What is Pradhan Mantri Jan Arogya Yojana

5paisa Research Team Date: 28 Dec, 2023 04:09 PM IST


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Pradhan Mantri Jan Arogya Yojana

PMJAY, also recognized as Ayushman Bharat, is a significant healthcare initiative led by the Government of India. Initiated on September 23, 2018, PMJAY strives to extend financial security to more than 100 million families, equivalent to around 500 million people, granting them the opportunity to avail high-quality healthcare services. This initiative has revolutionized India's healthcare sector, guaranteeing that individuals are not deprived of vital medical treatments due to financial constraints.

So, let’s learn about this Pradhan Mantri Arogya Yojana in detail through this post.

What is Pradhan Mantri Jan Arogya Yojana (PMJAY)?

PM JAY is a famous health insurance scheme that offers coverage of up to ₹5 lakh per family annually, covering both secondary and tertiary hospitalization expenses. The scheme encompasses various medical treatments, surgeries, and procedures, ensuring comprehensive healthcare services to the beneficiaries. It aims to bridge the gap between the privileged and underprivileged sections of society by offering cashless and paperless access to health services at network hospitals.

Pradhan Mantri Jan Arogya Yojana Eligibility

Pradhan Mantri Jan Arogya Yojana (PM JAY), also called Ayushman Bharat, is a healthcare initiative by the Indian government to provide financial protection and health coverage to economically vulnerable families. The eligibility criteria for PM JAY are as follows:

1. Socio-Economic Status: Families falling under the defined categories of the Socio-Economic Caste Census (SECC) database are automatically eligible for PM-JAY. These categories are determined based on the economic status of the individual.

2. Household Criteria: Families who dont have any earning adult member adult between 16 to 59 years, female-headed homes with no adult male member between 16 to 59 years, or families with a disabled member and no non-disabled adult are considered eligible.

3. Urban and Rural Areas: PM JAY covers eligible families both in rural and urban areas, ensuring comprehensive healthcare access regardless of the place of residence.

4. No Age Bar: Unlike many insurance schemes, PM JAY has no age criteria, making all family members, regardless of age, eligible for benefits.

Features of Pradhan Mantri Jan Arogya Yojana

1. Financial Coverage: PM JAY offers health coverage of up to ₹5 lakh per family annually, ensuring financial protection against major illnesses and medical procedures.

2. Cashless Treatment: Beneficiaries can avail of cashless treatment at empaneled public and private hospitals, reducing the burden of out-of-pocket expenses.

3. Portability: PM Jan Arogya Yojana beneficiaries can avail services across any empaneled hospital in India, promoting seamless healthcare access regardless of geographical location.

4. No Cap on Family Size: Unlike many insurance schemes, PM Jan Arogya Yojana covers even large families, ensuring every family member receives medical attention.

5. Paperless and Transparent: The scheme operates in a paperless and transparent manner, using technology for verification and approval, reducing bureaucratic hassles.

6. Beneficiary Identification: PM Jan Arogya Yojana uses socio-economic criteria for beneficiary identification, targeting vulnerable and economically weaker sections, ensuring support reaches those who need it the most.

7. Empowering Women: Families led by women, economically weaker women, and single-member households without a male adult are given priority, empowering women to access healthcare services.

8. Preventive Services: Pradhanmantri Jan Arogya Yojana emphasizes preventive healthcare services, promoting awareness and screenings for early detection of diseases, contributing to a healthier population.

How to claim for Pradhan Mantri Jan Arogya Yojana Apply Online?

• Visit the official site of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY).
• Click on the 'Am I Eligible' button and enter the mobile number to get an OTP for the verification.
• Fill in the required details like family members' information, income, and other necessary documents.
• Once done, you can check your eligibility and receive an e-card with a unique ID.
• Alternatively, visit a nearby Common Service Center (CSC) or ask for assistance at a PM-JAY kiosk for online registration.
• Submit the necessary documents, and the CSC operator will help you in the online application process.
• Upon successful verification, your family will be enrolled, and you can avail of the benefits at empaneled hospitals across India.

