PMJAY Scheme: Ayushman Bharat Yojana - Eligibility & Online Registration

What is Ayushman Bharat Yojana (PMJAY)?

Ayushman Bharat Yojana (PMJAY) is a flagship health insurance program of the Government of India, catering to over 12 crore poor and vulnerable families. The scheme provides comprehensive health insurance coverage for tertiary and secondary hospitalisation expenses. Moreover, it offers end-to-end cashless & paperless quality medical services at both public and private empanelled hospitals across India. Also, it is important to note that the beneficiaries need to carry an Ayushman card to avail of the services.

Key Highlights of PMJAY

Check out the key highlights of Pradhan Mantri Jan Arogya Yojana:

• Coverage Amount: ₹5 lakh per family per year
• Beneficiaries: Families identified under the Socio-Economic and Caste Census (SECC-2011) & senior citizens above 70 years of age.
• Nationwide Coverage: Valid across all empanelled public and private hospitals in India.
• Paperless Process: Hassle-free and fully digital.

Did You Know? PMJAY covers over 1,949 treatments, including life-saving surgeries like knee replacements, cardiac procedures, and cancer treatments.

Regular Health Insurance Plans vs Government Health Insurance Scheme

Here is the tabular difference between regular health insurance plans vs Government health insurance scheme:

Features of AB-PMJAY Scheme

PMJAY is the world's largest health assurance scheme that offers numerous benefits to ensure accessible and affordable healthcare for vulnerable sections of society. Below are the standout features of the scheme:

• Family Floater Scheme: Provides coverage for the entire family under a single policy.
• Cashless Healthcare: Beneficiaries can avail of cashless treatment at empanelled public and private hospitals across India.
• Pre-Existing Diseases (PED) Coverage: Pre-existing diseases are covered from the very first day of policy activation.
• Pre & Post-Hospitalisation Expenses: Covers up to 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses.
• Transport Costs Reimbursed: Reimburses expenses incurred for reaching the hospital.
• Day Care Expenses Included: Covers treatments that do not require 24 hours of hospitalisation.
• Health and Wellness Centres: Creation of 1.5 lakh health and wellness centres for primary healthcare across India.

Benefits of Ayushman Bharat Yojana

PMJAY ensures that approximately 40% of India's population, comprising the most vulnerable groups, receives access to quality healthcare. Listed below are the key benefits of the scheme:

• Wide Coverage: PMJAY covers 27 speciality areas, including oncology, cardiology, and orthopaedics.
• Follow-Up Treatments: Post-discharge care and medication expenses are included.
• Multiple Surgery Coverage: In case of multiple surgeries, costs are covered at decreasing rates for the second and third surgeries (50% and 25%, respectively).
• Critical Illness Coverage: Includes treatments for critical illnesses such as cancer, heart surgery, organ transplants, and more.
• No Restriction: This government health insurance scheme imposes no restriction on the family size, gender and age.

Ayushman Bharat Eligibility Criteria

Ayushman Bharat Yojana (PMJAY) eligibility is determined based on SECC-2011 data. Below are the specific criteria for rural and urban households:

1. For Rural Households:

   • Families living in kucha houses with one room.
   • Households with no adult male members aged 16-59 years.
   • Families with a disabled member and no able-bodied adult member.
   • SC/ST households.
   • Landless families dependent on manual casual labour.

2. For Urban Households:

   For urban areas, the workers in the following occupational categories can avail of the benefits of the PMJAY scheme:

   • Ragpicker
   • Domestic worker
   • Beggar
   • Street vendor/ Hawker / Cobbler/ other service provider working on streets
   • Construction worker/ Mason/ Plumber/ Painter/ Labour/ Welder/ Coolie / Security guard/ and other head-load worker
   • Sweeper / Mali / Sanitation worker
   • Home-based worker/ Handicrafts worker/ Artisan/ Tailor
   • Transport worker/ Conductor/ Driver/ Cart puller/ Rickshaw puller / Helper to drivers and conductors
   • Shop worker/ Peon in small establishment/ Assistant/ Helper/Attendant/ Delivery assistant / Waiter
   • Electrician/ Assembler/ Mechanic/ Repair worker
   • Washer-man/ Chowkidar

3. For Senior Citizens Above 70 Years:

   On 11th September 2024, the Union Cabinet approved free health insurance for all senior citizens aged 70 and above under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). This will benefit around 6 crore senior citizens across 4.5 crore families, providing ₹5 lakh health coverage per family.

   Following are the key points to consider:

   • Eligible senior citizens will receive a separate Ayushman Bharat Card.
   • Senior citizens in families already covered under AB-PMJAY will get an additional ₹5 lakh cover exclusively for themselves.
   • Senior citizens who are already covered under public schemes like CGHS, ECHS, or Ayushman CAPF can choose between their existing plan or the Ayushman Bharat health insurance scheme.
   • Senior citizens with private insurance or Employees' State Insurance can also avail of AB-PMJAY benefits.

