Know All About PMJAY - Benefits & Coverage

Public health schemes in India are initiatives taken by the government to improve the health and well-being of its citizens. These schemes cover a wide range of topics, from primary health care, preventive care, and nutrition, to mental health services, reproductive health, and disease prevention.

The Indian government has taken various steps to improve the public health system and provide better access to health care for its citizens. The National Health Mission (NHM) is the flagship program of the government that works towards providing universal access to quality healthcare services. The NHM has launched multiple initiatives to provide health services to the rural and urban poor, to lower the burden of communicable and non-communicable diseases, and to improve the health of women, children, and other vulnerable populations.

One such scheme is Pradhan Mantri Jan Arogya Yojana or PMJAY. This blog will discuss the benefits, inclusions, exclusions and how to get enrolled under this scheme and benefit from it.

What is PMJAY?

Pradhan Mantri Jan Arogya Yojana (PMJAY), also known as Ayushman Bharat Yojana, is a scheme that aims to help the financially weaker sections of society that require help with healthcare facilities. The Prime Minister launched it in 2018, and the health insurance scheme has about 50 crore Indian citizens under its umbrella. 18,059 hospitals have been empanelled, 4,406,461 beneficiaries have been admitted, and 10 crore e-cards have been issued since September 2019. You can go to the PMJAY portal to get registered and avail yourself of the benefits of this scheme.

The PMJAY beneficiaries receive an e-card with which they can avail of the services at hospitals anywhere in India. You also get cashless treatment. Its coverage includes 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses. Expenses like OT (Operation Theatre) and other 1,400 procedures are covered under PMJAY. It grants ₹5 lakhs to every family yearly and provides healthcare to the economically underprivileged people in society.

PMJAY Benefits

The scheme takes care of the underprivileged and financially vulnerable sections of our society, and these are the benefits of PMJAY

• All hospitalisation expenses are covered with cashless transactions
• Availability of hospitalisation accommodation
• Costs related to pre-hospitalisation and post-hospitalisation
• Covers complications that might arise during the treatment
• Available to all members of the family
• No cap on gender, age, or family size 
• Includes pre-existing conditions

PMJAY Coverage

The Ayushman Bharat Yojana Scheme covers the following critical illnesses or diseases:

• Carotid angioplasty with a stent 
• COVID-19
• Anterior spine fixation
• Laryngopharyngectomy with gastric pull-up
• Prostate cancer
• Coronary artery bypass graft
• Double valve replacement
• Pulmonary valve replacement
• Tissue expander for disfigurement following burns

What Is the Application Process For PMJAY?

The PMJAY does not have a particular application process. The SECC (Socio Economic and Caste Census) 2011 has identified beneficiaries, and everyone under that is covered. People who are a part of the RSBY (Rashtriya Swasthya Bima Yojana) scheme are also covered. There is a process with which you can check your eligibility. Let's see: 

• Go to the official PMJAY portal
• Click on "Am I Eligible"
• Enter your mobile number and the CAPTCHA 
• Click on "Generate OTP"
• Select your State by mobile number/ration card number/HHD number/name
• Verify whether you are covered or not

There is another way if you do not want to check this online. You can visit any Empanelled Health Care Provider (EHCP) and check. 

You can also call the PMJAY call centre on 14555 or the toll-free number 1800-111-565. 

What is the Hospitalisation Process under PMJAY?

If you or a family member requires hospitalisation, you are not required to pay anything under the PMJAY scheme if you are admitted to any of the empanelled public or private hospitals. The entire hospitalisation and treatment process is cashless due to a 60:40 cost-sharing arrangement between the centre and the state. There are about 25 medical specialities that you can avail of, such as:

• Neurosurgery
• Paediatrics
• Orthopaedics
• Cardiology
• Oncology

However, surgical and medical expenses cannot get reimbursement simultaneously. If more than one surgery is required, then the highest cost of the package is paid. A 50% waiver follows it in the second case and a 25% discount in the third. 

There is no waiting period for pre-existing diseases with PMJAY, unlike other health insurances. 

If anyone covered under the PMJAY is hospitalised, they can go to any private or government hospital and get hospitalised free of charge. 

Exclusions Under PMJAY

This scheme provides financial protection against illness and hospitalisation expenses for up to ₹5 lakhs per family per year. However, certain treatments and procedures are excluded from the coverage of PMJAY. These exclusions are:

• Individual diagnostics for evaluation
• Organ transplants
• Fertility related procedures
• Cosmetic related procedures
• Drug rehabilitation program
• OPD

How to Download PMJAY Card Online?

The PMJAY Golden Card is issued to every beneficiary to ensure paperless, cashless, and portable transactions. The e-card has all the necessary information about the patient. You must carry this card mandatorily when you avail of any service under the PMJAY scheme. 

The following is the process to get the Golden Card:

• Visit the official PMJAY website: (https://mera.pmjay.gov.in/search/login)
• Login using your registered contact number 
• Enter the CAPTCHA and generate your OTP
• Provide your HHD code to the CSC (Common Service Centre) for them to check the code and related details
• Ayushman Mitra or the CSC representatives would complete the process
• Pay Rs. 30 to get the PMJAY card

Why Should You Have a Health Insurance?

Health insurance benefits are plenty, the most crucial being getting medical treatment without burning a hole in your pocket. Using PMJAY allows you to stay away from the debt trap because many people take up loans to get their medical treatment. PMJAY allows you to get treatment for up to Rs. 5 lac. You can also buy health insurance policies from the Best Health Insurance Company In India, such as Niva Bupa. They offer more benefits and coverages for you and your loved ones.

You can also purchase Family Health Insurance Plans to ensure your family is financially secure under one umbrella. With Niva Bupa, you can buy individual health insurance plans with low health insurance cost  or even Best Health Insurance For Senior Citizens. Niva Bupa would cover all your necessary medical expenses, and you can feel financially secure regarding medical treatments. Buying health insurance plans online is easy, and you can visit Niva Bupa's website to choose from a list of excellent insurance plans. The health insurance claims are hassle-free, and you can avail any of the services anytime online.