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Pradhan Mantri Jan Arogya Yojana (PMJAY) or Ayushman Bharat Yojna is a scheme that aims to help the economically vulnerable class with the medical facility. This scheme was out on 23rd September 2018 by the Prime Minister Narendra Modi. This scheme covers almost 50 crore citizens in India. Just one year after it was out almost 18,059 hospitals have been impaneled. There are over 4,406,461 Lakh beneficiaries that have been admitted and over 10 crore e-cards have been issued.
The Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme plans to make secondary and tertiary healthcare completely cashless. The PM Jan Arogya Yojana beneficiaries get an e-card that can be used while visiting the hospitals within the country. This e-card helps in getting the cashless treatment.
The coverage usually includes 3 days of pre-hospitalization and 15 days of post-hospitalization expenses. Around 1,400 procedures with the cost like OT expenses are taken care of. Pradhan Mantri Jan Arogya Yojana (PMJAY) and the e-card provide a coverage of Rs. 5 lakh per family, per year thus helping the economically disadvantaged obtain easy access to healthcare services.
Click here to visit the official website of PMJAY :- https://pmjay.gov.in/
Eligibility criteria:
The PMJAY scheme aims to provide healthcare to 10 crore families, who are mostly poor and have less income, this scheme covers health insurance and provides coverage of Rs. 5 lakhs rupees per family.
Amongst the 10 crore families, almost 8 crores families are in rural areas, and rest 2 crores are in urban regions. There are some pre-condition which allow who can avail of the benefits from this scheme or can not cover of Rs. 5 lakh per family. The 10 crore families comprise 8 crore families in rural areas and 2.33 crore families in urban areas. Broken into smaller units, this means the scheme will aim to cater to 50 crores individual beneficiary
In the rural areas, the PMJAY health cover is available to:
- Those living in scheduled caste and scheduled tribe households.
- Families with no male members aged 16 to 59 years.
- Beggars and those who are surviving on alms.
- Families with no individuals aged between 16 and 59 years.
- Those who have at least one physically challenged member in their family.
- Families living in one-room makeshift houses with no proper walls or roofs.
- Manual scavengers families
The main reason for targeting the rural areas more is that medical attention is more required in such areas where there is no awareness of the medical facilities or how and when to seek medical attention. If we see the National Sample Survey Organisation, almost 82% of the urban households do not have access to healthcare insurance or assurance. Almost 18% of the urban residents borrow money to avail the medical treatment. This scheme helps and targets such people who are in the need of money to avail of the medical treatments. Almost 5 Lakh rupee per family is available for them when they need it.
Who all are applicable to avail the PMJAY health cover care benefits in rural areas:
- Those who are living in the scheduled caste and scheduled tribe households.
- Family with no male member aging from 16 years to 59 years.
- Beggars and people with no income sources.
- Families with the disabled or physically challenged member or with no abled member.
- Legally released bonded laborers.
- Families living in one-room house sets.
- Manual scavenger families.
There are also some predefined people who are not entitled to the scheme to name them few are:
- Someone who owns a two, three, or a four-wheeler.
- Those who own merchandised farming equipment or a motorized boat.
- Those who have Kisan cards with a credit limit of around Rs. 50000
- Government Employees.
- Those who are earning a monthly income above Rs. 10000
- Those who own Refrigerators and landlines.
- Those who have a decent house or own 5 acres or more of the agricultural land.
What all are covered and what not covered in the PMJAY scheme:
The scheme includes:
- Medical examination, consultation, and treatment.
- Pre-hospitalisation.
- Non-intensive and intensive care services.
- Medicine and medical consumables.
- Diagnostic and laboratory services.
- Accommodation.
- Medical implant services, wherever possible.
- Food services.
- Complications arising during treatment.
- Post-hospitalization expenses for up to 15 days.
- COVID-19 (Coronavirus) treatment.
Apart from all these included in the scheme there are few things which are not included even if you come under this scheme.
Few points such as:
- OPD charges
- Drug Rehab
- Cosmetic surgeries
- Infertility treatment
- Organ transplant
- Individual diagnostics
There are lots of benefits that you can avail of if you come under the PMJAY scheme.
First of all, it allows you to have cashless treatment, your accommodation is included in the scheme. It can be used by the family member as well. Unlike different policies which usually do not include the pre-existing condition from day one, it covers them from day one. As it can be used by the family members, there is no limit to the number of family members who all can avail of the scheme benefits. It includes pre and posts hospitalization costs.
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