About PM-JAY Illness Coverage

The government of India launched the PM-JAY scheme; this scheme helps a certain category of people to meet all their medical expenses. PM-JAY is currently the world's largest health assurance scheme and is 100% financed by the government. The government has provided its citizens with an Ayushman Bharat card cover treatment list which provides all the necessary information about the types of treatments.

The list of diseases covered under the Ayushman Bharat Yojana is also wide, which provides a scope of better financial help to the beneficiary. Ayushman Bharat card coverage can only be obtained by those who satisfy the criteria of a beneficiary. Ayushman Bharat coverage does not cover those citizens who are well off and can afford treatments.

List of critical diseases covered under PM-JAY Arogya Yojana

The PM-JAY scheme covers almost every critical disease common among people in India. The Ayushman Bharat card coverage has covered almost every critical disease and has made different provisions for each. This information is elaborated in detail in the Ayushman Bharat coverage list. The list is as follows:-

• Burn Management - Burns Management has a total of 6 packages. Only those eligible as beneficiaries of this scheme suffer through 2nd and 3rd degree burns on almost 10% of the total body for ages below 10 and above 60 and almost 20% for other ages.
• Cardiology - Almost all cardiology-related disease is covered under the PM-Jay insurance cover, and 20 packages have been approved along with 26 procedures.
• Cardio-thoracic - 34 Packages have been approved; although there are 118 procedures, you can get an easy auto approval through 4 simple procedures.
• Emergency Room - The emergency room has 3 approved packages; however, these are only available if the stay in the emergency room is at most 12 hours. All necessary facilities will also be available, such as stabilization, life support, and others.
• General Medicine - A general medicine package is a great relief for every beneficiary as it also covers the cost of services such as MRI, CT blood, and blood components. However, some of these services may require a low payment.
• General Surgery - General Surgery has 98 packages and provides aid for the expenses of general Surgeries; however, a general surgery package and a general medicine package can not be availed simultaneously.
• Infectious Disease - It has 3 packages that might not cover all infectious diseases, but the most critical ones are included along with infection of Covid-19. PMJAY also provides extra packages for HIV/AIDS, Tuberculosis and Leprosy.
• Interventional Neuroradiology - This has 10 packages that mostly cover treating diseases related to the central nervous system, spine, neck, and head.
• Medical Oncology - It contains 72 packages, most of which are concerned with the treatment and services for different types of cancer. In cancer care, pre-authorization is necessary at each successive step.
• Mental Disorders - In the mental disorder package, the pre-authorization for both treatment and hospital stay. The amount of aid ranges from ₹ 1000 to ₹ 10000.
• Neonatal Care - Pre-authorization is mandatory for a hospital stay, treatment, and package shifting. The aid claim ranges from ₹ 500 - ₹ 1500.
• Neurosurgery - Pre-authorization is mandatory; to claim the aids, it's mandatory to submit documents such as pre and postoperative x-ray and other required documents.
• Obstetrics & Gynecology - The 60 approved packages will include stay costs, consultation, food, diagnostics, and drugs for the patient. The cast may vary from ₹ 9,900 to ₹ 38,500.
• Ophthalmology - It mainly covers cataract Surgeries which are done for the implantation of IOL. The cost varies from ₹ 3,000 to ₹ 23,900.
• Surgery (Oral & Maxillofacial) - Only a little information is provided for it in the pm jay coverage scheme. The cost can be in the range of ₹ 500 - ₹ 15,000.
• Tissue and Organ Transplant - Only 1 package is available. The recipient's NOTTO ID, a work-up summary of the donor, and cross-match reports are mandatory for verifying Pre-authorization remarks.
• Orthopedics - Prior approval is mandatory for all replacement surgeries, and the cost is between ₹ 2,000 - ₹ 1,77,000.
• Otorhinolaryngology (ENT) - These packages cover almost all the issues related to the Eyes, Nose, and Throat. The range of package cover can be between ₹ 1,200 - ₹ 48,900.
• Pediatric Medical Management - Pediatric Medical Management packages allow you to extend the packages, but you need to submit some documents such as TPR charting, case sheets, diagnosis, and test reports.
• Pediatric Surgery - Pediatric surgery is a subspecialty of surgery that includes surgery on infants, children, fetuses, and young adults. The aid is between ₹ 1,800 to ₹ 45,000.
• Reconstructive & Plastic surgery - Pre-authorization is necessary for all the packages; however, in case of any emergency, limb, and life-saving surgery, the Pre-authorization is not mandatory.
• Polytrauma - The aid is provided for a cost between ₹ 1,000 - ₹ 75,000. The duration of everything is specified except the hospital stay because that can vary from case to case.
• Radiation Oncology - There is no specified time/duration of treatment for aid because the duration can vary from case to case and can even last up to a whole year. Cancer care treatment is also covered.
• Surgical Oncology - Pre-authorization remarks are necessary for all malignancies and treatments. For the treatment of cancer, pre-authorization is mandatory at each step.
• Urology -Prior approval is mandatory for surgeries that include Botox Injection, Deflux injection, urinary sphincter, and other specified inputs. Package aid varies between ₹ 1,000 - ₹ 42,000.

