Everything You Need to Know About Pradhan Mantri Jan Aarogya Yojna (PMJAY)

Every citizen of a nation is an asset to the country. Isn't it evident that when citizens are healthy, the nation is also healthy and can focus on its full-fledged development? Health is a critical issue in our country, and there is a section of Indian society that cannot afford medical treatments. So to make medical therapies efficiently and economically available for the entire nation, the Government of India has been trying for ages.

Ayushman Bharat is one such initiative that was unveiled on 23rd September 2018. It was initiated per the guidelines of National Health Policy 2017 with the primary objective of Universal Health Coverage. Ayushman Bharat is built on two different pillars, i.e., the creation of the Health and Wellness Centre (HWC) and Pradhan Mantri Jan Arogya Yojana. Both of them have a supportive approach to each other.

Health and Wellness Centres are healthcare centres instated to provide Comprehensive Primary Health Care (CPHC), i.e., overall medical support, whether physical, mental, or social well-being. On the other hand, we have Pradhan Mantri Jan Arogya Yojana, whose objective is to provide health insurance coverage to the citizens of India who are below the poverty line and make medical treatments available for them.

Let us read about PMJAY in detail in the below-given sections:

Pradhan Mantri Jan Arogya Yojana (PMJAY)

PMJAY, one of the pillars of the Ayushman Bharat Yojana, aims to financially support the poor people in our nation. This is undisputedly the biggest health coverage scheme in the world. Earlier also, the Government of India had financial aid for low-income families, such as National Health Policy Scheme (NHPS) and Rashtriya Swasthya Bima Yojana (RSBY).

PMJAY is nothing but a reincarnation of the National Health Policy Scheme. But PMJAY is much bigger than NHPS because another insurance scheme, i.e., RSBY, was also included. PMJAY is a National Health Insurance Scheme (NHIS) that covers up to 5 lakh rupees per family annually, and it applies to all the poor people in India. PMJAY also announced a list of 1,393 medical procedures that can be availed under the scheme. It is a multi-stakeholder model comprising the Central Government, State Governments, and partners from the insurance sector. PMJAY is built on the trust of providing accessible and affordable health care to financially weaker sections of India. This scheme has been successful in its mission to provide financial support for the poor and vulnerable areas of the population.

Why PMJAY: Background

Under PMJAY, each family gets health insurance of 5 lakh rupees yearly for secondary-level and tertiary-level treatment, including hospitalisation.

About 40% of the Indian population is entitled to PMJAY health insurance. It is approximately 10.74 families that come below the poverty line. One of the significant advantages of this scheme is that it covers both pre-existing and new medical conditions. As per the model, PMJAY pays for medical bills in full or part, depending on the type and severity of the condition.

PMJAY is a significant step taken by the Government of India toward providing healthcare services to the underprivileged sections of the population. PMJAY ensures that no one is deprived of proper medical care, even if they do not have enough money. It also enables people to access quality healthcare facilities without any financial burden. With the help of this scheme, India will be able to achieve its goal of providing Universal Health Coverage. This will help reduce poverty and improve the health of its citizens. Thus, PMJAY is an excellent step towards achieving good health for all.

Features of PMJAY

There is no doubt that PMJAY is one of the top-notch schemes. It is not only aimed at providing financial aid for medical treatments, but it also covers various flaws in our health Infrastructure. So let's look at the features of PMJAY in detail.

• The primary benefit of PMJAY is that each family that comes under the poverty line is eligible for a health cover of Rs. 5 lakhs per year.
• Since it is a Government of India scheme, the entire burden of money is on the shoulders of the government. Also, it can finance the whole PMJAY budget without getting into any alliance with private or public sector organisations.
• It covers around 40% of the Indian population, i.e., it can finance around 10.74 crore families.
• Under PMJAY, no family is entitled to receive cash for treatment. Also, the insured money only covers the amount when they are treated. Thus, it promotes a culture of cashless transactions.
• PMJAY's vision is to provide expensive medical treatments that most people cannot access.
• PMJAY covers the cost of treatment and has schemes to cover pre-hospitalization charges for a maximum of 3 days. For post-hospitalization, it can cover expenses for a maximum of 15 days.
• Since the PMJAY gov in allows to take policy and is meant for the entire family, it doesn't matter how many members a family has.
• PMJAY has no age or gender restriction; it covers the expense for the entire family, from an hour-born child to the eldest of the house.
• Not only does it cover the expenses of hospitalisation, but it also covers all the additional charges from the pre-treatment tenure, including diagnostics, consulting fees, etc.
• PMJAY is a centre provisioned so one can get treatment in any part of India and can enjoy the benefits of PMJAY.It is already discussed that PMJAY covers all the expenses, including surgeries, room charges, consulting fees, diagnostics, medicines, etc. Carry your PMJAY golden card, as it covers the cost of the patient's food and more.

