Ayushman Card – Check PMJAY Eligibility Online at pmjay.gov.in

Read on to know the eligibility criteria and application process for the Ayushman Bharat Pradhan Mantri Jan Arogya scheme.
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15 July 2023

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.

What is PMJAY (Ayushman Bharat Yojana)?

Considered one of the world's largest healthcare schemes, Ayushman Bharat Yojana aims to extend coverage to over 50 crore Indian citizens, especially those from economically weaker sections. Launched in September 2018, PMJAY provides health insurance plans with a maximum sum insured amount of Rs. 5 lakh. The government health insurance scheme covers most medical treatment costs, medications, diagnostics, and pre-hospitalisation expenses. Moreover, it offers cashless hospitalisation services through the Ayushman health card, usable at any empanelled hospital nationwide. Beneficiaries can access hospitalisation for necessary treatment by presenting their PMJAY e-card.

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:

Features

Details

Name of the Scheme

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) or Ayushman Bharat National Health Protection Scheme (NHPS)

Launch date for PMJAY

September 23, 2018

Coverage (per family)

Rs. 5 lakh/year

Procedures covered

1,400 procedures

Pre-hospitalisation expenses coverage

Up to 3 days

Post-hospitalisation expenses coverage

Up to 15 days

Website

https://www.pmjay.gov.in/

Helpline Numbers

1800-111-565 or 14555

Email Id

ayushmanbharat.csc@gmail.com


PMJAY health cover categories: Eligibility criteria for rural and urban

The PMJAY scheme aims to provide healthcare to ten crore families. These mostly include the poor and people with lower middle income, through a health insurance scheme covering Rs. 5 lakh per family. The ten crore families comprise eight crore families in rural areas and 2.33 crore families in urban areas. Broken into smaller units, this means that the scheme will aim to cater to 50 crore individual beneficiaries.

To qualify for Ayushman Bharat Yojana, applicants must belong to one of the specified categories: SC/ST, Lower Income Group, or EWS. You can ascertain your Ayushman card eligibility by utilising the ‘Am I Eligible’ feature on the official website.

However, the scheme has certain pre-conditions by which it picks who can avail of the health cover benefit. While in the rural areas, the list is mostly categorised on lack of housing, meagre income, and other deprivations.

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 cover 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

While not everyone is entitled to these government schemes, getting health, motor or other general insurance policies may not be suitable for all pockets. Thus, Bajaj Finance brings insurance and subscription plans affordable for all.

What is covered under Ayushman Bharat Yojana Scheme or PMJAY?

With the aim of providing accessible healthcare to the economically disadvantaged, the Ayushman Bharat Yojana Scheme, including the AB-PMJAY and Ayushman card, offers comprehensive coverage of up to Rs. 5 lakh per family annually for secondary and tertiary hospitalisation care.

Health insurance provided under AB-PMJAY encompasses various components, such as medical examination, consultation, and treatment, pre-hospitalisation services, both non-intensive and intensive care, medication and medical consumables, diagnostic and laboratory tests, accommodation, medical implants where necessary, food services, treatment-related complications, and post-hospitalisation expenses for a duration of up to 15 days.

What is not covered under Ayushman Bharat Yojana Scheme or PMJAY?

Just like other health insurance policies, Ayushman Bharat Yojana Scheme has its exclusions. The following components are not covered under the scheme:

  • Out-Patient Department (OPD) expenses
  • Drug rehabilitation
  • Cosmetic surgeries
  • Fertility treatments
  • Individual diagnostics
  • Organ transplant

How to check Ayushman Bharat Yojana eligibility online

To verify your eligibility for Ayushman Bharat online, adhere to the following steps:

Step 1: Go to the official website of Ayushman Bharat Yojana at https://www.pmjay.gov.in/

Step 2: Access the "Am I Eligible" section on the homepage.

Step 3: Input your mobile number and captcha code on the subsequent page, then click the "Generate OTP" button.

Step 4: Enter the OTP received on your mobile and click the "Verify OTP" button.

Step 5: On the subsequent page, furnish essential information such as name, state, age, family members, and income details.

Step 6: Once all details are entered, click the "Submit" button.

Affordable insurance and subscription plans to meet all your needs

Paying high premiums for insurance policies may not be feasible for everyone. With affordable insurance and subscription plans that are easy to buy and access, you can secure yourself from medical emergencies, vehicle damages, credit card fraud, and more. For example, you can buy a personal accident cover of up to Rs. 10 lakh starting from just Rs. 230.

Bajaj Finance Insurance Mall offers over 300 plans across various categories like health, motor, life, and pocket-friendly subscription and insurance policies.
You can buy them online, with zero paperwork and claim benefits at the time of need.

Some of our pocket-friendly health plans

Medical packages and hospitalisation process in Ayushman Bharat scheme (PMJAY)

Individuals in specific and families, in general, can benefit from the Rs. 5 lakh insurance cover provided by the Pradhan Mantri Jan Arogya scheme. This lump sum is enough to cover the medical and surgical treatments in 25 specialities: 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 the PMJAY scheme, which comes under the larger umbrella scheme of Ayushman Bharat Yojana. Should any beneficiary or anyone in their family require hospitalisation, they need not pay anything, provided they are admitted in any empanelled government or private hospital.

The cashless treatment and hospitalisation are 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. They manage kiosks in hospitals for those unaware of the PMJAY scheme.

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PMJAY illness coverage: List of critical diseases covered under PM Jan Arogya Yojana

PMJAY helps households access secondary and tertiary care by funding up to Rs. 5 lakh per family per year. This assistance is valid for daycare procedures and even applies to pre-existing conditions. PMJAY extends coverage for over 1,350 medical packages at empanelled public and private hospitals.

