Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana

What is Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana?

AB PM-JAY is a health insurance scheme for low-income families in rural and urban areas. The scheme aims to provide affordable healthcare facilities to the Poor. It is the largest health assurance scheme in the world which aims at providing a health cover of ₹5,00,000/- per family per year.

Benefit

AB PM-JAY provides cashless cover of up to ₹ 5,00,000/- to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment: 1. Medical examination, treatment, and consultation 1. Pre-hospitalization 1. Medicine and medical consumables 1. Non-intensive and intensive care services 1. Diagnostic and laboratory investigations 1. Medical implantation services (where necessary) 1. Accommodation benefits 1. Food services 1. Complications arising during treatment 1. Post-hospitalization follow-up care up to 15 days The benefits of ₹ 5,00,000/- are on a family floater basis which means that it can be used by one or all members of the family. Under AB PM-JAY, there is no cap on family size or the age of members. In addition, pre-existing diseases are covered from the very first day. Any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.

Level

Central

Ministry / Dept.

Ministry Of Health & Family Welfare

Benefit type

cash

Key eligibility

> **Rural Beneficiaries** Out of the total seven deprivation criteria for rural areas, PM-JAY covered all such families who fall into at least one of the following six deprivation criteria and automatic inclusion(Destitute/ living on alms, manual scavenger households, primitive tribal group, legally

Last verified

Recently

Benefits

AB PM-JAY provides cashless cover of up to ₹ 5,00,000/- to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment: 1. Medical examination, treatment, and consultation 1. Pre-hospitalization 1. Medicine and medical consumables 1. Non-intensive and intensive care services 1. Diagnostic and laboratory investigations 1. Medical implantation services (where necessary) 1. Accommodation benefits 1. Food services 1. Complications arising during treatment 1. Post-hospitalization follow-up care up to 15 days The benefits of ₹ 5,00,000/- are on a family floater basis which means that it can be used by one or all members of the family. Under AB PM-JAY, there is no cap on family size or the age of members. In addition, pre-existing diseases are covered from the very first day. Any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.

Eligibility

Documents Required

How to Apply

1. Step 1: Offline application — step 1

   The Arogya Mitra searches the available list of beneficiaries using details such as name, location, ration card number, mobile number, or the RSBY URN of the beneficiary. After this, the beneficiary is searched for in the BIS. The individual is identified and the scanned valid ID documents are then uploaded.

2. Step 2: Offline application — step 3

   To get a PMJAY e-card for themselves and their family, a potential beneficiary needs to visit either a hospital or a Community Service Centre (CSC) for identification and follow the steps mentioned below:

3. Step 3: Offline application — step 5

   Step 1: Potential AB-PMJAY beneficiaries are to submit the PM letter/ RSBY URN/ RC Number/ Mobile Number - The operator (commonly known as the Arogya Mitra) searches the available list of beneficiaries. The operator does this by entering details such as name, location, Ration Card number, mobile number, or even RSBY URN of the beneficiary.

4. Step 4: Offline application — step 7

   Step 2: Search in the BIS Application - The operator searches for the potential beneficiary in the entitled SECC, RSBY, State Health Scheme, Additional Data Collection Drive databases.

5. Step 5: Offline application — step 9

   Step 3: Individual Identification - The identification process is carried out if the name is found in the list. For this, documents like Aadhaar or any government ID and a Ration Card or an alternative family ID are required to validate against the details available in the system. Scanned documents are then uploaded.

6. Step 6: Offline application — step 11

   Step 4: Family Identification - The Arogya Mitra then identifies the family records through the ration card and the scanned documents are then uploaded. The Arogya Mitra then submits the individual and family records to the trust/insurance company for approval.

7. Step 7: Offline application — step 13

   Step 5: Approval or Rejection - The Health insurance company or trust may then approve or recommend rejection for the submitted beneficiaries. The cases that are recommended for rejection will be finally verified for approval or rejection by the State Health Agency (SHA).

8. Step 8: Offline application — step 15

   Step 6: E-card Issuance - On approval by SHA/insurance company/trust, an e-card will be issued to the beneficiary.

Sources & References

• Official scheme website ↗
• Source record ↗
• Information is summarised from official government sources. Verify all details on the official website before applying.