Everything You Need to Know About Pradhan Mantri Jan Arogya Yojana (PM-JAY) : Eligibility, Benefits, Application Process, and More!

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Pradhan Mantri Jan Arogya Yojana (PM-JAY), an essential component of the Ayushman Bharat scheme, was launched under the National Health Policy of 2017 to achieve Universal Health Coverage. Designed to meet the Sustainable Development Goals (SDGs) with the commitment to “leave no one behind,” PM-JAY aims to provide healthcare by shifting from a segmented approach to a comprehensive, need-based system. It provides financial protection for secondary and tertiary healthcare, ensuring access to quality medical services for economically vulnerable families.

What is Pradhan Mantri Jan Arogya Yojana?

Launched by the Prime Minister on September 23, 2018, the PMJAY scheme aims to provide health insurance coverage to approximately 500 million Indian citizens. Over the years, the Ayushman card has facilitated many success stories. Recently, the scheme has been extended to include all senior citizens aged 70 and above, offering ₹5 lakh in annual health insurance coverage, regardless of economic status.

Features of Pradhan Mantri Jan Arogya Yojana

Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a flagship health scheme under the Ayushman Bharat initiative, providing secondary and tertiary care to economically vulnerable families with financial protection. Here are some of its key features:

• World’s Largest Government-Funded Health Scheme: Fully financed by the government, PM-JAY is the world’s most extensive health insurance/assurance program.
• Comprehensive Financial Coverage: Provides ₹5 lakh per family per year for secondary and tertiary hospitalization at empanelled public and private hospitals across India.
• Massive Beneficiary Base: Covers over 12 crore economically vulnerable families, benefiting approximately 55 crore individuals.
• Cashless Treatment: Enables beneficiaries to access healthcare services at hospitals directly without any upfront payments.
• Preventing Medical-Induced Poverty: Aims to reduce catastrophic healthcare expenses that push nearly six crore Indians into poverty annually.
• Pre & Post-Hospitalization Coverage: Covers expenses for diagnostics and medicines, including up to 3 days before and 15 days after hospitalization.
• No Restrictions: Available to families regardless of size, age, or gender.
• Coverage from Day One: All pre-existing medical conditions are covered immediately upon enrollment.
• Nationwide Portability: Beneficiaries can receive cashless treatment at any empanelled hospital across India.
• Extensive Medical Services: Covers 1,929 procedures, including costs for medicines, diagnostics, surgeries, physician fees, ICU, OT, and room charges.
• Equal Reimbursement for Public & Private Hospitals: Public hospitals receive reimbursements at par with private hospitals for healthcare services.

Benefits of Pradhan Mantri Jan Arogya Yojana

PM-JAY offers comprehensive health coverage, ensuring financial protection and access to quality medical care. With cashless treatment, hospitalization benefits, and no age or family size restrictions, it provides essential healthcare support to eligible families.

• Financial Coverage: Provides up to ₹5 lakh per family per year for medical expenses.
• Extensive Treatment Coverage: Covers 1,929 procedures, including doctor’s fees, room charges, diagnostics, ICU, and surgical costs.
• Cashless Treatment: Beneficiaries can avail of cashless medical services at public and private hospitals across India.
• Pre & Post-Hospitalization Benefits: Includes coverage for three days before hospitalization and 15 days after, including medicines and diagnostics.
• No Restrictions: Open to all eligible families regardless of age, gender, or family size.
• Easy Access: Only a valid ID is required to utilize Ayushman Bharat benefits at empanelled hospitals.

How to Apply for Pradhan Mantri Jan Arogya Yojana (Online Registration)

Here is a step-by-step guide on how to register for the Pradhan Mantri Jan Arogya Yojana:

1. Visit the official PMJAY website.
2. Click on the ‘Am I Eligible’ tab from the top menu.
3. Enter the captcha code, mobile number, and OTP for verification.
4. Fill in the captcha again and click ‘Login’.
5. Select your state, district, and search criteria, then fill in all the required details.
6. If your family is eligible, your name will appear in the results.
7. If you do not have a PMJAY card, click on the ‘Apply’ button under the ‘Action’ column.
8. Authenticate your Aadhaar card through OTP received at your registered mobile number and fill in the other required details.
9. Your Ayushman Bharat Yojana registration will be complete.

