Ayushman Bharat – PM-JAY

About PM-JAY

The scheme “Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana” implemented by the National Health Authority (NHA) under Ministry of Health and Family Welfare, Government of India, aims to provide cashless hospitalisation coverage of ₹5,00,000 per family per year to poor and vulnerable families for secondary and tertiary healthcare services. It was launched on 23rd September 2018 in Ranchi, Jharkhand, by the Hon’ble Prime Minister of India.
"Ayushman Bharat" is an attempt to move from a sectoral and segmented approach to health service delivery to a comprehensive need-based health care service. This scheme aims to undertake path-breaking interventions to holistically address the healthcare system (covering prevention, promotion, and ambulatory care) at the primary, secondary, and tertiary levels. Ayushman Bharat adopts a continuum of care approach, comprising two interrelated components, which are -

• Health and Wellness Centres (HWCs): The scheme aims to provide comprehensive primary healthcare services, including maternal and child health, non-communicable disease care, free essential drugs, and diagnostics, close to people’s homes. The centres promote preventive healthcare and healthy behaviours to reduce the risk of chronic diseases.
• Pradhan Mantri Jan Arogya Yojana (PM-JAY): The second component under Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojna or PM-JAY as it is popularly known. It aims to provide cashless health insurance coverage of up to ₹5,00,000 per family per year for secondary and tertiary hospitalization to poor and vulnerable families.

About NHA

National Health Authority (Nha) Is The Apex Body Responsible For Implementing India’s Flagship Public Health Insurance/Assurance Scheme Called “Ayushman Bharat Pradhan Mantri Jan Arogya Yojana” & Has Been Entrusted With The Role Of Designing Strategy, Building Technological Infrastructure And Implementation Of “Ayushman Bharat Digital Mission” To Create A National Digital Health Eco-System. Nha Is Leading The Implementation For Ayushman Bharat Digital Mission (Abdm) In Coordination With Different Ministries/Departments Of The Government Of India, State Governments, And Private Sector/Civil Society Organizations.

Benefits of PM-JAY Scheme

Financial Health Insurance Cover:
• Annual Hospitalization Coverage: Cashless coverage up to ₹5,00,000/- per family per year.
• Comprehensive Treatment Costs: Covers consultation, medicines, diagnostics, surgery, ICU, implants, accommodation, and food.
• Pre and Post Hospitalization Support: Covers 3 days pre-hospitalization and 15 days post-hospitalization expenses.
• Treatment Complication Coverage: Covers complications arising during treatment.
Coverage Features:
• Pre-Existing Disease Coverage: Covers all pre-existing diseases from day one.
• No Family Size Limit: No restriction on age, gender, or family size.
• Nationwide Portability: Benefits available across India in empanelled hospitals.
• Wide Procedure Coverage: Covers approximately 1,929 medical procedures.

Eligibility Criteria (Rural & Urban)

Rural Beneficiaries:
Out of the total seven deprivation criteria for rural areas, PM-JAY covered all such families who fall into at least one of the following six deprivation criteria and automatic inclusion(Destitute/ living on alms, manual scavenger households, primitive tribal group, legally released bonded labour) criteria:

1. Only one room with kucha walls and kucha roof
2. No adult member between ages 16 to 59
3. Households with no adult male member between ages 16 to 59
4. Disabled member and no able-bodied adult member
5. SC/ST households
6. Landless households deriving a major part of their income from manual casual labour
Automatically included Households without shelter
7. Destitute/ living on alms,
8. Manual scavenger families,
9. Primitive tribal groups,
10. Legally released bonded labour.

Urban Beneficiaries:
For urban areas, the following 11 occupational categories of workers are eligible for the scheme:

1. Ragpicker
2. Beggar
3. Domestic worker
4. Street vendor/ Cobbler/hawker / other service provider working on streets
5. Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and other head-load worker
6. Sweeper/ Sanitation worker/ Mali
7. Home-based worker/ Artisan/ Handicrafts worker/ Tailor
8. Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller
9. Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter
10. Electrician/ Mechanic/ Assembler/ Repair worker
11. Washer-man/ Chowkidar

How to Apply / Check Eligibility

• Visit official PM-JAY website
• Enter mobile number & verify via OTP
• Search by ration card / mobile / name
• Visit nearest CSC for assistance

Documents Required

1. Age & Identity Proof (Aadhaar Card / PAN Card)
2. Proof of Address
3. Contact Details (Mobile Number, E-mail)
4. Caste Certificate
5. Income Certificate
6. Document Proof of Current Family Status (Joint or Nuclear)
7. Aadhaar Card

Application Process (Offline & Online)

Online: Check eligibility through official portal and generate e-card.

Offline: Visit empanelled hospital or Common Service Center (CSC) with documents.

Exclusions

• Those who own a two, three, or four-wheeler or a motorized fishing boat.
• Those who own mechanized farming equipment.
• hose who have Kisan cards with a credit limit of ₹50,000/-.
• Those employed by the government.
• Those who work in government-managed non-agricultural enterprises.
• Those earning a monthly income above ₹10,000/-.
• Those owning refrigerators and landlines.
• Those with decent, solidly built houses.
• Those owning 5 acres or more of agricultural land.

Frequently Asked Questions

Q: Will beneficiaries have to pay anything to get covered under this scheme?
No. All eligible beneficiaries can avail free services for secondary and tertiary hospital care for identified packages under PM-JAY at public hospitals and empaneled private hospitals. Beneficiaries will have cashless and paperless access to health services under PM-JAY.

Q: What is the enrollment process? Is there any time period for enrollment?
PM-JAY is an entitlement based mission. There is no enrollment process. Families who are identified by the government on the basis of deprivation and occupational criteria using the SECC database both in rural and urban areas are entitled for PM-JAY.

Q: Is there any registration fee?
No, PM-JAY is completely free.

Q: Can private hospitals provide treatment?
Yes, if empanelled under PM-JAY.