Benefits of PMJAY

• PMJAY is advantageous as one gets Rs. 5 lakhs for their treatment, and they don't need to pay a single penny to reimburse the amount.
• Poor people are also able to get treated and live healthy life. Also, this will help many to fight poverty and help them to focus on different expenses.
• This protects around six crore people hunted down by diseases and struggling to get treated yearly. Moreover, for such families whose savings are just a tiny amount for treatment for all such families, PMJAY comes to the rescue.
• It focuses on women, girl children, and senior citizens and prioritises their treatment.
• Unlike other insurance policies, it covers pre-existing illnesses and fully reimburses all pre-illness-related expenses.
• Since to bring PMJAY in use, one only needs to have the PMJAY card. Thus its cashless transaction eases the bill reimbursement process for cardholders.
• It also allows private hospitals registered under Ayushman Bharat to participate in developing health infrastructure.
• PMJAY also aims to provide benefits to the rural population of India, which cannot access proper healthcare facilities. Thus, it will bridge the gap between rural and urban people.
• The government has kept a record of all the hospitals it has tie-ups with to look into better treatments. Also, their list is regularly updated to ensure that the best treatments are provided to the patients.

Eligibility under PMJAY - rural and urban

The SECC-2011 list decides the eligibility of PMJAY. SECC-2011, i.e. Socio-Economic and Caste Census. Here, all the people from a backward place are considered, be it from financial conditions or caste factors.

Apart from this, there are some more distinctions to this. Also, there are different eligibility requirements for rural and urban areas.

Rural Areas

If residents of rural areas fulfil any of the given criteria, they are counted in SECC-2011 and are eligible for PMJAY.

• Anyone with a complete kutcha house consisting of such walls and floors with only one room.
• Family with no adult male from age 16 to 59 years old.
• If a family has a disabled member and no physically abled member.
• Scheduled Caste or Scheduled Tribe families
• Houseless and Landless families whose primary source of income comes from manual labour.

Urban Areas

For urban areas, the eligibility criteria are different from those for rural areas. The criteria are given below:

• Domestic Servants and helpers
• Beggars
• Ragpickers
• People who are street hawkers, street vendors, etc.
• Construction site labourers, coolies, plumbers, painters, security guards, and masons.
• Sanitary workers, gardeners, and sweepers.
• Handicraftsman and tailors
• Mechanics
• Electricians

Medical packages and hospitalisation process in Ayushman Bharat Schemes

Medical Package Provisions

1. Under Ayushman Bharat Scheme, one is eligible to get treatment under the provisioned 25 specialities in the Ayushman Bharat Scheme. Some of them are as follows:

• Neurology
• Orthopedics
• Covid-19
• Oncology
• Cardiology
• Pediatrics

2. It covers medical expenses and surgical expenses as well. But both cannot be covered simultaneously.

3. If you have been diagnosed with more than one disease and need to undergo more than one surgery. In this case, PMJAY covers the expense of one surgery completely. Then for the second, it covers half the cost. The third surgery covers a quarter of the payment.

Hospitalisation Process

One can be hospitalised in any hospital that is an Ayushman Bharat Health Facility. You will only need to keep your PMJAY card with you, and all your expenses and bills will be covered under the PMJAY.

You can download a PMJAY card using their website in a few steps. Also, this Ayushman health card will have all your details like your ID, your family's ID, and so on.

If you still need to opt for the PMJAY card online, apply; now is a perfect time to avail these benefits of the Pradhan mantri jan arogya yojana.

Conclusion

Health Infrastructure is one of the major concerns of any nation. For India, it is a very serious and cautious subject. Government has to keep trying to develop the health infrastructure, but it is only possible once its services are appropriately utilized. Moreover, its benefits must be fully utilized because there are diseases whose treatment is expensive. The majority of Indians cannot cover them. So to tackle this solution, Ayushman Bharat and PMJAY are the correct duos fighting every day for the survival of Indian citizens.

FAQ

Can one get treated in any hospital and reimbursed by PMJAY?

No, only those hospitals which are registered under Ayushman Bharat are the healthcare facilities where one will be reimbursed.

Is there any role of state governments in Ayushman Bharat?

Yes, the insurance reimbursement is shared between the central and state government. The state government covers 40% of the amount, and the central government covers the rest 60%.

What documents are required to apply for PMJAY?

The following documents are required to apply for PMJAY on pmjay gov.in

• Age & Identity Proof (Aadhaar Card/PAN Card)
• Caste certificate
• Contact details (mobile, address, email)
• Document proof of the current status of the family to be covered (Joint or nuclear)
• Income certificate (maximum annual income to be only up to Rs. 5 lakh a year)

Who is eligible to apply for the Pradhan Mantri Jan Arogya Yojana?

Anyone under 65 who falls under the Below Poverty Line (BPL) category is eligible for PMJAY. This includes people in both urban and rural areas, such as domestic servants, beggars, ragpickers, street vendors, and hawkers, as well as construction site labourers, coolies, plumbers, painters, security guards, masons, sanitary workers, gardeners and sweepers, handicraftsman and tailors, mechanics, electricians, etc.