PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government. The PMJAY scheme aims to provide healthcare to ten crore families. These mostly include the poor and people with lower middle income, through a health insurance scheme covering Rs. 5 lakh per family.
PM-JAY provides cashless cover of up to Rs.500000 to each eligible family per annum for listed secondary and tertiary care conditions. PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital. It covers up to 3 days of pre-hospitalization and 15 days of post-hospitalization expenses such as diagnostics and medicines. There is no restriction on family size, age, or gender. All pre-existing conditions are covered from day one. Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
The biggest advantage of the scheme is that all pre-existing conditions are covered from day one. Further, a beneficiary can visit any impaneled public or private hospital in India to avail of cashless treatment. Services include approximately 1,929 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges, etc.
Benefit Cover Under PM-JAY:
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
Eligibility in rural areas:
In the rural areas, the PMJAY health cover is available to:
Those living in scheduled caste and scheduled tribe households.
Beggars and those surviving on alms.
Families with no individuals aged between 16 and 59 years.
Families have at least one physically challenged member and no able-bodied adult member.
Landless households make a living by working as casual manual labourers.
Primitive tribal communities, legally released bonded laborers.
Families living in one-room makeshift houses with no proper walls or roofs.
Manual scavenger families.
Eligibility in Urban area
Washerman/watchmen, rag pickers, mechanics, electricians, repair workers, domestic help, sanitation workers, gardeners, sweepers, home-based artisans, or handicraft workers, tailors, cobblers, hawkers, and other services provided on streets or pavements, plumbers, masons, construction workers, porters, welders, painters, and security guards, transport workers like drivers, conductors, helpers, cart, or rickshaw pullers, assistants, peons in small establishments, delivery boys, shopkeepers and waiters.
Persons Not Eligible for PM-AJY:
Those employed by the Government,
Those who own 2/3/4 wheelers or motorized fishing boats, mechanised farming equipment,
Those who have a Kisan card with a limit of Rs.50000/-.,
Those earning a monthly income above Rs.10000/-,
Those owning refrigerators and landlines,
Those owning decent, solidly built houses,
Those owning 5 acres or more of agricultural land,
If you belong to the SC or ST Category, then additionally, you could register online for this program.
Following is the List of Documents Required for Ayushman Bharat Card 2024 that you need to gather to get the advantages of the Health Scheme. You need to have both soft and hard copies of these documents to complete the registration system.
Documents Required:
Aadhar Card., Mobile Number., PAN Card Number., Ration Card., Voter ID Card., SC/ST Certificate., Income Certificate., Mobile Number., Passport Size Photograph.
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