Ayushman Bharat Health Insurance Scheme which is also known as Pradhan Mantri Jan Arogya Yojana is important and has helped a lot to the economically disadvantaged society of India. Go through the below-given importance of this scheme:

• Financial Protection: Ayushman Bharat is launched to provide financial protection to Indian families against expensive medical bills. It is designed in such a way that a family should not be affected due to medical emergencies.
• Quality Healthcare: Ayushman Bharat gives access to quality healthcare services and cashless treatment at government and private hospitals. This ensures timely access to quality healthcare without worrying about medical costs.
• Comprehensive Coverage: Ayushman Bharat covers a wide range of secondary and tertiary healthcare care procedures, including surgeries, medical tests, and hospitalisations. This ensures that beneficiaries have access to the necessary treatments.

Key Features of the Ayushman Bharat Health Scheme (PMJAY)

Key features of the Ayushman Bharat Health Scheme are given below:

• PMJAY is the world's largest health insurance scheme that is fully financed by the Government of India.
• Under the Ayushman Bharat Health Scheme, one can get cashless treatment at public and private hospitals.
• Pre-hospitalisation of 3 days and post-hospitalisation expenses of 15 days are covered under this scheme which will help in the diagnostics and medicine.
• All pre-existing diseases are covered from day 1.

Eligibility Criteria for PMJAY

Go through the below-given eligibility criteria of PMJAY:

This scheme covers all the members of the family with no restrictions on family size, gender, or age.

The PMJAY eligibility criteria depend on whether people live in rural areas or urban areas.

Rural Area

• Households without a proper shelter for example kachha wall or roof.
• Households with no adult members aged 16–59 years.
• Homes with a female head and no male adult males between the ages of 16 and 59.
• If there is a disabled person in the home then the family is eligible for PMJAY.
• ST and SC families.

Urban Area

In urban areas this scheme is provided to families based on their occupations and the occupations that are eligible for this scheme are:

• Domestic workers
• Street vendors, cobblers, hawkers
• Construction worker, Plumber, Mason, Labour, Painter, Welder/ Security guard/ Coolie and other head-load worker
• Home-based worker, Artisan, Handicrafts worker, Tailor
• Transport worker, Driver, Conductor, Helper to drivers and conductors, Cart puller, Rickshaw puller.

Types of Treatments and Medical Services Covered in Ayushman Bharat Health Plan

Ayushman Bharat, also known as Pradhan Mantri Jan Arogya Yojana offers a wide range of coverage and comprehensive benefits. This comprehensive coverage aims to provide financial protection to poor and vulnerable families. Below are the types of treatment and medical services covered by the Ayushman Bharat Health Plan:

• Pre-hospitalisation
• Treatment, Medical Examination, and consultation
• Medicine and medical consumables
• Diagnostic and laboratory investigations
• Non-intensive and intensive care services
• Accommodation benefits
• Food services
• Complications arising during treatment
• Post-hospitalization follow-up care up to 15 days

Inclusions for Hospitalizations, Surgeries, and Treatments Under PMJAY

Go through the below-given inclusion of Pradhan Mantri Jan Arogya Yojana:

• Pre-Hospitalisation Expenses: It covers up to 3 days of pre-hospitalisation expenses.
• Hospitalisation Expenses: provides coverage for medical tests, surgeries, nursing care, doctor's fees, room costs, and other essential medical procedures.
• Post-Hospitalisation Expenses: It covers post-hospitalisation expenses up to 15 days after discharge.
• Intensive Care Unit (ICU): It covers both general and specialised ICU care.
• Accommodation and Food: It covers the accommodation and food expenses for the patient during the hospitalisation.
• Diagnostic: The scheme covers medical tests required before hospitalisation.

How to Register for Ayushman Bharat PMJAY?

Follow the below-given steps to register for Ayushman Bharat PMJAY:

Step 1:

Visit the official website of PMJAY.

Step 2:

Click on the “Am I eligible” tab at the top right corner of the screen.

Step 3:

Enter your mobile number and provide the captcha.

Step 4:

Enter the OTP received on the provided mobile number.

Step 5:

Check your eligibility by entering the required information like name, age, family member details, caste, income details etc.

Step 6:

The system will verify the details and provide you with the eligibility results.

Step 7:

After verification, upload documents such as Aadhar cards, ration cards, and other government-issued documents.

Step 8:

After verification of all documents, an e-card will be given to the policyholder to avail the benefit of the scheme.

Documents Required for Enrollment of the PMJAY

The documents that are required for the enrollment of the PMJAY are mentioned below:

• Identity Proof: Aadhar card/ PAN card/ voter ID/ passport/ driving license
• Address Proof: Electricity bill/ voter ID/ rent agreement/ Ration Card
• Income Proof: Income certificate/ BPL certificate ( If applicable )
• Caste Certificate: This is only applicable to ST/SC households.

How to Find Network Hospitals of PMJAY?

Go through the below-mentioned process to find the network hospitals of PMJAY:

Step 1:

Visit the official website of PMJAY.

Step 2:

Click on the “Find Hospital” tab in the top right corner of the screen.

Step 3:

Enter your location details by filling in the state and district sections of the form.

Step 4:

Select the types of hospitals, specialities, and hospital names.

Step 5:

The website will display a list of network hospitals in your area, along with their contact information and other relevant details.

Exclusions under the Ayushman Bharat Plan

Exclusions under the Ayushman Bharat Plan are mentioned below:

• Outpatient Department
• Cosmetic surgeries and procedures
• Fertility treatment
• Dental treatment
• Drug and Alcohol Rehabilitation
• Self-Inflicted Injuries
• HIV/AIDS Treatment

Claim Settlement Process of Ayushman Bharat Health Insurance Scheme

Follow the below-mentioned process to file a claim for the Ayushman Bharat Health Insurance Scheme:

• Visit the nearest network hospital for treatment and provide the Ayushman Card at the registration desk with identity proof.
• An official, known as Ayushman Mitra, will confirm the beneficiary's eligibility in the PMJAY database at the hospital.
• A doctor will evaluate the treatment cost and then it will be given to the insurer.
• The hospital submits a pre-authorization request to the insurer or the state health agency via the PMJAY online portal.
• After the claim is approved, the beneficiary receives cashless treatment for the approved procedure.
• The hospital handles all expenses directly with the insurer under the PM-JAY scheme.

FAQs

Ques 1. How much coverage does PMJAY offer?

Ans. In PMJAY Rs.5 lakh per family is given for secondary and tertiary care hospitalisation, which can be used during a medical emergency or for any medical treatment.

Ques 2. Is there any premium to be paid for PMJAY?

Ans. No, there is no premium to be paid for PMJAY because it is totally funded by the government of India.

Ques 3. What types of treatments are covered under PMJAY?

Ans. There are different kinds of treatment that are covered Under PMJAY such as surgeries, medical tests, hospitalisations, ICU charges etc.

Ques 4. Is the treatment under PMJAY completely cashless?

Ans. PMJAY provide cashless treatment to the policyholder at their network hospitals and the policyholder will not have to pay any cash to the hospital at the time of treatment.

Ques 5. What is the future of PMJAY?

Ans. In order to give Indians better access to healthcare, the government is working to continuously improve the program, increase its coverage, and better its effectiveness.

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