Eligibility Criteria for Pradhan Mantri Jan Arogya Yojna

Pradhan Manti Jan Arogya Yojana was rolled out as Ayushman Bharat Yojana in September 2018 by Prime Minister Narendra Modi. The scheme was launched to ensure affordable healthcare services to the underprivileged section of the society. Pradhan Manti Jan Arogya Yojana is a health insurance scheme. The scheme has covered over 50 crore citizens of India and approximately 10 crore underprivileged households without any limitations of age and family size. The scheme subsumes the senior citizen health insurance scheme and the Rashtriya Swasthya Bima Yojana

 

The scheme covers nearly 40% of the poorest and the vulnerable population. It not only increases the access to budgeted and quality healthcare and medication, but also provides other needs such as on time treatments, patient satisfaction, better health outcomes and improvement in productivity.

 

Features of Pradhan Mantri Jan Arogya Yojana

 

• No limit on family size and age of members.
• Girl children, women and senior citizens are prioritised.
• Empanelled and public hospitals are bound to provide free treatment. 
• Covers the costs of primary, secondary and tertiary healthcare.
• Surgery, medical and daycare treatments, cost of medicines and diagnostics are covered under 1,350 medical packages. 
• Apply to all the pre-existing diseases.
• Cashless and paperless procedures to provide quality healthcare service.
• The beneficiaries' eligibility is based on the Socio-Economic Caste Census (SECC).
• The scheme offers a cashless hospitalisation facility and covers pre and post-hospitalisation costs.
• It also covers follow-up medical treatments for up to 15 days.

 

Eligibility Criteria for Pradhan Mantri Jan Arogya Yojana - Rural Sector

Pradhan Mantri Jan Arogya Yojana has been launched to help the rural population by covering up to Rs. 5 lakh per family on medical expenses so that this section can avoid debt traps.

 

The following entities are covered under the PMJAY:

• Families residing in only one room makeshift house or a house with no wall or roof. 
• Landless families earning their income from manual casual labour.
• Female-headed families (where there are no male members between the age of 16-59 years)
• Families who have at least one disabled member and no non-disabled adult member.
• Families from Scheduled Castes/Scheduled Tribes
• Beggars or those living on alms
• Manual scavengers
• Primitive tribal groups
• Legally released bonded labourers

 

 

Eligibility Criteria for Pradhan Mantri Jan Arogya Yojana - Urban Sector

According to the National Sample Survey Organisation, 18% of urban citizens avail healthcare services by borrowing money in one form or another. Thus, the government has launched Pradhan Mantri Jan Arogya Yojana for urban workers' families to safeguard their interests.

 

The Following Entities are Covered Under the Scheme:

 

• Service providers working on streets like Street vendors/ cobblers/ hawkers.
• Ragpicker
• Beggars
• Domestic workers
• Coolie and other headload workers
• Construction workers/ Plumbers/ Painters/ Welders/ Security guards
• Sweeper/ Sanitation worker /Gardener
• Artisans/ Handicrafts workers/ Tailors
• Shopworkers/ Assistants/ Peon in small offices / Helpers / Delivery boys or girls/ Waiters
• Transport workers/ Drivers/ Conductors/ Helper to drivers and conductors/ cart puller/ Rickshaw puller
• Electrician / Mechanic/ Assembler/ Repair worker
• Washerman/washerwoman

 

People who are not Entitled to PMJAY

• Owner of two, three or four-wheelers vehicle or a motorised fishing boat.
• Government employees.
• Kisan card holder with a credit limit of Rs 5 lakh.
• Families with proper and decent houses.
• Owner of 5 acres or more of agricultural land
• People who have mechanised farming equipment
• People earning a monthly income of more than Rs 10,000

 

Criteria for Hospitals to be Empanelled

Similar to setting eligibility criteria for beneficiaries, the government has come up with the eligibility criteria for a hospital to be empanelled. The criteria are:

 

• The hospital registered with state health agencies.
• The qualified medical and nursing staff of the hospital must be available 24/7.
• The hospital must have at least 10 in-patient beds.
• The hospital must have an accessible washroom.
• The hospital must have all the equipment and technical necessities.
• An interoperable IT software should be installed to manage data.
• A complete record of patients admitted under PMJAY must be maintained and shared with the government.
• Accessible ambulances and other emergency services.
• There should be a blood bank and pathology in the area.
• Water, electricity, and bio-medical waste disposal should be available in the hospital.

 

How to Check the Eligibility for PMJAY?

• Visit the official website of Pradhan Mantri Jan Arogya Yojana
• Click on the tab 'Am I Eligible?'
• Enter the phone number CAPTCHA code and click to 'Generate OTP'.
• Submit all the details, including your name, state, ration card number, and household number.
• If you are eligible for PMJAY, your name will flash on the screen.
• To check the eligibility by call, you can call helpline numbers - 14555 and 1800111565.

 

PMJAY is one of the many options available for health insurance. However, private health insurance is also quite beneficial, as it can provide more coverage and benefits for you and your family. For instance, Niva Bupa Super Saver - Family Health Insurance can provide health coverage of Rs 1 crore at an affordable premium. Besides, one can also avail of tax benefits with Niva Bupa health insurance. Niva Bupa's health insurance plans have been designed and created for the overall well-being of individuals and their families.

 

Conclusion:

PMJAY has not only benefitted many underprivileged and poor family of the country, it has also covered and provided what a weaker section of society cannot think to afford. Though implementing anything bigger in such a vast populated country, success is not possible without the challenges and frauds. But government is continuously keeping its eye on the fraudster and is bringing more tough laws to punish them.

 

But in a nutshell This scheme has become a boom for the eligible citizen and their family. It has benefitted and saved many of those people for whom proper treatment was just a dream.