PMJAY Ayushman Bharath Eligibility

PMJAY Ayushman Bharath Eligibility

PMJAY Ayushman Bharath Eligibility : Ayushman Bharat, a flagship scheme of Government of India, was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC). This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to “leave no one behind.” Ayushman Bharat is an attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service.

This scheme aims to undertake path breaking interventions to holistically address the healthcare system (covering prevention, promotion and ambulatory care) at the primary, secondary and tertiary level. Ayushman Bharat adopts a continuum of care approach, comprising of two inter-related components, which are –

• Health and Wellness Centres (HWCs)
• Pradhan Mantri Jan Arogya Yojana (PM-JAY)

PMJAY : The second component under Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojana or PM-JAY as it is popularly known. This scheme was launched on 23rd September, 2018 in Ranchi, Jharkhand by the Hon’ble Prime Minister of India, Shri Narendra Modi.

Ayushman Bharat PM-JAY is the largest health assurance scheme in the world which aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 12 crores poor and vulnerable families (approximately 55 crore beneficiaries) that form the bottom 40% of the Indian population.

The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively. PM-JAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened.

It subsumed the then existing Rashtriya Swasthya Bima Yojana (RSBY) which had been launched in 2008. The coverage mentioned under PM-JAY, therefore, also includes families that were covered in RSBY but are not present in the SECC 2011 database. PM-JAY is fully funded by the Government and cost of implementation is shared between the Central and State Governments.

FEATURES of PM-JAY

• PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government.
• It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
• Over 12 crore poor and vulnerable entitled families (approximately 55 crore beneficiaries) are eligible for these benefits.
• PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
• PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.
• It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
• There is no restriction on the family size, age or gender.
• All pre–existing conditions are covered from day one.
• Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
• Services include approximately 1,929 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.
• Public hospitals are reimbursed for the healthcare services at par with the private hospitals.

Benefit Cover Under PM-JAY

Benefit Cover Under PM-JAY : Benefit cover under various Government-funded health insurance schemes in India have always been structured on an upper ceiling limit ranging from an annual cover of INR30,000 to INR3,00,000 per family across various States which created a fragmented system.

PM-JAY provides cashless cover of up to INR5,00,000 to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment.

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

The benefits of INR 5,00,000 are on a family floater basis which means that it can be used by one or all members of the family. The RSBY had a family cap of five members. However, based on learnings from those schemes, PM-JAY has been designed in such a way that there is no cap on family size or age of members. In addition, pre-existing diseases are covered from the very first day.

This means that any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.

FAQs related to the benefits for senior citizens under the AB-PMJAY scheme

1. Which age and income group of senior citizens are eligible under Ayushman Bharat PMJAY?
   Answer: All senior citizens aged 70 or above, regardless of economic status, are eligible for free medical treatment up to ₹5 lakh under this scheme.
2. How many senior citizens are aged 70 years or above in India?
   Answer: Approximately 6 crore senior citizens, belonging to around 4.5 crore families, are aged 70 or above in India.
3. What are the eligibility criteria for senior citizens under this scheme?
   Answer: The only eligibility criterion is that the individual must be aged 70 years or above, as determined by the age recorded in their Aadhaar card, regardless of economic status.
4. Is Aadhaar mandatory for enrolment in the scheme?
   Answer: Yes, Aadhaar-based e-KYC is mandatory for the enrolment and issuance of
   Ayushman cards for eligible senior citizens.
5. What documents are required to enrol in the AB PMJAY Senior Citizen Scheme?
   Answer: Aadhaar is the only document needed for enrolment in the AB PMJAY Senior Citizen Scheme.
6. If only the birth year is mentioned in Aadhaar, how is the date of birth determined?
   Answer: If only the birth year is recorded in Aadhaar, January 1st of the year following the recorded birth year will be considered as the date of birth.
7. Both my parents are over 70 years old. Do I need to enrol each of them separately in the
   AB PMJAY Senior Citizen Scheme?
   Answer: No, separate enrolments aren’t needed. After enrolling the first family member
   aged 70 or above, you can add other family members aged 70 or above under the scheme using the “Add Member” feature on our enrolment portal.
8. Will senior citizens receive a separate Ayushman card?
   Answer: Yes, a distinct Ayushman card will be issued to all eligible senior citizens aged 70 years and above.
9. Can we apply for an Ayushman card online for our parents who are 70 or older?
   Answer: Yes, the beneficiary can apply for the Ayushman Bharat Senior Citizen Scheme
   through our website portal – www.beneficiary.nha.gov.in and the Ayushman App (available for Android on the Google Play Store).
10. Can I receive treatment immediately after enrolling in the AB PMJAY Senior Citizen
    Scheme?
    Answer: Yes, beneficiaries can begin accessing treatment from the first day of enrolment. There is no waiting period for any disease or treatment, so coverage starts immediately.
11. My father is over 70 years old and earns more than ₹50,000 per month from his business. Is he eligible for this scheme? Answer: Yes, there is no income limit set by the government for eligibility under this scheme. Any Indian citizen aged 70 or above is eligible, irrespective of income.
12. Both my paternal and maternal grandparents are over 70 years old. Will they each receive ₹5 lakh coverage under PM-JAY? Answer: No, the ₹5 lakh coverage is provided on a family basis. Both your grandparents will be covered, but the ₹5 lakh annual limit is shared between them as part of the same family.
13. My family is already a beneficiary of Ayushman Bharat. Will my father, who is over 70 years old, receive the additional top-up benefit? Answer: Yes, your father is eligible for the additional top-up benefit. However, he will need to redo his Aadhaar eKYC.
14. My family is an Ayushman Bharat beneficiary. Will we all now get a cover of ₹10 lakh under this scheme? Answer: No, the additional ₹5 lakh coverage is only for family members aged 70 or above. The rest of the family will continue to receive their existing ₹5 lakh coverage.
15. My father is over 70 years of age, and I have health insurance for him through a private company. Will my father still be a beneficiary under PM-JAY? Answer: Yes, your father is eligible for PM-JAY coverage even if he has private health insurance.
16. My parents are over 70 years of age and covered under ESIC. Will they still be beneficiaries under PM-JAY? Answer: Yes, your parents are eligible for PM-JAY coverage even if they are covered under ESIC.
17. I am a retired government employee above 70 years old and have a CGHS card. Can I also enrol myself in this scheme? Answer: Yes, you are eligible. However, as per government rules, citizens who benefit from any other government health scheme must choose either their existing scheme benefits or those under AB PM-JAY. This means if you have CGHS, you must choose between CGHS and Ayushman Bharat PM-JAY, as benefits from both schemes cannot be availed simultaneously.
18. If my parents opt for AB PM-JAY and surrender their current government health scheme, is there any provision to switch back to their previous government health insurance scheme? Answer: No, once your parents choose the AB PM-JAY scheme and surrender their existing government health insurance, they cannot switch back. This is a one-time option and cannot be reversed.

SUGGESTION FOR YOU : Kurnool State Government Pensioners Association, Kurnool. Near C. Camp “Ayushman Bharat Pradhan Mantri Jan Arogya Yojana” e-KYC being done. Eligibility persons can get.