Pradhan Mantri Jan Arogya Yojana (PMJAY)

Shruti

October 23, 2024

The Pradhan Mantri Jan Arogya Yojana (PMJAY) is an important part of the government’s efforts to provide universal health coverage. This initiative is part of the Ayushman Bharat Yojana as recommended by the National Health Policy 2017.

Here’s what you need to know about the Ayushman Bharat health card, the Pradhan Mantri Jan Arogya Yojana list, the PMJAY app and more.

What is Pradhan Mantri Jan Arogya Yojana (PMJAY)?

The Pradhan Mantri Jan Arogya Yojana is one of the 2 components of the Ayushman Bharat yojana. The central government launched this scheme on 23rd September, 2018. Today, it has become one of the largest health assurance schemes in the world. It was earlier known as the National Health Protection Scheme (NHPS).

At its core, the Pradhan Mantri Jan Arogya Yojana provides an annual health cover of Rs 5 lakhs per family. This may be used for secondary and tertiary care hospitalization. The PMJAY list has about 55 crore beneficiaries listed. The funding is provided entirely by the government with the cost of implementation shared by the central and state governments.

There are 2 key differences between the Pradhan Mantri Jan Arogya Yojana and earlier government-funded health insurance programs. Firstly, Pradhan Mantri Jan Arogya Yojana raises the cover from Rs 30,000 to Rs 3,00,000 per family to Rs 5,00,000 per family. Secondly, it has removed the earlier cap of 5 members per family.

Key Features of the Pradhan Mantri Jan Arogya Yojana (PMJAY)

The Pradhan Mantri Jan Arogya Yojana provides poor and vulnerable families with an annual health insurance cover of Rs. 5 lakhs per family. This may be used to get cashless access to secondary and tertiary medical care in private empanelled and public hospitals.

There are currently over 22,500 empanelled hospitals in the country. Ayushman Bharat card holders can visit any empanelled hospital across the country to avail these services.

There are no limitation to the size of a beneficiary’s family, age or gender. Unlike many other insurance schemes, PMJAY covers all pre-existing conditions. Pradhan Mantri Jan Arogya Yojana covers:

3 days of pre-hospitalization expenses
15 days post-hospitalization expenses
Expenses for about 1,929 procedures
All treatment related costs including doctor’s fees, diagnostic service fees, medicines, supplies, OT and ICU charges
Expenses connected with treatment-related complications

NHA PMJAY Family Insurance

PM-JAY has been designed to provide health insurance for families rather than each individual. The sum of Rs 5 lakhs as provided by this scheme can be used by one or all members of the family as required.

For example, it may be used to cover medication for the father as well as his daughter’s surgery in the same year.

Expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

A significant expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana was approved in September 2024. The scheme will now provide health coverage to all senior citizens over the age of 70 years irrespective of their income.

The move is expected to benefit 6 crore senior citizens. People who are eligible for other public health insurance schemes such as the Ex-Servicemen Contributory Health Scheme (ECHS), Central Government Health Scheme (CGHS), or Ayushman Central Armed Police Force (CAPF) can choose to continue with their existing coverage or switch to Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.

Senior citizens in families already covered by PMJAY will get an additional annual top-up cover worth Rs 5 lakhs. This amount is dedicated to their care and cannot be shared with other members of the family. They will also get a new distinct Ayushman Bharat health card.

Pradhan Mantri Jan Arogya Yojana Eligibility

PMJAY is designed for families facing poverty who would otherwise not be able to get health insurance. For rural beneficiaries to be eligible, they should meet at least one of the following criteria:

Their house should have kucha walls and a kucha roof
The family should not have any adult members between the age of 16 and 59 years
SC/ST households
The family may derive most of their income from casual, manual labour.

Destitute families or people living on alms, primitive tribal groups and manual scavenger households are automatically included in the Pradhan Mantri Jan Arogya Yojana scheme.

Eligibility criteria for urban beneficiaries include:

Ragpickers
Beggars
Domestic workers
Street vendor such as cobblers and hawkers
Construction workers including plumbers, masons, painters, welders and other head-load workers
Sweepers and Sanitation workers
Home-based workers such as artisans, handicraft workers and tailors
Transport workers, Drivers, Conductors, Helpers to drivers and conductors, cart pullers and rickshaw pullers
Shop workers, assistants, peons in small establishments, helpers, delivery assistants, attendants and waiters
Electricians, mechanics, assemblers and repair workers
Washer-men and chowkidars

Pradhan Mantri Jan Arogya Yojana Exclusions

This Ayushman Bharat scheme does not cover:

People who own a 2, 3, 4-wheeler or motorized fishing boat
People who own mechanized farming equipment
People with Kisan cards that have a credit limit of ₹50,000/-
Government employees
People working in government-managed non-agricultural enterprises
People earning a monthly income above ₹10,000/-
People owning refrigerators and landlines
People with decent, solidly built houses
People who own 5 acres or more of agricultural land

Ayushman Bharat Health Insurance Enrolment

There is no need to enrol for the Ayushman Bharat health insurance scheme. PMJAY is an entitlement-based mission. Families living in rural and urban areas who meet the Pradhan Mantri Jan Arogya Yojana eligibility criteria can use this scheme to access cash-free treatment at empanelled hospitals.

Checking Pradhan Mantri Jan Arogya Yojana Eligibility

There is no need for additional Ayushman Bharat registration to benefit from the PMJAY scheme. You can easily check your Pradhan Mantri Jan Arogya Yojana eligibility status online.

Step 1: Visit https://pmjay.gov.in/

Step 2: Click on the ‘Am I Eligible’ tab

Step 3: Enter the captcha code and your mobile number and click on Verify. Enter the OTP as received via SMS

Step 4: Select PMJAY and the scheme and choose your state from the drop-down list. Select PMJAY as the sub scheme and pick your district. Choose to search for eligibility by Family ID, Aadhaar number or PMJAY ID.

If your name is listed as a beneficiary PMJAY, you can opt to receive the information in the form of a text message by clicking the ‘Get SMS’ button.

Ayushman Bharat Registration for e Card

As a beneficiary PMJAY, you can download your Ayushman Bharat card from the Ayushman application. This application is available as a free download from the Google Playstore.

Step 1: Search for your name in the beneficiary PMJAY list. Select your state, PMJAY scheme and district from the drop-down menus. You can search by Family ID, Aadhaar number, name, PMJAY ID or location.

Step 2: When you find your name on the list, pay attention to the colour tab. If your name is listed in orange or red, you will need to complete the eKYC steps. Click on the Do e-KYC button to proceed.

Step 3: Authenticate yourself via Aadhaar OTP, finger print, IRIS scan or face authorization.

Step 4: Once verified, you will need to authenticate the beneficiary Aadhaar and Mobile number with an OTP.

Step 5: The E-KYC page will open. E-KYC can be completed by Aadhaar OTP, finger print, IRIS scan or face authorization.

Step 6: Take a photograph to capture your image as the Pradhan Mantri Jan Arogya Yojana beneficiary. If the photograph has a match score higher than 80%, the eKYC request will be automatically approved.

Step 7: Enter additional details such as your relationship with the head of the family, year of birth, PINCODE, district and other address details.

Step 8: Log in to the application after 15-20 minutes and click on the Download Card button beside your name in the beneficiary list. The Ayushman Bharat card will be downloaded as a pdf file.

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