Pradhan Mantri Jan Arogya Yojna (PMJAY) : Check Eligibility, Age Limit, Registration, Benefits, Helpline Number

Ayushman Bharat Yojana, also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY), is a scheme that aims to help the economically weaker section of society who needs healthcare facilities.

The PMJAY scheme was rolled out by the Prime Minister on September 23, 2018. This health insurance scheme covers about fifty crore citizens in India. Ayushman card already has several success stories to its credit. As a most recent addition to the benefits covered under the PMJAY scheme, all senior citizens above 70 years of age, irrespective of their socio-economic background will be eligible for a Rs. 5 lakh health insurance coverage per year. In this article, we will further discuss in detail the benefits, coverage, eligibility, exclusions, and more about the Ayushman Bharat Yojana.

What is PMJAY (Ayushman Bharat Yojana)?

The Ayushman Bharat Yojana (PMJAY), a flagship health insurance initiative of the Government of India, provides comprehensive coverage for tertiary and secondary hospitalisation expenses. This program is designed to benefit over 12 crores impoverished and vulnerable families.

The Ayushman Bharat Yojana - National Health Protection Scheme has now been renamed Pradhan Mantri Jan Arogya Yojana. This plans to make secondary and tertiary healthcare completely cashless for the underprivileged section of society. The PM Jan Arogya Yojana beneficiaries get an Ayushman card to avail of services at an empanelled hospital, public, or private, anywhere in the country. With the PMJAY scheme, you can enjoy the benefit of walking into a hospital and obtaining cashless treatment.

About Ayushman Bharat scheme and card (PMJAY): Overview

PMJAY provides Rs. 5 lakh coverage to every family per year, thus helping the economically disadvantaged access healthcare services easily. Given below are the key details about the Ayushman Bharat Yojana:

Key highlights of PMJAY

PMJAY (Pradhan Mantri Jan Arogya Yojana) is a flagship government health insurance scheme with the following features:

• Coverage: Provides financial protection of up to Rs. 5 lakh per family per year for hospitalisation expenses.
• Eligibility: Encompasses families identified as beneficiaries under the Socio-Economic and Caste Census (SECC-2011).
• Geographic reach: Offers nationwide coverage across a comprehensive network of empanelled public and private hospitals.
• Operational efficiency: Facilitates a seamless and paperless process for accessing healthcare benefits.

What are the Eligibility criteria of PMJAY for rural and urban?

Eligibility for PMJAY is determined based on data from the Socio-Economic and Caste Census 2011 (SECC-2011). The following criteria apply to rural and urban households:

Rural households:

• Households residing in dwellings constructed with unbaked mud or other non-durable materials and comprising only a single room.
• Households lacking any adult male member within the age group of 16 to 59 years.
• Families with at least one disabled member and no able-bodied adult member for support.
• Households belonging to Scheduled Castes (SC) or Scheduled Tribes (ST) communities.
• Landless families primarily dependent on manual, casual labor for their livelihood.

Urban households:

PMJAY coverage extends to individuals employed in the following occupations:

• Domestic workers
• Street vendors
• Sanitation workers
• Construction laborers
• Transport workers (including drivers, conductors, and rickshaw pullers)

Eligibility criteria for senior citizens above 70 years

On September 12, 2024, the Union Cabinet approved the expansion of PMJAY for all senior citizens above 70 years of age. The specifications of the eligibility have been given below:

• All senior citizens, above 70 years of age, irrespective of their social-economic status will be given a health coverage of up to Rs. 5 lakh under this scheme.
• This expansion will enable the ease of financial expenses that may be required by senior citizens for healthcare.
• The Centre and State governments will share the cost of this extended coverage.
• Senior citizens aged 70 and above, who belong to families already covered under AB PM-JAY, will receive an additional top-up coverage of up to Rs 5 lakh per year exclusively for themselves. This coverage will not need to be shared with other family members below the age of 70.
• Senior citizens with private health insurance can benefit from the scheme alongside their existing coverage.
• Seniors enrolled in other public health schemes, such as CGHS, ECHS, or Ayushman CAPF, must choose between their existing coverage and the new Ayushman Bharat health insurance.

All eligible senior citizens will be issued a separate health card to facilitate easier access to the scheme’s benefits.

PMJAY Rural

The 71st round of the National Sample Survey Organisation reveals that a staggering 85.9% of rural households do not have access to any healthcare insurance or assurance. Additionally, 24% of rural families access healthcare facilities by borrowing money. Ayushman Bharat Yojana aims to help this sector by providing yearly assistance of up to Rs. 5 lakh per family. The scheme will aid economically disadvantaged families as per data in the Socio-Economic Caste Census 2011. Here too, households enrolled under the Rashtriya Swasthya Bima Yojana (RSBY) will come under the ambit of the PM Jan Arogya Yojana.

In the rural areas, the PMJAY health cover is available to:

• Those living in scheduled caste and scheduled tribe households
• Beggars and those surviving on alms
• Families with no individuals aged between 16 and 59 years
• Families having at least one physically challenged member and no able-bodied adult member
• Landless households who make a living by working as casual manual labourers
• Primitive tribal communities
• Legally released bonded labourers
• Families living in one-room makeshift houses with no proper walls or roof
• Manual scavenger families

PMJAY Urban

According to the National Sample Survey Organisation (71st round), 82% of urban households do not have health insurance. Further, 18% of Indians in urban areas have addressed healthcare expenses by borrowing money in one form or the other. Pradhan Mantri Jan Arogya Yojana helps these households avail of healthcare services by providing funding of up to Rs. 5 lakh per family per year. PMJAY will benefit urban workers’ families in the occupational category present in the Socio-Economic Caste Census 2011. Further, any family enrolled under the Rashtriya Swasthya Bima Yojana will benefit from the PM Jan Arogya Yojana.

In the urban areas, those who can avail of the government-sponsored scheme consist mainly of:

• Washerman/ watchmen
• Rag pickers
• Mechanics, electricians, repair workers
• Domestic help
• Sanitation workers, gardeners, sweepers
• Home-based artisans, or handicraft workers, tailors
• Cobblers, hawkers, and other services provided on streets or pavements
• Plumbers, masons, construction workers, porters, welders, painters, and security guards
• Transport workers like drivers, conductors, helpers, cart, or rickshaw pullers
• Assistants, peons in small establishments, delivery boys, shopkeepers, and waiters

People not entitled to health coverage under Pradhan Mantri Jan Arogya Yojana:

• Those who own a two, three or four-wheeler or a motorised fishing boat
• Those who own mechanised farming equipment
• Those who have kisan cards with a credit limit of Rs. 50000
• Those employed by the government
• Those who work in government-managed non-agricultural enterprises
• Those earning a monthly income above Rs. 10000
• Those owning refrigerators and landlines
• Those with decent, solidly built houses
• Those owning 5 acres or more of agricultural land

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Benefits of Ayushman Bharat Yojana

The Pradhan Mantri Jan Arogya Yojana (PMJAY) provides crucial healthcare access to approximately 40% of India's population, encompassing the most vulnerable segments. Key advantages of the scheme include:

1.  Comprehensive coverage: Encompasses 27 specialty areas, encompassing oncology, cardiology, and orthopaedics.
2.  Post-Discharge care: Ensures coverage for post-discharge care and associated medication expenses.
3.  Multi-surgical coverage: Provides financial support for multiple surgeries, with subsequent procedures covered at reduced rates (50% and 25% for the second and third surgeries, respectively).
4.  Critical illness coverage: Extends financial assistance for the treatment of critical illnesses, including cancer, heart surgery, organ transplants, and other life-threatening conditions.