Ayushman Bharat Yojana Scheme - How to Apply , Benefits , Eligibility and Documents Required

Ayushman Bharat Yojana Scheme - How to Apply, Benefits, Eligibility and Documents Required: PMJAY or Pradhan Mantri Jan Arogya Yojana is a national health scheme (government health insurance) rolled out by the government of India. This scheme aims to provide free access to healthcare for low income earners and marginalized sections of society by providing health insurance. Roughly the bottom 50% of the country qualifies for this scheme.

How to Apply For Ayushman Bharat Yojana Scheme

 
PMJAY program is part of the Indian government's National Health Policy. It was launched in September 2018 by the Ministry of Health and Family Welfare. The ministry later established the National Health Authority as an organization to administer the program. It is a centrally sponsored scheme and is jointly funded by both the federal government and the states. Ayushman Bharat yojana scheme is the world's largest government sponsored healthcare program by size.

Also Read: Corrections in Ayushman Bharat Health Card

Benefits of the Ayushman Bharat Yojana Scheme

1. The criteria for eligibility are derived from the Socio-Economic and Caste Census 2011 to maximize the outreach of the scheme.
2. No restriction is placed on family size, age or gender and all previous medical conditions are covered under the scheme. PMJAY scheme covers 3 days of pre-hospitalization and 15 days of post-hospitalization costs, including diagnostic care and expenses on medicines.
3. Ayushman Bharat Yojana scheme provides health coverage for 10 crore households or 50 crores Indians providing a cover of ₹5 lakh per family per year for medical treatment in empanelled hospitals, both public and private.
4. Pradhan Mantri Jan Arogya Yojana offers cashless payment and paperless recordkeeping through the hospital or doctor's office.
5. PMJAY scheme is portable and a beneficiary can avail of medical treatment at any PMJAY empanelled hospital outside their state and anywhere in the country.
6. Beneficiaries of the Ayushman Bharat Yojana scheme are provided access to free COVID-19 testing.
7. The scheme includes 1,393 medical procedures.
8. Includes costs for diagnostic services, drugs, room charges, physician’s fees, surgeon charges, supplies, ICU and OT charges.
9. Public hospitals are reimbursed at par with private hospitals.
10. Cashless hospitalization.

Below are some of the critical illnesses covered under the Ayushman Bharat Yojana:

1. Prostate cancer.
2. Double valve replacement.
3. Coronary artery bypass graft.
4. COVID-19.
5. Pulmonary valve replacement.
6. Skull base surgery.
7. Anterior spine fixation.
8. Laryngopharyngectomy with gastric pull-up.
9. Tissue expander for disfigurement following burns.
10. Carotid angioplasty with stent

Below is the list of medical procedures that is not covered under PMJAY

1. Out-Patient Department (OPD) expenses.
2. Drug rehabilitation.
3. Cosmetic surgeries.
4. Fertility treatments.
5. Individual diagnostics
6. Organ transplant.

Eligibility criteria for the Ayushman Bharat Yojana scheme:

The eligibility criteria are based on the data availed from the Socio-economic caste census 2011 for economically disadvantaged families. Households enrolled under the Rashtriya Swasthya Bima Yojana(RSBY) will also come under the ambit of PMJAY.

 
Eligibility criteria are specified for urban and rural households separately and the eligibility of the hospitals where PMJAY can be availed is also specified and it is as follows:

 
There are six deprivation criteria to identify the rural families that are eligible for the benefits of the scheme. They are:

1. Families that do not have an earning adult member aged between 16 and 59 years.
2. Households are headed by female members having no adult male members aged between 16 and 59 years.
3. Households with a single room have makeshift walls and roofs.
4. Households belonging to the Scheduled Castes and Scheduled Tribes categories.
5. Households that have disabled members with no able members offering support.
6. Landless households with manual labour as their basic source of income.

In addition, the following households are automatically eligible:

1. Destitute families who rely on alms.
2. Families of manual scavengers.
3. Households without proper shelter.
4. Families of bonded labour.
5. Primitive and particularly vulnerable tribal groups.

