ‘pucca’ houses, 5acre or more agricultural land, farming equipment, landline phone, fishing boat, and monthly income is more than Rs 10,000.

Details & Benefits of PM-JAY Scheme:

  • PM-JAY will provide a health insurance cover per family amounting to Rs 5 lakh.
  • It aims to provide the facility to 50 crore people in India.
  • It will pave the way for cashless treatment at enlisted hospitals.
  • It also includes secondary and tertiary medical costs.
  • The Scheme costs will be shared by Central and State Governments in 60:40 ratio.
  • The Scheme also covers expenses for 3 days of pre-hospitalisation and 15 days of post-hospitalisation.
  • It covers insurance for 1393 medical procedures including critical illnesses such as Prostate Cancer, Coronary Artery Bypass Grafting, Double Valve Replacement., Pulmonary Valve Replacement, Skull Base Surgery, Anterior Spine Fixation, Laryngopharyngectomy with Gastric Pull-up, Tissue Expander for disfigurement following burns, and Carotid Angioplasty with a stent.
  • The Scheme can be availed at any of the government empanelled public and private hospitals in the country.
  • It does not put the criteria for the age limit.
  • All the necessary medical costs on ICU, OT, surgeon and doctor fee, medication are covered under this Scheme
  • In cases of multiple surgeries, the highest cost would be covered and 50% of second and 25% of the third.
  • Food services, hospital accommodation and diagnostic procedures are also included in the insurance package.
  • The Scheme includes 25 specialities such as cardiology, neurosurgery, oncology, paediatrics, orthopaedics, etc.

Application Procedure

The application has to be made through the government web portal  https://www.pmjay.gov.in/. The eligibility of the family can be checked through the portal. An E-card will be generated and identification documents have to be verified from PM-JAY kiosks. Finally, after the procedure of verification of eligibility and identification is complete, the E-Card will be printed with a unique AB PM-JAY number which will be required for its usage.

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