Ayushman Bharat Pradhan Mantri Jan Arogya Yojana आयुष्मान भारत भारत सरकार ₹5,00,000/- लाख रूपये फ्री में

आयुष्मान भारत, भारत सरकार की एक प्रमुख योजना है, जिसे राष्ट्रीय स्वास्थ्य नीति 2017 की अनुशंसा के अनुसार, सार्वभौमिक स्वास्थ्य कवरेज (UHC) के लक्ष्य को प्राप्त करने के लिए शुरू किया गया था। यह पहल सतत विकास लक्ष्यों (SDG) और इसकी प्रमुख प्रतिबद्धता, “किसी को भी पीछे न छोड़ना” को पूरा करने के लिए डिज़ाइन की गई है।

आयुष्मान भारत, स्वास्थ्य सेवा वितरण के क्षेत्रीय और खंडित दृष्टिकोण से आगे बढ़कर एक व्यापक आवश्यकता-आधारित स्वास्थ्य सेवा की ओर बढ़ने का एक प्रयास है। इस योजना का उद्देश्य प्राथमिक, द्वितीयक और तृतीयक स्तरों पर स्वास्थ्य सेवा प्रणाली (रोकथाम, संवर्धन और चलित देखभाल सहित) को समग्र रूप से संबोधित करने के लिए अग्रणी हस्तक्षेप करना है। आयुष्मान भारत एक सतत देखभाल दृष्टिकोण अपनाता है, जिसमें दो परस्पर संबंधित घटक शामिल हैं, जो हैं –

Details

Ayushman Bharat, a flagship scheme of the Government of India, was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC). This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to “leave no one behind.”

Ayushman Bharat is an attempt to move from a sectoral and segmented approach to health service delivery to a comprehensive need-based health care service. This scheme aims to undertake path-breaking interventions to holistically address the healthcare system (covering prevention, promotion, and ambulatory care) at the primary, secondary, and tertiary levels. Ayushman Bharat adopts a continuum of care approach, comprising two inter-related components, which are –

1. Health and Wellness Centres (HWCs)

2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) was launched on 23rd September 2018 in Ranchi, Jharkhand by the Hon’ble Prime Minister of India, Shri Narendra Modi.

AB PM-JAY is the largest health assurance scheme in the world which aims at providing a health cover of ₹ 5,00,000 per family per year for secondary and tertiary care hospitalization to over 10.74 crores poor and vulnerable families (approximately 50 crore beneficiaries) that form bottom 40% of the Indian population. The households included is based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively. PM-JAY is fully funded by the Government and the cost of implementation is shared between the Central and State Governments.

Benefits

AB PM-JAY provides cashless cover of up to ₹ 5,00,000/- to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment:

Medical examination, treatment, and consultation
Pre-hospitalization
Medicine and medical consumables
Non-intensive and intensive care services
Diagnostic and laboratory investigations
Medical implantation services (where necessary)
Accommodation benefits
Food services
Complications arising during treatment
Post-hospitalization follow-up care up to 15 days

The benefits of ₹ 5,00,000/- are on a family floater basis which means that it can be used by one or all members of the family. Under AB PM-JAY, there is no cap on family size or the age of members. In addition, pre-existing diseases are covered from the very first day. Any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.

Eligibility

Rural Beneficiaries

Out of the total seven deprivation criteria for rural areas, PM-JAY covered all such families who fall into at least one of the following six deprivation criteria and automatic inclusion(Destitute/ living on alms, manual scavenger households, primitive tribal group, legally released bonded labour) criteria:

Only one room with kucha walls and kucha roof
No adult member between ages 16 to 59
Households with no adult male member between ages 16 to 59
Disabled member and no able-bodied adult member
SC/ST households
Landless households deriving a major part of their income from manual casual labour

Urban Beneficiaries

For urban areas, the following 11 occupational categories of workers are eligible for the scheme:

