Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a part of the Ayushman Bharat initiative. It provides health insurance to the economically weaker sections of India. Ayushman Bharat aims to cover 50 crore citizens of India from both rural and urban regions. The Ayushman Bharat Yojana will provide a sum insured of ₹5 Lakhs. This will cover the following expenses:

• Diagnostic cost

• Medical treatments

• Hospitalisation

• Pre-existing illnesses

• Several critical ailments

Register for PM-JAY with this simple process to avail of quality healthcare services.

 

The National Sample Survey Organisation conducted their 71st round of survey. This survey reports that over 85.9% of people in rural areas do not have access to a basic healthcare plan. Moreover, 24% of the rural population seeks healthcare facilities by borrowing money.

 

This is where the Pradhan Mantri Jan Arogya Yojana scheme comes in handy. It helps these people avoid getting into a debt trap and avail health facilities. This scheme is economically beneficial to underprivileged households. Families who enrol for Rashtriya Swasthya Bima Yojana will be covered under PM-JAY.

Here is the list of benefits that are covered and all that is not covered under the Ayushman card:

PM-JAY scheme provides funding of ₹5 lakh per family annually. The PM-JAY scheme can be used for day care procedures and even for pre-existing illnesses. Some of the critical illnesses covered in the PM-JAY insurance plan are as follows:

• Prostate cancer

• Coronary artery bypass grafting

• Double valve replacement

• Carotid angioplasty with stent

• Pulmonary valve replacement

• Skull base surgery

• Laryngopharyngectomy with gastric pull-up

• Anterior spine fixation

• Tissue expander for disfigurement following burns

• COVID-19 treatment and testing

Individuals and families can utilise the health coverage of ₹5 lakh under this scheme. This can cover surgical and medical expenses of almost 25 specialties that include:

• Cardiology

• Neurology

• Oncology

• Paediatrics

• Orthopaedics
   

However, you cannot reimburse medical and surgical expenses simultaneously. Here is the process for multiple surgeries:

1. The surgery with the highest cost is paid in the first instance

2. A 50% waiver is offered for the second surgery

3. A 25% discount on the third
    

Additionally, PM-JAY has no waiting period for pre-existing illnesses. This service comes under a larger umbrella scheme of Ayushman Bharat Yojana. If you need urgent medical assistance, you do not have to worry about the expenses incurred. However, ensure that you seek treatment at a government or private hospital.
 

Moreover, this scheme provides cashless treatment and hospitalisation. This is possible because of the 60:40 cost-sharing ratio between the Centre and States. Upon enrolling you and your family members will receive an Ayushman card. This card is issued and verified by professionals known as Ayushman Mitras. The Ayushman card is an e-card that allows you to avail the benefits of PM-JAY at any of the network hospitals.

You can file a complaint or grievance on the CGRMS portal. Here is how you can file a complaint offline:

• Contact the Ayushman Bharat scheme helpline operated by your State/NHA

• Send a letter, email, or fax to the official SHA/NHA address

• Meet the District Grievance Nodal Officer (DGNO). Your complaints will be formally processed here. The DGNO will enter your grievances via offline mode in the portal.
  
  

For technical support related to the PM-JAY, head to https://mera.pmjay.gov.in/search/login

 

To summarise, comprehensive health insurance is required to handle medical expenses. There are people who cannot afford health insurance plans. The PM-JAY scheme ensures that help is given to underprivileged families. Health is an essential aspect of our lives, and it should not be ignored at any cost. Register online for the Ayushman Bharat card to receive quality healthcare. Thus, every citizen of our country will be able to lead a healthy life.

The PMJAY scheme contact and mailing information is as follows:

 

Contact Number:

14555 or 1800-111-565 (both toll-free)

 

Mailing Address:

National Health Authority of India

3rd, 7th and 9th Floor,

Tower-L,

Jeevan Bharati Building,

Connaught Palace,

New Delhi – 110001

 

You also get easy access to the information related to PM Jan Arogya Yojana with the Ayushman Bharat app. It is available on the Google Play Store for Android users only as of now. The app offers the facility to check your eligibility criteria for the scheme. You can even search for the empanelled hospitals around you.

PM-JAY is one of the world’s largest national health insurance schemes. Under this insurance scheme, the government has launched several healthcare initiatives such as:

• National Health Protection Scheme (NHPS)

• Rashtriya Swasthya Bima Yojana (RSBY)

• Senior Citizen Health Insurance Scheme (SCHIS)

• Central Government Health Scheme (CGHS)

• Employees’ State Insurance Scheme (ESIS). 
   

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