NOTE: The Ayushman Card eligibility criteria is the same as mentioned above.

Who is Not Eligible for the Ayushman Bharat Yojana?

The following groups are excluded from PMJAY coverage:

• Households owning a motorised fishing boat or two, three or four-wheelers
• Government employees
• Families with an annual income exceeding ₹10,000
• Owners of agricultural land above 5 acres.
• People with refrigerators, landline phones, or farming equipment.
• Those who own Kisan cards with a credit limit of ₹50,000.
• People working in government-managed non-agricultural enterprises.
• Families who own solidly built houses.

How to Register for PMJAY Online?

The steps for PMJAY registration online are as follows:

Step 1: Visit the www.pmjay.gov.in login website and click on the “Am I Eligible?” option on the top.

Step 2: On the next page, choose login as “Beneficiary”.

Step 3: Enter the captcha code & phone number and click on the “Verify” button. An OTP will be sent to your registered mobile number.

Step 4: Enter the OTP you received and the captcha code again to log in.

Step 5: Select your state, sub-scheme, & district and provide details like your name, ration card number, or household number.

Step 6: If eligible, your name will appear on the results screen.

Pro Tip: Keep your Aadhaar and ration card handy during the AB-PMJAY registration process.

Documents Required for PMJAY Registration

To apply for PMJAY, ensure you have the following documents:

• Identity Proof: Aadhaar Card or PAN Card
• Income Certificate: Proof of your family's income
• Caste Certificate: For SC/ST households
• Residential Proof: Address verification

How to Apply for an Ayushman Card for Senior Citizens?

The steps to apply for an Ayushman Card for senior citizens above 70 years of age are as follows:

Step 1: Go to the BIS website by the National Health Authority (NHA).

Step 2: Type in the captcha code & mobile number and hit the “Verify” button. You will receive an OTP on the provided number.

Step 3: Enter the OTP and captcha code again to log in.

Step 4: On the next page, click the “Click Here to Enroll” button on the banner.

Step 5: Enter your Aadhaar number, captcha code and click on “Search”. It will show whether or not the Aadhaar number already exists in the database.

Step 6: For fresh enrolment, tap on the “Click Here” button below.

Step 7: On the next page, verify the Aadhaar number and Allow the consent.

Step 8: To proceed, type in the Member's Aadhaar OTP and User's Mobile OTP.

Step 9: On the declaration, make the necessary selection and click on “Proceed”.

Step 10: Complete the KYC details accurately and certify that the information you entered is true to your knowledge. Then, click on the “Submit” button.

The e-KYC will be completed, and the Ayushman Card for senior citizens will be available for download after some time.

How to Download Ayushman Bharat Card Online?

Here's how you can download your Ayushman Bharat e-card:

Step 1: Go to the official Ayushman Bharat PMJAY website and click on the "Am I Eligible" option in the top menu.

Step 2: Select the "Beneficiary” option, enter the captcha code, and type in your registered mobile number.

Step 3: Verify your number by entering the OTP you received.

Step 4: After successful login, select the relevant state, sub-scheme, and district from the available options.

Step 5: Under the "Search By" option, choose either Aadhaar number, family ID, or PMJAY ID, and enter the required information.

Step 6: Once verified, the system will display the list of family members registered under Ayushman Bharat Yojana.

Step 7: Look for the name of the family member whose Ayushman card you need to download.

Step 8: Click the "Download" button next to their name, and the Ayushman Bharat golden card will be saved as a PDF on your device.

NOTE: Make sure to print the downloaded Ayushman card for future reference.

What is Covered Under PMJAY?

The PMAY covers expenses incurred on the following treatment components:

• Medical examination, treatment and consultation
• Pre-hospitalisation expenses up to 3 days
• Post-hospitalisation follow-up care up to 15 days
• Medicine and medical consumables
• Complications arising during treatment
• Diagnostic and laboratory investigations
• Non-intensive and intensive care services
• Medical implantation services
• Accommodation benefits
• Food services

What is Not Covered Under PMJAY?

Take a look at the PMJAY exclusion list below:

• Outpatient care (OPD)
• Drug rehabilitation
• Cosmetic treatments
• Organ transplants
• Fertility treatment

Common Treatments Covered Under PMJAY

PMJAY covers over 1,949 procedures, including:

• Skull base surgery
• Double valve replacement
• Coronary artery bypass grafting (CABG)
• Pulmonary valve surgery
• Chemotherapy for cancer

Is COVID-19 Covered Under PMJAY?

Yes.

The Ayushman Bharat scheme provides coverage for COVID-19 treatment. The expenses covered include the following:

• Quarantine and isolation costs
• Hospitalisation for COVID-19-related complications
• Diagnostic tests at empanelled hospitals

PMJAY Toll-Free Helpline

For queries or assistance related to Ayushman Bharat-PMJAY, you can contact the following helpline numbers:

• 14555
• 1800-111-565

PMJAY: FAQS