This was the list of all critical diseases covered under PM-JAY Arogya Yojna.

Benefits of illness covered under the PM-JAY Scheme

The PM-JAY Scheme provides several different monetary benefits to citizens approved as beneficiaries. The Ayushman Bharat universal health coverage covers up to Rs. 5 lakhs per family year. This cover can be utilized for hospitalization for secondary and tertiary care. The Ayushman Bharat coverage includes all the empanelled public and private hospitals across India. Almost 10.74 crores of vulnerable and poor families are beneficiaries of PM-JAY insurance cover. The PM-JAY coverage is continuously adding more and more people as its beneficiaries.Benefits include:
Pradhan Mantri Jan Arogya Yojana (PM-JAY) offers insurance for a wide range of illnesses and medical procedures. The main medical benefits covered under the PM-JAY program include:

1. Inpatient Hospitalization: PM-JAY will bear the hospital expenses such as room rent, nursing care expenses, and meal expenses.
2. Pre- and post- Hospitalization Expenses: Expenses before and after hospitalization are covered for up to 15 days and up to 30 days, respectively.
3. Day Care Procedures: PM-JAY will cover the cost of day care that requires hospitalization for less than 24 hours.
4. AYUSH Treatment: PM-JAY covers the cost of treatments within the framework of Ayurveda, Yoga, Naturopathy, Unani, Siddhas and Homeopathy (AYUSH).
5. Organ transplantation: PM-JAY pays for organ transplants, including kidney, liver and heart transplants.
6. Cancer treatment: PM-JAY will cover the cost of cancer treatment including chemotherapy and radiation therapy.
7. Cardiovascular treatment: PM-JAY pays for cardiovascular treatments such as angioplasty, bypass surgery, and pacemaker implantation.
8. Neonatal and Maternal Care: PM-JAY covers the costs of neonatal and maternal care, including follow-up care for both the birth and mother and child.
9. Mental health: PM-JAY covers treatment costs for mental illnesses such as schizophrenia, bipolar disorder and depression.

It's important to note that the exact medical benefits covered by the PM-JAY Plan may vary slightly depending on the state where you receive treatment. Additionally, the system provides certain exclusions such as: Cosmetic surgery and experimental treatments are not covered under this scheme.

Conclusion

The PM-JAY insurance coverage, widely known as pradhan mantri Jan arogya Yojana insurance coverage, has saved many lives in recent years. The people who are the beneficiaries of this scheme can get the required treatments with no or fewer fees. This scheme covers almost all the critical diseases which are common in our country.
The treatment and aids provided for those diseases are elaborated above in the lists of critical diseases. Also, the benefits of this yojana provided to its beneficiaries are mentioned above. This scheme will provide a new ray of hope for those who cannot afford proper treatments. It is in the best interest of every citizen to stay informed about this yojana and its benefits.

Frequently Asked Questions (FAQ)

Are other diseases and treatments also covered under the PM-JAY Scheme?
The list of critical diseases the government provides includes treatment for almost all diseases. However, treatments such as unspecified surgeries are also covered under the PM-JAY Scheme. Much addition to the treatments is unnecessary; however, the government is still improving the scheme.

What aid is received for the cost coverage for each of the treatments?
The list of critical diseases elaborates on the aid receivable for each treatment. The amount of aid can vary from disease to disease and case to case. The amount of aid can also be extended in some cases.

Who is eligible to receive benefits under the PM-JAY Scheme?
The eligibility criteria for the PM-JAY Scheme are age and socio-economic criteria defined by the government. All citizens who fall under these criteria are eligible to receive the benefits of the PM-JAY Scheme.