All About Ayushman Bharat Yojana, Eligibility & Application

Ayushman Bharat Yojana is a scheme that helps the economically weaker sections of society receive healthcare facilities. Also known by the name Pradhan Mantri Jan Arogya Yojana (PMJAY), and rolled out on the 23rd of September 2023 by the Prime Minister, this health insurance scheme covers around 50 crore citizens of India.

Here are some of the most important features/characteristics of this National Health Protection Scheme:

• The scheme provides a coverage of Rs. 5 lakhs to every eligible family per year. This amount will cover treatments in 25 specialities (such as cardiology, neurosurgery, paediatrics, oncology, orthopaedics, etc.)
• The scheme makes secondary and tertiary healthcare paperless and cashless for the underprivileged sections.
• It takes care of about 1,400 treatments/procedures along with all related costs, such as OT charges. The patients can also reach out to their respective doctors for follow-up for full recovery.
• PMJAY allows treatment at empanelled/network public and private hospitals and covers the costs of hospitalization and medication as well.
• It further covers 3 days of pre-hospitalization as well as 15 days of post-hospitalization expenses.

PMJAY is one of the biggest healthcare schemes funded by the Government of India. While it covers 10 crore families without any limitations on family size and age, the scheme lets the people below the poverty line receive the required treatment.

Moreover, the plan is specially designed for those without access to the internet or online health plans. It recompenses the cost of transportation incurred during hospitalization and covers all day-care expenses.

PMJAY Coverage and Eligibility

Rural:

The scheme covers 8 crore families in rural areas. These have been selected based on those with deprivations such as lack of housing and meager income. It will help families as per the data in the Socio-Economic Caste Census 2011 as well as the households enrolled under the RSBY (Rashtriya Swasthya Bima Yojana).

The following are the ones eligible from rural areas:

• Those living in scheduled tribe and scheduled caste households
• Families without individuals between 16 and 59 years of age
• Beggars and those dependent on alms
• Primitive tribal communities
• Families with at least one physically challenged person and no able-bodied adult member
• Legally released bonded laborers
• Landless households living by working as casual manual laborers
• Manual scavenger families
• Families surviving in one-room makeshift houses without proper roofs/walls

Urban:

The PMJAY scheme is to help the families of urban workers in the occupational category, that are present in the Socio-Economic Caste Census 2011. It is also to benefit those enrolled under the RSBY.

The following are the ones eligible from urban areas:

• Watchmen/washermen
• Rag pickers
• Domestic help
• Electricians, mechanics, repair workers
• Sanitation workers, sweepers, gardeners
• Hawkers, cobblers and other services provided on pavements or streets
• Home-based artisans, tailors, or handicraft workers
• Masons, plumbers, painters, construction workers, welders and security guards
• Assistants, delivery boys, peons in small establishments, shopkeepers, and waiters
• Transport workers such as conductors, drivers, rickshaw/cart pullers, helpers

The ones who are not entitled to health coverage under PMJAY are those:

• Owning a 2, 3 or 4-wheeler, or a motorised fishing boat
• Having kisan cards with Rs. 50,000 as the credit limit
• Working in non-agricultural enterprises managed by the government
• Employed by the government
• Owning landlines and refrigerators
• Earning above Rs. 10,000 per month
• Having decent and solidly built houses
• Owning five acres or more of agricultural land

One may note here that medical and surgical expenses can’t be reimbursed at the same time. In case multiple surgeries are needed, the highest package cost in the first instance is paid for. This is followed by a 50% waiver for the second and a 25 % discount for the third. Moreover, there won’t be any waiting period for pre-existing diseases under this scheme.

PMJAY Illness Coverage

PMJAY coverage and assistance are valid for daycare procedures and are also applicable for pre-existing conditions. There are over 1,350 medical packages for which the scheme extends coverage.

Here is a list of some of the critical illnesses covered:

• Coronary artery bypass grafting
• Carotid angioplasty with stent
• Prostate cancer
• Double valve replacement
• Skull base surgery
• Anterior spine fixation
• Laryngopharyngectomy with gastric pull-up
• Pulmonary valve replacement
• Tissue expander for disfigurement after burns

Here is another list of some of the exclusions under PMJAY:

• Drug rehabilitation programme
• OPD
• Organ transplants
• Cosmetic procedures
• Individual diagnostics (for evaluation)
• Fertility-related procedures

Utilising the features of the PMJAY scheme will help people be free of the risk of a debt trap and any strain on their finances.

How to Apply for the Scheme

You need not apply anywhere to avail yourself of the benefits of the Ayushman Bharat Yojana. If you are eligible, you just need to get the e-card.

To check your eligibility:

• Visit the PMJAY portal, click on ‘I am Eligible’
• Enter your mobile number as well as the CAPTCHA code, and click on ‘Generate OTP’
• Select your state, then search by name/ HHD number/ ration card number/ mobile number
• Alternatively, you can also approach any EHCP or Empanelled Health Care Provider. One may also choose to call the call centre number: 14555 or 1800-111-565.

Coming to the e-card generation aspect, you can reach out to a PMJAY kiosk and get your Aadhaar or ration card verified. You will require family identification proofs including a government-certified list of members, an RSBY card and a PM letter. You will receive a printed e-card with the unique AB-PMJAY ID, which you can use at any time in the future.

Conclusion

Ayushman Bharat Yojana is also known as the AB-PMJAY scheme. It subsumes the RSBY and SCHIS or Senior Citizen Health Insurance Scheme. This scheme is helpful not just for the poor, but also for the destitute families in both rural and urban areas. It covers 40% of the vulnerable families of the country and is free of cost.