Documents Required for Pradhan Mantri Jan Arogya Yojana

To enroll in the Pradhanmantri Jan Arogya Yojana (PM-JAY), applicants need to provide specific documents.

1. Identity Proof: Aadhaar card, voter ID, PAN card, or government-issued ID.
2. Residence Proof: Aadhaar card, utility bills, or any document verifying the applicant's address.
3. Income Proof: Income certificate, BPL card, or any other document indicating the family's economic status.
4. Passport-sized Photographs: Recent passport-sized photographs of the family members applying for the scheme.
5. Mobile Number: A mobile number linked to Aadhaar for authentication and communication purposes.
6. SECC Category: Families categorized under the Socio-Economic Caste Census (SECC) are automatically eligible for PM-JAY, with no additional documentation required.

Providing these documents ensures eligibility verification and enables eligible beneficiaries to access the healthcare benefits PM-JAY offers.

How to Claim Under Pradhan Mantri Jan Arogya Yojana?

To make a claim under Pradhan Mantri Arogya Yojana (PM-JAY):

1. Hospital Admission: Get admitted to an empaneled hospital and provide your PM-JAY e-card or Aadhaar card for verification.

2. Treatment and Discharge: Receive necessary medical treatment per the prescribed guidelines and get discharged upon recovery.

3. Claim Processing: The hospital will process your claim and submit the necessary documents to the insurance provider for reimbursement.

4. Cashless Treatment: If the treatment is cashless, the hospital directly claims payment from the insurance provider, and the person doesn't need to pay anything.

5. Reimbursement: If you paid for treatment upfront, contact the insurance company with all the necessary documents to reimburse expenses incurred during hospitalization.

How to Check Pradhan Mantri Jan Arogya Yojana Card Status Online?

You can check the Pradhan Mantri Jan Arogya Yojana (PM-JAY) card status online.
1. Visit the Official Website: First visit the official PM-JAY website (https://pmjay.gov.in/).
2. Click on the 'Am I Eligible' button: You will find this button on the homepage and click on it.
3. Enter Aadhaar Number: Enter the number of the family head and the security code displayed on the screen.
4. Verification Process: The system will verify your eligibility based on the provided Aadhaar number.
5. Check Status: After verification, the website will display the status of your PM-JAY card application.
6. Helpline Number: If facing issues, contact the PM-JAY helpline (14555) for assistance.
7. SMS Service: Alternatively, you can also check your PM-JAY status by sending an SMS in the format "PMJAY <SPACE> Ration Card Number" to 14555 from the registered mobile number.

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Frequently Asked Questions

Under this scheme Pradhan Mantri Jan Arogya Yojana scheme, beneficiaries are covered for medical expenses up to ₹5 lakh per family annually. However, this financial coverage includes varied healthcare services, treatments, surgeries, and hospitalizations, ensuring significant financial protection against major illnesses and medical procedures.

In Pradhan Mantri Jan Arogya Yojana (PM-JAY), the HHD (Household ID) number is a unique identification number assigned to eligible families. It helps in the identification and verification of beneficiaries, ensuring that the entitled households receive the benefits of the scheme. The HHD number facilitates streamlined administration and efficient healthcare service delivery under PM-JAY.

The Government of India introduced the scheme called Pradhan Mantri Jan Arogya Yojana on September 23, 2018. It is also known as Ayushman Bharat and its primary objective is to extend financial security to more than 100 million families in India, granting them access to high-quality healthcare services while alleviating the financial burden of medical costs.

The benefits of PM-JAY can be availed by families identified as deprived and vulnerable based on socio-economic criteria. This includes rural households, urban laborers' families, families with disabled members, and those without male members aged 16-59, among others.

Pradhan Mantri Jan Arogya Yojana (PM-JAY) excludes services such as cosmetic surgeries, fertility treatments, organ transplants for certain conditions, drug rehabilitation programs, and other non-essential or experimental medical procedures. These exclusions ensure that the scheme focuses on providing coverage for essential and life-saving healthcare services to beneficiaries.