Ayushman Bharat
Ayushman Bharat is a special health scheme started by the Government of India. It was launched in 2018 to make sure everyone has access to good healthcare. This scheme aims to help poor and vulnerable families, so no one is left behind in getting medical care.
Table of Contents
Ayushman Bharat has two main parts:
- Health and Wellness Centres (HWCs)In February 2018, the government announced that it would set up 1,50,000 Health and Wellness Centres. These centres will help people get the medical care they need right in their neighbourhoods. They will provide services for mothers and children and help manage diseases like diabetes and heart issues.The focus of these centres is to keep people healthy by teaching them about good habits and encouraging them to stay active. This way, we can reduce the chances of serious health problems.
- Pradhan Mantri Jan Arogya Yojana (PM-JAY)The second part of Ayushman Bharat is called PM-JAY. It was launched on 23rd September 2018 by Prime Minister Narendra Modi in Ranchi, Jharkhand.PM-JAY is one of the largest health insurance schemes in the world. It offers health coverage of up to ₹5 lakh per family every year for hospital treatments. This scheme is for over 12 crore poor families, which is about 55 crore people in India. Families are chosen based on their economic status.PM-JAY was formerly known as the National Health Protection Scheme. It also includes families that were part of an earlier scheme started in 2008. The costs of this scheme are completely funded by the government.
Key Features of PM-JAY
- PM-JAY provides ₹5 lakh health insurance for each family every year.
- It covers secondary and tertiary hospital treatments in both public and private hospitals.
- Over 12 crore poor families can benefit from this scheme.
- Patients do not have to pay anything at the hospital when they receive treatment.
- The scheme helps families avoid huge medical expenses that could push them into poverty.
- It covers some expenses before and after hospitalization.
- There are no limits on family size or age, and all existing medical conditions are covered from day one.
- Beneficiaries can use the insurance in any empanelled hospital across the country.
- It includes about 1,929 different medical procedures, covering all related costs, such as medicines and doctors’ fees.
Benefits Under PM-JAY
Earlier government health schemes had a limit on how much they would pay for treatment, but PM-JAY provides coverage of up to ₹5 lakh for each eligible family. This includes:
- Medical check-ups and treatment
- Expenses before going to the hospital
- Medicines and medical supplies
- Care in regular and intensive wards
- Tests and laboratory investigations
- Hospital stay costs
- Food services during treatment
- Follow-up care for up to 15 days after leaving the hospital
The ₹5 lakh coverage can be used by any family member, and there is no limit on how many members can be covered. This means that everyone in the family can get the treatment they need, even if they had health issues before joining the scheme.
Eligibility for Ayushman Bharat
Rural Beneficiaries
For families living in rural areas, PM-JAY helps those who meet at least one of the following six criteria for deprivation:
- They live in a house with only one room and have kucha (temporary) walls and roof.
- There is no adult member aged 16 to 59 in the household.
- There are no adult male members aged 16 to 59.
- There is a disabled person in the family, and no one else can work.
- The family belongs to the Scheduled Caste (SC) or Scheduled Tribe (ST).
- They are landless and earn most of their income from casual labour.
Urban Beneficiaries
In urban areas, people from the following 11 job categories can apply for the scheme:
- Ragpickers
- Beggars
- Domestic workers
- Street vendors, cobblers, hawkers, and other service providers
- Construction workers, plumbers, masons, labourers, painters, welders, security guards, and coolies
- Sweepers and sanitation workers
- Home-based workers, artisans, handicrafts workers, and tailors
- Transport workers like drivers, conductors, helpers, cart pullers, and rickshaw pullers
- Shop workers, assistants, peons in small businesses, delivery helpers, and waiters
- Electricians, mechanics, assemblers, and repair workers
- Washermen and chowkidars (watchmen)
Exclusions
The following groups are not eligible for the scheme:
- People who own a two-wheeler, three-wheeler, or four-wheeler, or a motorized fishing boat.
- Those with mechanized farming equipment.
- Individuals with Kisan cards having a credit limit of ₹50,000.
- Government employees.
- Workers in government-managed non-agricultural enterprises.
- Those earning more than ₹10,000 a month.
- People who own refrigerators or landline phones.
- Families living in well-built houses.
