Jan Arogya Yojana

To achieve the Universal Health Coverage (UHC) vision, Ayushman Bharat, a major scheme of the Government, was launched in 2017.

An integrated approach to healthcare will be used at all three levels, which includes pre-emptive care, promotion, and follow-up care. The Ayushman Bharat program takes a comprehensive approach to health care, consisting of two interrelated components such as:

• Health and Wellness Centres (HWCs)
• Pradhan Mantri Jan Arogya Yojana (PM-JAY)

PM-JAY is a health assurance scheme that covers the bottom half of the poor and vulnerable population. This number comes close to 107.4 million low-income families, i.e., about 500 million beneficiaries. The scheme aims to cover the cost of secondary and tertiary care hospitalisation up to a covered sum of Rs. 5,00,000 per annum.

PM-JAY was formerly known as the National Health Protection Scheme (NHPS). It absorbed the 2008-launched Rashtriya Swasthya Bima Yojana (RSBY), which came into effect earlier. Therefore, families covered by PM-JAY also include those that are not included in SECC 2011 but were covered by RSBY.

Cost to the beneficiaries:

There is no cost to be borne by the beneficiaries. A government budget supports the scheme. PM-JAY’s actual premiums and implementation costs are fully split between the Central and State Governments in a ratio as directed by the Ministry of Finance.

Eligibility:

Socio-Economic Caste Census 2011 (SECC 2011) has set out deprivation and occupational criteria for households in rural and urban areas. In addition, the families covered under the previous scheme of RSBY are also eligible.

Benefits available to the beneficiaries:

• Under this plan, hospitalisation coverage of Rs. 5,00,000 is provided in both public and private hospitals in all cases except primary care.
• It provides cash free access to healthcare services for the beneficiary.
• Coverage of expenses up to three days prior to hospitalisation and 15 days after hospitalisation sheltered under the scheme.
• Unlike the RSBY, which placed an upper limit on the number of family members, the PM-JAY does not have a maximum number of family members, an age limit, or a gender limit.
• The plan will cover all already existing medical issues from the first day. If you are suffering from a disease before enrolling in the scheme, you can access treatment under the scheme once you enroll.
• The benefits are on a floating basis, which means one or all family members can avail of the benefits.
• PM-JAY covers a list of over 1,350 packages at empanelled private and public hospitals.

Exclusion of expenses under PM-JAY:

• OPD
• Rehabilitation program for drug addicts
• Procedures related to cosmetic surgery
• The treatment of infertility
• Transplantation of organs
• Diagnostics for each individual

How to apply?

One does not have to follow a specific procedure for applying for PM-JAY. However, to check whether you are eligible or not, follow the below-mentioned steps:

1. Visit https://pmjay.gov.in/about/pmjay and click on “Am-I-eligible”?
2. Input your mobile number and the CAPTCHA code to generate a One Time Password (OTP)
3. Once logged in, select your state
4. After that, search by your name/phone number or ration card number
5. Based on the results, you can determine whether you are eligible to apply for the scheme or not

Alternatively, dial 14555 or 1800-111-565 at the Ayushman Bharat Yojana Call center to check your eligibility.

Once eligible, generate an e-card by submitting personal and family identification documents like:

1. Aadhar card/Ration Card
2. Family members are listed on a government-certified list, RSBY card, or PM letter.

This will generate a PM-JAY unique ID that can be used in the future as proof of eligibility.