Medical Insurance is becoming popular now a days in India and COVID-19 has provided a big push for quantum jump in its popularity. However, those who need it most can afford it least. The weaker section of the society who is pulling on their daily life on stressed financial budget cannot, in spite of their best intentions, afford medical insurance. This is an irony of our society. An incident of a hospitalisation for a poor family pushes the family in a debt trap. If the breadwinner of the family has to be hospitalised, the financial wound becomes deeper, leaving long-lasting implications on the family. The aged people with no earning capacity and no savings have to suffer the pain – they are more vulnerable but less cared for. In order to provide universal free health care to all eligible citizens, the Government of India first announced the Ayushman Bharat Yojana as a universal health care plan in February 2018 in the Union budget of India. The Yojana has been touted as the world’s largest health care programme in the world. An important milestone under Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojana (PMJAY) which was launched on 23/09/2018 by our Honourable Prime Minister Shri Narendra Modi.
The features of the PMJAY:
1. It is a means tested (eligibility based on the economic position of the family) scheme. The households included are based on the deprivation criteria of Socio-Economic Caste Census 2011 (SECC 2011) and occupation for rural and urban areas respectively.
2. It subsumed the old Rashtriya Swasthya Bima Yojana (RSBY) which was introduced in 2008. Hence, PM-JAY covers families that were covered in RSBY but are not present in the SECC 2011 list. The beneficiaries under Employee State Insurance Scheme (ESIS) are also covered.
3. PM-JAY is fully funded by the Government and cost of implementation is shared between the Central and State Governments. It is implemented under the aegis of National Health Authority.
4. Hospitalisation (in public and private empanelled hospitals in India) expenses to the extent of Rs. 5,00,000/- (Rs five lakh only) is provided to the family per year.
5. PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
6. It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
7. There is no restriction on the family size, age or gender.
8. All pre–existing conditions are also covered from day one.
9. Beneficiary can avail the medical treatment from any empanelled public or private hospital across the country.
10. Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician's fees, room charges, surgeon charges, OT and ICU charges etc.
11. The cap on benefit of Rs. 5,00,000 per year is on a family floater basis which means it can be used by one or more members of the family.
12. COVID-19 patients can avail free treatment at empanelled hospitals.
Who Is Not Eligible for PMJAY?
The people falling under one or more categories are not eligible for PMJAY:
- Those who have mechanised farming equipment.
- Who owns a two, three or four-wheeler.
- Those who hold a Kisan card.
- Government employees.
- Those who own a motorised fishing boat.
- Those who are earning more than Rs.10,000 per month.
- Those who are working in government-run non-agricultural enterprises.
- Those who own more than 5 acres of agricultural land.
- Those who own landline phones or refrigerators.
- Those who live in decently built houses.
How to apply online for Ayushman Bharat Yojana?
Follow the following steps for applying online for PMJAY card (popularly known as a Gold Card):
- Visit the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana official website at https://pmjay.gov.in/
- Click on ? mark (“Am I Eligible”) icon (on right hand top corner).
- Enter your contact details (mobile number), Captcha code and generate OTP.
- Select your state
- Select Category (Search your name by your name or mobile number (if registered in (SECC) Socio Economic and Caste Census 2011) or HHD (a 24 digit Household Id number given to each family in SECC 2011) or Ration Card number)
- If you search by Name, fill in your name, Father’s name, Mother’s name, Spouse’s name, your gender, age, district name, village name, area(Rural / Urban), PIN Code, etc. Care: if the details are not filled in properly, you might not find your name in the list even though you are in the eligible list.
- Click on 'Family Members' tab to find the family members listed in SECC database
- HHID is also available along with the details of the family members. Note down the HHID on a piece of paper for reference in future.
- Click on “GET DETAILS ON SMS” and fill up your mobile number and Captcha code and Click on submit button.
- A message will appear on the screen “SMS has been sent to your mobile number XXXX. Thank you”.
- With this SMS, visit a CSC (Common Service Centre) or Community Health Centre/ Empanelled Hospital in your vicinity.
- Each member of the family has to give the biometrics (finger print) which will be verified with Aadhar database to confirm the identity of the beneficiary. The photo and other details are auto-populated from the Aadhar database and printed on the card.
- Each member is given a separate PMJAY Card (Gold Card). The card is required to avail the benefit under the AB-PMAJY.
- Family members can be added due to birth or addition due to marriage or name of a family member is left out due to some genuine error.
- Alternatively, you can approach any Empanelled Health Care Provider (EHCP) or dial the Ayushman Bharat Yojana call centre number: 14555 or 1800-111-565 to know whether you are eligible or not under PMJAY.
- To know the details of benefits under the PMJAY, just send Hi on WhatsApp Number
+91 98689 14555 (Just Ask Master Ayushman service).
Progress so far:
More than 12.58 crore cards (till March, 2021) have been issued under the PMJAY. It has been lauded as the largest universal health care initiative in the world. It has earned many accolades from the international organisations, including World Health Organisation. The scheme aims to cover 50 crores beneficiaries. By the end of June 2021, as many as 1,91,32,000 patients have availed the hospitalisation treatments worth Rs 13,412 crore through a network of 21,565 public and private empanelled hospitals. The National Health Authority has also prepared detailed guidelines to issue eCard to the beneficiaries.
Disclaimer: The information given in the blog is only for general awareness and must not be construed as a professional advice. Readers are advised to consult the professionals in any subject matter of the blog before acting on the information discussed in the blog. The readers who are acting otherwise are doing so at their own risk.
(The reader’s comments are welcome at gnpatel@gujaratinfotech.com)
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