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Ayushman Bharat Yojana: Are You Eligible For The PMJAY Scheme?

  • Highlights

  • PMJAY aims to provide healthcare to 10.74 crore poor families

  • The eligibility is based on the SECC 2011 data

  • The beneficiaries can avail services across India

  • Priority is given to girl child, women and senior citizens

In September this year, Prime Minister Narendra Modi rolled out an ambitious government-sponsored health insurance scheme. This project plans to provide an annual health cover of Rs.5 lakh per family which is aimed to benefit about 50 crore citizens in the country. The Ayushman Bharat Yojana - National Health Protection Scheme, which has now been renamed as Pradhan Mantri Jan Arogya Yojana, plans to make secondary and tertiary healthcare completely cashless. Find out if you qualify to benefit from this large-scale healthcare programme.

a) Categories of people entitled for the health cover

The Pradhan Mantri Jan Arogya Yojana (PMJAY) aims to “free the poor from the clutches of poverty due to which they cannot afford healthcare.” The PMJAY scheme aims to provide healthcare to 10 crore families, who are mostly poor and have lower middle income, through a health insurance scheme providing a cover of Rs.5 lakh per family. The 10 crore families comprise 8 crore families in rural areas and 2.33 crore families in urban areas. Broken into smaller units, this means the scheme will aim to cater to 50 crore individual beneficiaries.

However, the scheme has certain pre-conditions by which it picks who gets to avail of the health cover benefit. While in the rural areas the list is mostly categorized on lack of housing, meagre income and other deprivations, the urban list is of PMJAY beneficiaries is drawn up on the basis of occupation.

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

  • 1) Those living in scheduled caste and scheduled tribe households

  • 2) Families with no male member aged 16 to 59 years

  • 3) Beggars and those surviving on alms

  • 4) Families with no individuals aged between 16 and 59

  • 5) Families having at least one physically challenged member and no able-bodied adult member

  • 6) Landless households who make a living by working as casual manual labourers

  • 7) Primitive tribal communities

  • 8) Legally released bonded labourers

  • 9) Families living in one-room makeshift houses with no proper walls or roof

  • 10) Manual scavenger families

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

  • 1. Washerman/chowkidars

  • 2. Rag pickers

  • 3. Mechanics, electricians, repair workers

  • 4. Domestic help

  • 5. Sanitation workers, gardeners, sweepers

  • 6. Home-based artisans or handicraft worker, tailors

  • 7. Cobblers, hawkers and others providing services by working on streets or pavements

  • 8. Plumbers, masons, construction workers, porters, welders, painters and security guards

  • 9. Transport workers like drivers, conductors, helpers, cart or rickshaw pullers

  • 10. Assistants, peons in small establishments, delivery boys, shopkeepers and waiters

b) Categories of people not entitled for the health cover:

  • 1. Those who own a two, three or four-wheeler or a motorised fishing boat

  • 2. Those who own mechanised farming equipment

  • 3. Those who have Kisan cards with a credit limit of Rs.50000

  • 4. Those employed by the government

  • 5. Those who work in government-managed non-agricultural enterprises

  • 6. Those earning a monthly income above Rs.10000

  • 7. Those owning refrigerators and landlines

  • 8. Those with decent, solidly built houses

  • 9. Those owning 5 acres or more of agricultural land

c) How to check if you are eligible

Visit the government website and click on the Am I Eligible section. Type in your mobile number to receive a one-time password. Once the OTP is generated, enter this on the slot provided and verify it. It is possible to search whether you are in the SECC database for the Pradhan Mantri Jan Awas Yojana by entering either your mobile or ration card number, the SECC or the Rastriya Swasthya Bima Yojana (RSBY) unique registration number (URN). If the search yields results, you can opt for receiving a mobile text message with the RSBY URN which can be used in the future.

d) Medical packages and hospitalization process

The Rs.5 lakh insurance cover provided by the Pradhan Mantri Jan Arogya scheme can be utilized not just by individuals in particular, but also by families in general. This lumpsum is enough to cover both the medical and surgical treatments in 25 specialities among which are cardiology, neurosurgery, oncology, paediatrics, orthopaedics, etc. However, medical and surgical expenses cannot be reimbursed simultaneously.

If multiple surgeries are necessary, the highest package cost is paid for in the first instance followed by a 50% waiver for the second and a 25% discount for the third. Unlike other health insurance schemes, there is no waiting period for pre-existing diseases under PMJAY scheme, which comes under the larger umbrella scheme of Ayushman Bharat Yojana. Should any beneficiary or anyone in their family require hospitalization, they need not pay anything, provided they are admitted in any empanelled government or private hospital.

The cashless treatment and hospitalization is made possible due to a 60:40 cost sharing agreement between the Centre and states. Once identified as a genuine beneficiary, you or your family member will be issued a health card by specially trained Ayushman Mitras, who man kiosks in hospitals for those unaware of the PMJAY scheme.

With these details in hand, you can benefit from the features of the Pradhan Mantri Jan Awas Yojana or help someone else get the healthcare cover benefit.

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