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Ayushman Bharat Health Insurance Scheme

Under Ayushman Bharat Health Insurance Scheme, the beneficiaries are entitled to receive coverage of up to Rs. 5 Lakh each year in order to avail healthcare services in any form be it primary, secondary or tertiary.

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Ayushman Bharat Yojana

Ayushman Bharat Yojana is a National Health Protection Scheme launched by the Government of India in the year 2018. This scheme is also known as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana Scheme or AB-PMJAY Scheme. This scheme not only caters to the needs of poor but rural households as well, thus it is financially beneficial for both poor and destitute families in urban and rural areas. Under this scheme, the citizens can avail best healthcare services with an insurance cover of up to Rs. 5 Lakh for each household per annum for secondary and tertiary hospitalisation expenses. It is a paperless insurance scheme and provides cashless hospitalisation cover at network private hospitals and public hospitals.

Also, this scheme includes expenses for around 1400 exorbitant treatments such as knee replacement, skull surgery, etc.

Basic Details About AB-PMJAY

Scheme Name Ayushman Bharat Yojana
Introduced By Prime Minister Shri Narender Modi
Implemented and Supervised By Ministry of Health and Family Welfare
Launch Date

September 2018

Beneficiaries under the Scheme Poor Households of the Nation
Coverage Amount Rs. 5 Lakh
Official Website www.pmjay.gov.in

Salient Features of Ayushman Bharat Yojana

Let us know about the salient features of Ayushman Bharat Yojana, to understand the health insurance scheme better:

  • It is a family floater health insurance scheme offering a sum assured of Rs. 5 Lakh per annum for each household enrolled under this scheme.
  • It is designed specifically for individuals who are below the poverty line.
  • This scheme offers its beneficiaries cashless healthcare services in any of the private network hospitals and public sector hospitals.
  • Under this insurance scheme, coverage is also offered for certain pre-existing diseases.
  • Also, this scheme offers recompensation for the transportation expenses incurred by the beneficiaries during the pre-hospitalisation and post-hospitalisation expenses.
  • Under this health scheme backed by the government, various healthcare and wellness centres would be established according to the socio-economic caste census data.

What Is Covered Under Ayushman Bharat Health Insurance Scheme?

The healthcare coverage offered under Ayushman Bharat Health Insurance Scheme are as follows:

  • This scheme offers the beneficiary coverage for medical tests, treatment and consultation fees.
  • Under this scheme, the beneficiary is offered coverage for pre-hospitalisation expenses and expenses for post-hospitalisation is offered for up to 15 days.
  • Also, the Ayushman Bharat Yojana scheme offers coverage for medicine consumables, medicine cost, hospitalisation accommodation expenses, ICU and Non-intensive services.
  • The beneficiary is also offered coverage for expenses incurred towards diagnostic procedures, complications that arise during treatment and similar expenses.
  • It also offers coverage for medical implantation services wherever needed.

Critical Diseases Covered Under PMJAY Scheme

Under this scheme, over 1300 medical packages are provided at any of the listed private hospitals and all the government health centre or hospitals. Some of the critical illnesses covered under PMJAY are as follows:

  • Prostate Cancer
  • Carotid Angioplasty with stent
  • Skull base surgery
  • Coronary artery bypass grafting
  • Anterior spine fixation
  • Pulmonary Valve Surgery
  • Surgery for Double valve replacement

Who All are not Entitled to Receive Coverage Under PMJAY Scheme?

The following individuals are not offered coverage under Ayushman Bharat Health Insurance Scheme:

  • Individuals, who own vehicles such as three-wheeler, two-wheeler or car
  • Individuals with a monthly income of more than Rs. 10,000
  • Government Employees
  • People having farming equipment, machinery, motorized fishing boats and a kisan card.
  • People living in proper houses or having agriculture land more than 5 acres.
  • Individuals employed under non agricultural enterprises run by the government.

Benefits Offered Under Ayushman Bharat Yojana Scheme

Around 40% of the vulnerable and destitute households are offered coverage under Ayushman Bharat Yojana Scheme. The benefits offered to them under this health insurance scheme is as follows:

  • The healthcare treatment and other health services offered under this insurance scheme are available throughout the nation absolutely free of cost.
  • This scheme offers the beneficiary with coverage for medical test, treatment and consultation fee.
  • Under this scheme, the beneficiary is offered coverage for pre-hospitalisation expenses and expenses for post-hospitalisation is offered for up to 15 days.
  • Also, the Ayushman Bharat Yojana scheme offers coverage for medicine consumables, medicine cost, hospitalisation accommodation expenses, ICU and Non-intensive services.
  • The beneficiary is also offered coverage for expenses incurred towards diagnostic procedures, complications that arise during treatment and similar expenses.
  • It also offers coverage for medical implantation services wherever needed.

How to Apply for Ayushman Bharat Yojana?

It is very easy to register yourself for Ayushman Bharat Yojana. All the beneficiaries who are a part of RSBY health scheme and are identified under Socio-economic caste census, 2011, are eligible to apply for this scheme. To register for PMJAY scheme online, follow the below mentioned easy steps:

Step 1: Go to the official government website for Ayushman Bharat Scheme. Click on the ‘Am I eligible’ tab.
Step 2: Submit your contact number and captcha code. Then, generate the OTP by clicking on the option provided.
Step 3: Enter your name, state, phone number, ration card number, household number.
Step 4: In case your family members are covered under this scheme, then your name would get displayed in the search results.

Documents Needed to Register for Ayushman Bharat Yojana Scheme

You require the following list of documents to apply for Ayushman Bharat Yojana Scheme:

  • Identity and Age Proof (PA Card/Aadhar Card)
  • Contact Information (email. Address, mobile number)
  • Income Certificate
  • Caste Certificate
  • Document proof for the present status of the household to be covered (whether nuclear or joint)

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FAQ About Ayushman Bharat Yojana

  • Would I receive maternity coverage under JSY?

    Under Ayushman Bharat Yojana, the beneficiary is offered compensation for normal delivery and labour, C-section and deliveries involving high risk. However, it does not offer coverage for JSY and other benefits associated with voucher schemes.

  • What needs to be done if the hospital administration refuses to offer treatment to the beneficiary covered under PMJAY scheme?

    The beneficiary in such a case needs to file a complaint and the grievance would get redressed by the appointed grievance redressal committee within 30 days.

  • Is coverage for cancer offered under PMJAY scheme?

    Yes, coverage for cancer treatment is offered under PMJAY scheme.

  • How can I update my data in Ayushman Bharat Yojana?

    To update the data, the beneficiaries can contact the helpline number at 14555 or 1800- 111- 565 or by going to the common service centre.

  • Is coverage offered to the farmers under PMJAY scheme?

    Under this scheme, the coverage is offered to poor individuals both in urban and rural areas.