Ragpicker
Beggar
Domestic worker
Street vendor/ Cobbler/hawker / other service provider working on streets
Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and other head-load worker
Sweeper/ Sanitation worker/ Mali
Home-based worker/ Artisan/ Handicrafts worker/ Tailor
Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller
Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter
Electrician/ Mechanic/ Assembler/ Repair worker
Washer-man/ Chowkidar

Exclusions

1. Those who own a two, three, or four-wheeler or a motorized fishing boat.

2. Those who own mechanized farming equipment.

3. Those who have Kisan cards with a credit limit of ₹50,000/-.

4. Those employed by the government.

5. Those who work in government-managed non-agricultural enterprises.

6. Those earning a monthly income above ₹10,000/-.

7. Those owning refrigerators and landlines.

8. Those with decent, solidly built houses.

9. Those owning 5 acres or more of agricultural land.

Application Process

Offline

The Arogya Mitra searches the available list of beneficiaries using details such as name, location, ration card number, mobile number, or the RSBY URN of the beneficiary. After this, the beneficiary is searched for in the BIS. The individual is identified and the scanned valid ID documents are then uploaded.

To get a PMJAY e-card for themselves and their family, a potential beneficiary needs to visit either a hospital or a Community Service Centre (CSC) for identification and follow the steps mentioned below:

Step 1: Potential AB-PMJAY beneficiaries are to submit the PM letter/ RSBY URN/ RC Number/ Mobile Number – The operator (commonly known as the Arogya Mitra) searches the available list of beneficiaries. The operator does this by entering details such as name, location, Ration Card number, mobile number, or even RSBY URN of the beneficiary.

Step 2: Search in the BIS Application – The operator searches for the potential beneficiary in the entitled SECC, RSBY, State Health Scheme, Additional Data Collection Drive databases.

Step 3: Individual Identification – The identification process is carried out if the name is found in the list. For this, documents like Aadhaar or any government ID and a Ration Card or an alternative family ID are required to validate against the details available in the system. Scanned documents are then uploaded.

Step 4: Family Identification – The Arogya Mitra then identifies the family records through the ration card and the scanned documents are then uploaded. The Arogya Mitra then submits the individual and family records to the trust/insurance company for approval.

Step 5: Approval or Rejection – The Health insurance company or trust may then approve or recommend rejection for the submitted beneficiaries. The cases that are recommended for rejection will be finally verified for approval or rejection by the State Health Agency (SHA).

Step 6: E-card Issuance – On approval by SHA/insurance company/trust, an e-card will be issued to the beneficiary.

Apply Now

Documents Required

1. Age & Identity Proof (Aadhaar Card / PAN Card).

2. Proof of Address.

3. Contact details (Mobile, e-mail).

4. Caste Certificate.

5. Income Certificate.

6. Document Proof of the Current Status of the Family (Joint or Nuclear).

7. Aadhaar Card.

Frequently Asked Questions

Will beneficiaries have to pay anything to get covered under this scheme?

What is the enrollment process? Is there any time period for enrollment?

Will a card be given to the beneficiary?

Are Already existing illnesses covered under this scheme?

Are Benefits available for New born child under this scheme?

Are RSBY cardholders covered under the scheme?

Can benefits under this scheme be available without Aadhar Card?

What Who Is Aarogya Mitra?

How does Claim Submission process work?

What Is Pradhan Mantri Jan Arogya Yojana(PM-JAY)?

What Health Services Are Available Under PM-JAY?

Where Can Beneficiaries Avail Of Services Under PM-JAY?

Will Beneficiaries Have To Pay Anything To Get Covered Under This Scheme?

How Are The Beneficiaries Identified?

Can Those Families Whose Names Are Not On The List Avail The Benefits Under PM-JAY?

What Is The Maximum Time Required For Approval Of Claim Submission Requests?

Who Are The Members Of Various Grievance Committees?

Sources And References

Guidelines

Guidelines For Beneficiary Identification

Guidelines On Payment For Special Cases

Guidelines On Claim Settlement

UMANG

Was this helpful?