Some of the illnesses under critical health insurance are as follows:

  • Prostate cancer
  • Coronary artery bypass grafting
  • Double valve replacement
  • Carotid angioplasty with stent
  • Pulmonary valve replacement
  • Skull base surgery
  • Laryngopharyngectomy with gastric pull-up
  • Anterior spine fixation
  • Tissue expander for disfigurement following burns

Here are some of the exclusions under PMJAY:

  • OPD
  • Drug rehabilitation programme
  • Cosmetic-related procedures
  • Fertility-related procedures
  • Organ transplants
  • Individual diagnostics (for evaluation)

Advantages of health insurance in India

The main advantage of having a health insurance policy is that you can avail of medical treatment without suffering any strain on your finances. Moreover, as many Indians end up borrowing money informally to pay medical bills, utilising the features of PMJAY helps avoid the risk of a debt trap. You can get up to Rs. 5 lakh treatment under the Ayushman Bharat Yojana.

You may choose to buy a family health insurance plan to secure your entire family under one umbrella or go for an individual health insurance plan. For senior citizens, it is advised to have a separate health insurance plan to cover their medical expenses. Several health insurance plans for senior citizens provide adequate financial coverage.

Alternatively, you can also explore small-ticket health policies like Pocket Insurance offered through Bajaj Finance, which offers affordable policies catering to specific needs. You can easily apply for these policies online.

Ayushman Bharat registration: How to apply for Ayushman Bharat Yojana

There is no particular Ayushman Bharat registration procedure for PMJAY. PMJAY applies to all beneficiaries identified by the SECC 2011 and those already part of the RSBY scheme. However, here is how you can check if you are eligible to be a beneficiary of PMJAY.

  • Visit the PMJAY portal and click on 'Am I Eligible'
  • Enter your mobile number and the CAPTCHA code and click on ‘Generate OTP’
  • Then select your state and search by name/ HHD number/ ration card number/ mobile number
  • Based on the search results, you can verify if your family is covered under PMJAY

Alternatively, to know if you are eligible for PMJAY, you can approach any Empanelled Health Care Provider (EHCP). You can also call the Ayushman Bharat Yojana call centre number: 14555 or 1800-111-565.

Read more : How to apply for Ayushman card

Ayushman Bharat Yojana: PMJAY patient card generation

Once you are eligible for the PMJAY benefits, you can work towards getting an e-card. Your Aadhaar card or ration card will be verified at the PMJAY kiosk before issuing a card. Family identification proofs include a government-certified list of members, a PM letter, and an RSBY card. After verification, the e-card is printed along with the unique AB-PMJAY ID. You can use this as proof at any point in the future.

Government schemes offer higher coverage at lower premium prices. However, you can also look for health insurance policies with higher coverage and nominal premiums at the Bajaj Finance Insurance Mall. These policies provide coverage for critical illnesses, accidents, health check-ups, and additional add-on benefits.

Frequently asked questions

How can I check if I am eligible for the PMJAY scheme?

The Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme provides free medical treatment and hospitalisation for certain illnesses and procedures. To determine your eligibility for this incredible program, simply visit the official PMJAY website and enter your mobile number or ration card number. You will receive instant confirmation of your eligibility status, allowing you to take advantage of the many benefits provided by this scheme.

Is the PMJAY scheme applicable to all states in India?

The Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme applies to all states in India, providing medical treatment and hospitalisation benefits to eligible individuals in need.

Can I avail of cashless treatment under Ayushman Bharat Yojana?

Yes, you can avail of cashless treatment under the Ayushman Bharat Yojana. This scheme provides a range of benefits, including free medical treatment and hospitalisation for eligible individuals in need. To avail of cashless treatment, simply visit a hospital or medical facility that is empanelled under the Ayushman Bharat Yojana. The hospital will then provide cashless treatment, allowing you to receive the care you need without worrying about upfront payment.

Are pre-existing conditions covered under the PMJAY scheme?

Yes, there is coverage for pre-existing conditions under the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme. This means that if you have a medical condition that existed prior to being enrolled in the PMJAY scheme, you can still receive free medical treatment and hospitalisation benefits. However, certain exclusions and limitations may be applicable.

How do I register for a PMJAY card?

In order to register for a PMJAY (Pradhan Mantri Jan Arogya Yojana) card, you can visit your nearest empanelled hospital or Ayushman Mitra to complete the registration process. You will need to provide your identification documents, such as your Aadhaar card, to complete the registration process.

How can I link my Ayushman card with an Aadhaar card?

You can link your Ayushman card with an Aadhaar card by visiting the official Ayushman Bharat website or by visiting your nearest Ayushman Mitra. You will need to provide your Aadhaar card details and follow the process outlined on the website or by the Mitra.

How do I check the validity of my Ayushman card?

You can check the validity of your Ayushman card by visiting the official Ayushman Bharat website or by contacting your nearest Ayushman Mitra. You will need to provide your Ayushman card number and follow the process outlined on the website or by the Mitra to check the current validity status of your card.

Can I avail of PMJAY benefits if I have a pre-existing medical condition?

Yes, even if you have a pre-existing medical condition, you can still avail of the benefits under PMJAY. However, the treatment for your pre-existing condition will not be covered under the scheme. Under PMJAY, the government provides financial cover of up to Rs. 5 lakh per family for secondary and tertiary health services.

What is the eligibility for Ayushman Yojana?

People belonging to SC/ST category, families with no earning member above 16 years of age, having income less than Rs. 2.5 lakh, and the one’s listed in the PMJAY beneficiary list are eligible to apply for Ayushman Yojana.

Can I apply online for an Ayushman card?

Yes, you can apply online for the Ayushman card on the official PMJAY website.

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