Indialends, 08 Apr 2021

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Ayushman Bharat Yojana

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The Ayushman Bharat Yojana is also popular as Pradhan Mantri Jan Arogya Yojana (PMJAY). This scheme is to help economically vulnerable Indians who need healthcare facilities. The Prime Minister rolled out the health insurance scheme on 23 September 2018. This scheme covers almost cover 50 Crore Indian citizens. Till September 2019, almost 18,059 hospitals have empaneled, over 4,406,461 lakh beneficiaries have been admitted and over 10 crore e-cards have been issued.

The objective of the Ayushman Bharat scheme or Pradhan Mantri Jan Arogya Yojana plans to make secondary and tertiary healthcare completely cashless. The PM Jan Arogya Yojana beneficiaries have been allotted an e-card for availing the healthcare services at an impaneled hospital, public or private, anywhere in the country, with it, you can walk into a hospital and obtain cashless treatment.

The coverage under the Ayushman Bharat scheme consists of 3 days of pre-hospitalization and 15 days of post-hospitalization expenses. Around 1400 procedures with all related costs like OT expenses are taken care of. All in all, PMJAY and the e-card provide a coverage of Rs. 5 lakh per family, per year, thus helping the poor obtain easy access to healthcare services.

Eligibility criteria to get enrolled in Ayushman Bharat or Pradhan Mantri Jan Arogya Plans for rural and urban people:

The Pradhan Mantri Jan Arogya Scheme aims to spread the healthcare facilities as long as possible especially the poor section, lower middle income who are offering a cover of Rs 5 Lakh per family. Under 10 crore families, 8 crore families in rural areas, and 2.33 crore families in urban areas are getting the benefit of this scheme. If it is further divided into smaller units, this means the scheme will aim to cater to 50 crore individual beneficiaries.

For Rural Areas

The 71st round of the National Sample Survey organization reveals that a staggering 85.9% of rural households do not have any access to healthcare insurance or assurance. Approx. 24% of rural families get access to health care facilities by borrowing money.

PMJAY aims to help this sector to avoid being in a situation of debt trapped and avail services by providing yearly financial assistance of up to Rs. 5 lakh per family.

In the rural areas, the PMJAY health cover is available to:

• They should belong to schedule caste and schedule tribes’ households
• Families who are having no male members aged 16 to 59 years.
• Beggars or those who are surviving on alms
• Families who are having one physically disabled member and no able-bodied adult member.
• Landless households who make a living by working as a casual manual laborer
• Primitive tribal communities
• Legally released bonded laborer
• Families living in one-room makeshift houses with no proper walls or roof
• Manual scavenger families

Eligibility criteria for Urban areas

• Washerman/chowkidars
• Ragpickers
• Mechanics, electricians, repair workers
• Domestic help
• Sanitation workers, gardeners, sweepers
• Home-based artisans or handicraft workers, tailors
• Hawkers, cobblers, and others providing services by working on pavements or streets.
• Masons, Construction workers, porters, painters, security guards, plumbers, and welders. 
• Transport workers like helpers, Rikshaw pullers, conductors, and drivers
• Shopkeepers, waiters, peons, delivery boys, and assistants
  

The people who are not entitled to get enrolled in Pradhan Mantri Arogya Jan Yojana:

• Those who own a two, three, or four-wheeler or a motorized fishing boat
• Those who own mechanized farming equipment
• Those who have Kisan cards with a credit limit of Rs.50000
• Those employed in a Government office
• Those who work in government-managed non-agricultural enterprises
• Those earning a monthly income above Rs.10000
• Those owning refrigerators and landlines
• Those with decent, solidly built houses
• Those owning 5 acres or more of agricultural land
  

List of diseases covered under Pradhan Mantri Jan Arogya Yojana

• Prostate cancer
• Coronary artery bypass grafting
• Double valve replacement
• Carotid angioplasty with stent
• Pulmonary valve replacement
• Skull base surgery
• Laryngopharyngectomy with gastric pull-up
• Anterior spine fixation
• Tissue expander for disfigurement following burns
  

The minimal list of exclusions

• OPD
• Drug rehabilitation programs
• Cosmetic related procedures
• Fertility related procedures
• Organ transplants
• Individual diagnostics (for evaluation)

The hospitalization and cashless treatment are made possible due to a 60:40 cost-sharing agreement between the State and the Centre. Once the authority identified the patient as a genuine beneficiary, either patient or their family member will be provided with a health card by specially trained Ayushman Mitra, who man kiosks in hospitals for those unaware of the PMJAY scheme.

How to apply for Ayushman Bharat Yojana Scheme?

• Log in to the https://www.pmjay.gov.in/ and click on ‘Am I Eligible’
• Enter your mobile number and the CAPTCHA code and click on ‘Generate OTP’
  
• Then select your state and search by name/ HHD number/ ration card number/ mobile number
• Based on the search results you can verify if your family is covered under PMJAY