An urban family must belong to one of the listed occupational categories to be eligible for the scheme:

1. Street vendors, cobblers, and hawkers.
2. Domestic workers.
3. Rag pickers and beggars.
4. Construction site workers, plumbers, masons, painters, welders, and security guards.
5. Coolies.
6. Sweepers, sanitation workers, and gardeners.
7. Transport workers such as conductors, drivers, cart pullers, and others.
8. Artisans, home-based workers, handicraft workers, and tailors.
9. Washermen and watchmen.
10. Electricians, mechanics, repair workers, and assemblers.
11. Peons, helpers, shop workers, delivery assistants, attendants, and waiters

Similar to setting eligibility criteria for beneficiaries, the government has framed eligibility criteria for a hospital to be empanelled. The criteria are:

1. The hospital must be registered with state health agencies.
2. Qualified medical and nursing staff must be available 24/7.
3. The hospital must have a minimum of 10 in-patient beds.
4. The medical facility must have an accessible washroom.
5. An interoperable IT system should be in place to manage data.

A complete record of Ayushman Bharat patients must be maintained and shared with the government as per the requirement. 

1. Ambulance and other emergency services must be available.
2. A dedicated medical officer should be appointed to take care of AB-NHPS operations.
3. There should be a blood bank and testing laboratory in the vicinity.
4. The medical facility must have all the equipment and technical necessities.
5. The hospital must have facilities such as regulated water, electricity, and bio-medical waste disposal.

Documents required for Ayushman Bharat Yojana Scheme:

Below is the list of documents required to apply for the PMJAY scheme:

1. Identity and Age Proof (Aadhaar Card/PAN Card)
2. Details of your mobile number, email address and residential address.
3. Caste certificate
4. Income certificate
5. Documents stating your current family status.

How to apply for the Ayushman Bharat scheme online and offline:

STEP 1: To check if your name is in the PMJAY list 2020, you can check it through different methods. They are:

1. Common Service Centre (CSC): Visit the nearest CSCs or you can visit any of the empanelled hospitals to check if you are eligible for the healthcare scheme.

 
2. Helpline Numbers: PMJAY helpline numbers are available to get information about your eligibility for the scheme. You can contact 14555 or 1800-111-565.

 
3. Online: Visit the official website of the scheme (https://www.pmjay.gov.in/) and check if you are eligible for the scheme.

 
Step 2: Generating the Patient Card As mentioned above, the PM-JAY is a paperless, cashless scheme. To avail of the plan's benefits at any network hospital in India, eligible beneficiaries should provide the PM-JAY e-card during hospital admission. This e-card contains all the information about the patient and is applicable at all empaneled hospitals across India.

Once you have checked your eligibility for the scheme, the next step is to generate the e-card. It can be done either online or offline. Let’s see how you can get your patient card.

Offline Process

Once you have checked your eligibility, you can visit a nearby PMJAY kiosk. These kiosks are set up at government hospitals, district collector offices, etc. The PMAM (Pradhan Mantri Arogya Mitra) operating the booth will verify your identity and eligibility using the BIS (Beneficiary Identity System). This is when your e-card (PM-JAY Golden Card) will be generated.

Online Process

To generate the PM-JAY Golden card online, follow the steps below: 

1. Visit the official PM-JAY website (mera.pmjay.gov.in). Log in using your registered mobile number.
2. Generate your HHD code (Household ID number).

The rest of the process has to be completed offline. Provide the HHD code to the CSC (Common Service Centre). The CSC representatives, known as Ayushman Mitra, will help you with the rest of the process. They will check your details and issue the Ayushman Bharat card. You have to pay Rs. 30 to obtain the card.

Bottom Line: The Ayushman Bharat Yojana is an ambitious healthcare scheme that provides free healthcare to the needy. It offers health coverage for all members of eligible families. There are no restrictions based on the size of the family or the age of family members. Once you have received your Ayushman Bharat Patient Card, you can receive quality medical services at any empanelled public and private hospital across the country. Start by checking your eligibility and then apply for the Ayushman Bharat Golden Patient Card to avail the scheme's various benefits

How to Apply For Ayushman Bharat Yojana Scheme