Inclusions and Exclusions under Pradhan Mantri Jan Arogya Yojana

The PMJAY includes critical diseases and pre- and post-hospitalization expenses. Some of the diseases covered under the Ayushman Bharat Yojana are:

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

Additionally, beneficiaries can avail of free COVID-19 testing and treatment under this scheme.

However, some treatments are not covered under PMJAY, including:

• Organ transplants
• Outpatient department (OPD) services
• Standalone diagnostic tests
• Cosmetic procedures
• Drug rehabilitation programs
• Fertility treatment

Eligibility Criteria for Pradhan Mantri Jan Arogya Yojana

The eligibility criteria for registering on the Ayushman Bharat portal vary for rural and urban residents. Moreover, the Union Cabinet expanded the coverage of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in September 2024 to include all senior citizens aged 70 and above.

Eligibility Criteria for Rural Households:

• D1: Residing in a single-room house with kutcha walls and roof
• D2: No adult members aged 16 to 59 years
• D3: No adult male members aged 16 to 59 years
• D4: A disabled member with no non-disabled adults in the household
• D5: Belonging to Scheduled Castes (SC) or Scheduled Tribes (ST)
• D7: Landless families primarily dependent on manual labor for income

Eligibility Criteria for Urban Households:

• Beggars
• Waste collectors
• Domestic workers
• Street vendors, hawkers, cobblers, and other street service providers
• Construction workers, laborers, plumbers, security guards, painters, masons, welders, coolies, and other manual workers
• Sanitation workers, gardeners, and maintenance staff
• Home-based workers, handicrafts workers, artisans, and tailors
• Transport workers, conductors, drivers, helpers, rickshaw pullers, and cart pullers
• Shop workers, attendants, delivery assistants, waiters
• Electricians, assemblers, mechanics, and repair workers
• Security personnel (chowkidars) and washermen

Documents Required for Pradhan Mantri Jan Arogya Yojana

Here is a list of documents needed for the Ayushman Bharat portal login process:

• Aadhaar proof such as a driver’s license, voter ID, or passport
• Proof of residence, including utility bills, passport, or voter ID
• Family information, including the name and Aadhaar number of each member
• Caste certificates for beneficiaries from specific categories
• Income certificate
• Bank account details

How to Download Pradhan Mantri Jan Arogya Yojana Card

Beneficiaries can apply for the Ayushman Bharat Yojana Golden Card, which offers the convenience of paperless, cashless, and portable transactions under the PMJAY scheme. Simply present the card at any hospital for quick and easy service.

1. Go to the official PMJAY website and log in using your registered mobile number.
2. Enter the captcha code to generate an OTP and find the HHD code.
3. Provide the HHD code to a Common Service Center (CSC), where Ayushman Mitra or a CSC representative will assist you in completing the process.

How to Generate PM Jan Arogya Yojana Patient Card

To obtain a PMJAY patient card, follow these steps after qualifying for PMJAY benefits:

1. Log in to the official website.
2. Your ration card or Aadhaar card will be verified at the PMJAY kiosk before it is issued.
3. Confirm the family details from the certified list using a PM letter and an RSBY card.
4. Print the e-card with the unique AB-PMJAY ID after verification.
5. Use the e-card as valid proof for future use.

List of Diseases Covered Under Pradhan Mantri Jan Arogya Yojana

Some of the illnesses covered under critical health insurance include:

• 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

Some of the exclusions under PMJAY include:

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

In conclusion, PMJAY is the most massive initiative under the Ayushman Bharat scheme, providing full health insurance coverage to vulnerable families in India who cannot afford every healthcare-related cost. It offers cashless treatment, pre-and post-hospitalization benefits, and financial protection against high medical bills. Over the years, the scheme has expanded its reach to millions of citizens, including senior citizens above 70 years of age, through an easy registration process across the country with nationwide portability. It thus remains a lifeline for those in need of medical care, giving hope and support for a better future for all.

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