The need for a health insurance plan is felt by all, especially since medical costs have been increasing at an alarming rate. While the middle and higher-income individuals can easily afford a health plan for covering the medical costs, the poor often ignored the coverage for lack of funds. Therefore, to bring parity and access to quality healthcare to the poor and low-income class, the Prime Minister, Mr. Narendra Modi, launched the Pradhan Mantri Jan Arogya Yojana scheme on 23rd September 2018. Let’s understand the details of the scheme –
What is Pradhan Mantri Jan Arogya Yojana?
The Pradhan Mantri Jan Arogya Yojana (PMJAY) popularly called the Ayushman Bharat scheme, is a health insurance scheme for the poor and backward class families. The PMJAY scheme is the largest Universal Health Coverage (UHC) scheme which offers health insurance coverage of Rs.5 lakhs to about 50 crore beneficiaries or 10.74 crore poor families of India.
The salient features of the PMJAY scheme are as follows –
The beneficiaries who would be covered under the scheme have been selected based on the occupational and deprivation criteria of the Socio-Economic Caste Census (SECC) conducted in 2011 for rural and urban areas. Thus, only eligible families and individuals can be covered under the PMJAY scheme. So, the PMJAY eligibility criteria include the following –
In the urban areas, coverage under the PMJAY scheme can be availed by the following –
There is no limit on the entry age, number of members to be covered and the exit age under the scheme for eligible beneficiaries.
So, individuals who own any type of vehicle, have mechanized farming equipment, are employed by the Government, have a Kisan card with an Rs.50,000 limit, who earn Rs.10, 000 or more a month, work in non-agricultural enterprises which are managed by the Government, who own refrigerator and landlines, 5 acres of agricultural land or live in decently built houses cannot be covered under the PMJAY scheme.
Coverage under the Pradhan Mantri Jan Arogya Yojana scheme is offered for the following types of medical expenses –
Moreover, there are specially created packages for various treatments which you can avail as and when required.
However, there are some treatments which are not covered under the scheme. These include cosmetic treatments, drug rehabilitation costs, organ transplant surgeries, OPD expenses, fertility-related treatments and individual diagnosis for evaluating your health.
The PMJAY scheme has provided the much-needed health insurance coverage to the backward class individuals who could not afford quality healthcare services. The scheme provides cashless treatments thereby making it easier for individuals to get treated at empanelled hospitals. Moreover, the scope of coverage of the scheme is comprehensive making sure that most medical costs get covered.
Identified beneficiaries have been automatically enrolled under the PMJAY scheme by the Government. A health card has been issued to identified families and they can avail cashless treatments by presenting the card at the time of hospitalisation. You can check whether you are eligible for the scheme by visiting the Common Service Centre (CSC), calling the helpline number 14555 or 1800 111 565 or through the official PMJAY website.
To apply for the PMJAY scheme, you would have to submit your documents which include the following –
The claim process of PMJAY is quite simple. You have to find out the empanelled hospital which covers PMJAY treatments. Get admitted at the hospital and present your PMJAY health card for identification. Some paperwork would be completed to verify the identity of the insured and then treatments would be allowed on a cashless basis. You would not have to pay for the medical costs yourself as the scheme would pay the expenses itself.
The PMJAY scheme is a welfare scheme which aims to provide the poor with quality treatments in a medical emergency. It is a Government-funded scheme which works like a group health insurance scheme and provides free coverage. The Government has launched this scheme for the welfare of the backward classes and with the progress that the scheme has made, the potential for growth is good.