A Guide on Ayushman Bharat Yojana

Ayushman Bharat Scheme, also known as Pradhan Mantri Jan Arogya Yojana (PMJAY) was announced by our Hon’ble Prime Minister, Shri Narendra Modi on Independence day in 2018 and was launched on September 25 of the same year. It aims to provide cashless healthcare facilities to people below the poverty line. It caters to 50 crore individuals (almost 10 crore families) that form 40% of the bottom population.

Features of the Ayushman Bharat Scheme (PMJAY)

1. It is a National Health Protection Scheme designed for the weaker section of society.
2. The scheme provides maximum coverage of Rs. 5 lakh to every eligible family per year.
3. It is a family floater scheme (can be used by one or all the members of the family)
4. It covers pre-existing diseases from the very first day of availing the scheme.
5. It provides a cashless claim facility in public and private network hospitals.
6. The medical expenses are paid according to the pre-determined package rates (by the government).
7. There is no restriction on family size, age, or gender.
8. Benefits can be availed anywhere in the country.
9. It covers some critical illnesses including covid, prostate cancer, skull-based injury, etc.

Coverages: Ayushman Bharat Yojana

The scheme provides coverage of the following:

1. Registration charges
2. Medical treatment, medical examination, and consultation fee
3. 3 days pre-hospitalization expenses
4. 15 days of post-hospitalization expenses
5. Cost of medicines and drugs
6. Hospital bed charges
7. Nursing and boarding charges
8. Anesthesia, Blood Transfusion, Oxygen, O.T. Charges, Cost of Surgical Appliances, etc.
9. Food services to the patient
10. Expenses related to complications arising during the treatment

Eligibility Criteria for Rural Beneficiary

1. Families living in a one-room house with kuchcha walls and kuchcha roof (kachcha ghar)
2. Families comprising of members with no individual aged between 16 to 59 years of age
3. Families with no male adult member (between 16 to 59 years of age)
4. Families having at least one disabled member and no able-bodied adult member.
5. Family belonging to SC/ST
6. Landless households who make a living by working as casual manual labourers.

Eligibility Criteria for Urban Beneficiary

1. Ragpicker
2. Beggar
3. Cobbler/hawker and other people working on streets
4. Domestic help
5. Construction worker/Mason/Plumber/Painter
6. Security guard
7. Head load workers like coolie
8. Gardner/ sweeper
9. Artisan handicrafts worker/ tailor
10. Transport worker like driver/conductor/ rickshaw puller cart puller
11. Electrician/ Mechanic/ repair worker
12. Waiter shop worker/ assistant/ peon/ delivery assistant

How to Check if You are Eligible for PMJAY?

This scheme applies to all the beneficiaries as identified by SECC 2011 and the ones who are part of the RSBY scheme. To check, if you are eligible or not,

1. Visit the official website.
2. Click on “Am I eligible”
3. Enter your mobile number and CAPTCHA code and click on ‘Generate OTP’
4. Enter your state
5. Select search by name, ration card number, householder number, or mobile number.
6. Enter the details asked by the portal and then click on ‘search’
7. If you are eligible, then your name will reflect on the left side of the page.

You can also dial the Ayushman Bharat Yojna call center number: 14555 or 1800 111 565 to verify your eligibility.

If you are eligible for Ayushman Bharat Yojana, you must apply for the scheme.

If you face any problem related to insurance, you can contact Insurance Samadhan. We have helped resolve 14,500+ complaints of policyholders. We’ll be happy to help you.

Click on the below links to read some cases resolved by Insurance Samadhan:

Health Claim Rejection amid Covid-19

Mis-selling in a life insurance policy