- Those who own 5 acres or more of agricultural land.
Application Process
Offline Application
To apply for the PM-JAY scheme, a person can visit a hospital or Community Service Centre (CSC) for identification. Here are the steps to get a PM-JAY e-card:
Step 1: The Arogya Mitra checks the list of beneficiaries using details like name, location, ration card number, mobile number, or RSBY URN.
Step 2: The operator searches for the person in various databases, including SECC, RSBY, and State Health Scheme.
Step 3: If the name is found, the person must provide ID documents like an Aadhaar card and a ration card to confirm their identity.
Step 4: The Arogya Mitra then checks the family records through the ration card and uploads the scanned documents for approval.
Step 5: The health insurance company or trust will then approve or reject the application. If rejected, the State Health Agency will do a final check.
Step 6: If approved, an e-card will be issued to the beneficiary.
How to Apply Now
You can apply through the UMANG app.
Documents Required
- Age and identity proof (like Aadhaar Card or PAN Card).
- Proof of address.
- Contact details (mobile number, email).
- Caste certificate.
- Income certificate.
- Document showing the family status (joint or nuclear).
- Aadhaar card.
Also Check This Scheme:
- Indira Gandhi National Widow Pension Scheme (IGNWPS): 2024
- Indira Gandhi National Old Age Pension Scheme: Financial Security for Senior Citizens: 2025
- Pradhan Mantri Jeevan Jyoti Bima Yojana : 2024
Frequently Asked Questions (FAQs) about Ayushman Bharat and PM-JAY
Will beneficiaries have to pay anything to get covered under this scheme?
No, PM-JAY is a cashless scheme for beneficiaries at the point of service. They will not have to pay anything at the hospital.
What is the enrollment process? Is there any time period for enrollment?
Beneficiaries are identified based on the Socio-Economic Caste Census (SECC) 2011 data. There is no specific enrollment period; eligible families are automatically covered.
Will a card be given to the beneficiary?
Yes, eligible beneficiaries will receive an Ayushman Bharat card, which they can use to access services under the scheme.
Are already existing illnesses covered under this scheme?
Yes, all pre-existing conditions are covered from day one of the scheme.
Are benefits available for newborn children under this scheme?
Yes, newborns are automatically included in the coverage under PM-JAY.
Are RSBY cardholders covered under the scheme?
Yes, families that were previously covered under the Rashtriya Swasthya Bima Yojana (RSBY) are included in PM-JAY.
Can benefits under this scheme be available without an Aadhar Card?
While Aadhar is generally used for identification, beneficiaries can also avail of services using other forms of identification as stipulated by the state.
Who is Aarogya Mitra?
Aarogya Mitras are trained personnel present at hospitals to assist beneficiaries with the process of availing of services under PM-JAY, including helping with documentation and claim submissions.
How does the claim submission process work?
Claims are submitted by the empanelled hospitals on behalf of beneficiaries through a digital platform. Hospitals are required to submit necessary documents and details for reimbursement.
What is Pradhan Mantri Jan Arogya Yojana (PM-JAY)?
PM-JAY is a health assurance scheme under Ayushman Bharat, providing comprehensive health coverage of ₹5 lakhs per family per year for secondary and tertiary care hospitalization.
What health services are available under PM-JAY?
The scheme covers a wide range of services, including surgeries, diagnostics, and other inpatient treatments across various medical specialties.
Where can beneficiaries avail of services under PM-JAY?
Beneficiaries can avail of services at public and private empanelled hospitals across India.
How are the beneficiaries identified?
Beneficiaries are identified based on the data from the SECC 2011, focusing on socio-economic criteria.
Can those families whose names are not on the list avail of the benefits under PM-JAY?
Families not listed in the SECC 2011 data cannot avail of the benefits directly. However, they can appeal for inclusion based on specific criteria set by the state government.
What is the maximum time required for approval of claim submission requests?
The approval time for claims typically ranges from a few days to a few weeks, depending on the complexity and documentation provided.
Who are the members of various grievance committees?
Grievance committees typically include representatives from the health department, hospital administration, and community representatives. These committees are tasked with resolving issues faced by beneficiaries.
For any further queries or specific assistance, beneficiaries can reach out to local health officials or visit the official PM-JAY website.
