Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana

The scheme “Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana” implemented by the National Health Authority (NHA) under Ministry of Health and Family Welfare, Government of India, aims to provide cashless hospitalisation coverage of ₹5,00,000 per family per year to poor and vulnerable families for secondary and tertiary healthcare services. It was launched on 23rd September 2018 in Ranchi, Jharkhand, by the Hon’ble Prime Minister of India.
"Ayushman Bharat" is an attempt to move from a sectoral and segmented approach to 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 levels. Ayushman Bharat adopts a continuum of care approach, comprising two interrelated components, which are -

• Health and Wellness Centres (HWCs): The scheme aims to provide comprehensive primary healthcare services, including maternal and child health, non-communicable disease care, free essential drugs, and diagnostics, close to people’s homes. The centres promote preventive healthcare and healthy behaviours to reduce the risk of chronic diseases.

• Pradhan Mantri Jan Arogya Yojana (PM-JAY): The second component under Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojna or PM-JAY as it is popularly known. It aims to provide cashless health insurance coverage of up to ₹5,00,000 per family per year for secondary and tertiary hospitalization to poor and vulnerable families.

Financial Health Insurance Cover:

• Annual Hospitalization Coverage: Cashless coverage up to ₹5,00,000/- per family per year.- Comprehensive Treatment Costs: Covers consultation, medicines, diagnostics, surgery, ICU, implants, accommodation, and food.- Pre and Post Hospitalization Support: Covers 3 days pre-hospitalization and 15 days post-hospitalization expenses.- Treatment Complication Coverage: Covers complications arising during treatment.

Coverage Features:

• Pre-Existing Disease Coverage: Covers all pre-existing diseases from day one.- No Family Size Limit: No restriction on age, gender, or family size.- Nationwide Portability: Benefits available across India in empanelled hospitals.- Wide Procedure Coverage: Covers approximately 1,929 medical procedures.

Rural Beneficiaries

Out of the total seven deprivation criteria for rural areas, PM-JAY covered all such families who fall into at least one of the following six deprivation criteria and automatic inclusion(Destitute/ living on alms, manual scavenger households, primitive tribal group, legally released bonded labour) criteria:

1. Only one room with kucha walls and kucha roof
2. No adult member between ages 16 to 59
3. Households with no adult male member between ages 16 to 59
4. Disabled member and no able-bodied adult member
5. SC/ST households
6. Landless households deriving a major part of their income from manual casual labour

• Automatically includedHouseholds without shelter

1. Destitute/ living on alms,
2. Manual scavenger families,
3. Primitive tribal groups,
4. Legally released bonded labour.

Urban Beneficiaries

For urban areas, the following 11 occupational categories of workers are eligible for the scheme:

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

1. Those who own a two, three, or four-wheeler or a motorized fishing boat.
2. Those who own mechanized farming equipment.
3. Those who have Kisan cards with a credit limit of ₹50,000/-.
4. Those employed by the government.
5. Those who work in government-managed non-agricultural enterprises.
6. Those earning a monthly income above ₹10,000/-.
7. Those owning refrigerators and landlines.
8. Those with decent, solidly built houses.
9. Those owning 5 acres or more of agricultural land.

Offline

• The Arogya Mitra searches the available list of beneficiaries using details such as name, location, ration card number, mobile number, or the RSBY URN of the beneficiary. After this, the beneficiary is searched for in the BIS. The individual is identified and the scanned valid ID documents are then uploaded.

• To get a PMJAY e-card for themselves and their family, a potential beneficiary needs to visit either a hospital or a Community Service Centre (CSC) for identification and follow the steps mentioned below:
  Step 1: Potential AB-PMJAY beneficiaries are to submit the PM letter/ RSBY URN/ RC Number/ Mobile Number - The operator (commonly known as the Arogya Mitra) searches the available list of beneficiaries. The operator does this by entering details such as name, location, Ration Card number, mobile number, or even RSBY URN of the beneficiary.
  Step 2: Search in the BIS Application - The operator searches for the potential beneficiary in the entitled SECC, RSBY, State Health Scheme, Additional Data Collection Drive databases.
  Step 3: Individual Identification - The identification process is carried out if the name is found in the list. For this, documents like Aadhaar or any government ID and a Ration Card or an alternative family ID are required to validate against the details available in the system. Scanned documents are then uploaded.
  Step 4: Family Identification - The Arogya Mitra then identifies the family records through the ration card and the scanned documents are then uploaded. The Arogya Mitra then submits the individual and family records to the trust/insurance company for approval.
  Step 5: Approval or Rejection - The Health insurance company or trust may then approve or recommend rejection for the submitted beneficiaries. The cases that are recommended for rejection will be finally verified for approval or rejection by the State Health Agency (SHA).
  Step 6: E-card Issuance - On approval by SHA/insurance company/trust, an e-card will be issued to the beneficiary.

Online

Step 1:****** Register on the UMANG Portal

• Visit the official website of UMANG. In the top right corner of the landing page, click "Register." You will be taken to the Registration Page.

Step 2:****** Mobile Number Verification and MPIN Creation

• You will be redirected to the mobile number verification page. Enter your mobile number and get it verified via OTP. Create an MPIN to complete the registration process. You will be taken to the UMANG homepage. Login using your Mobile Number and MPIN.

Step 3:****** Accessing Services on UMANG

• In the tabs provided at the bottom of the page, click on the "All Services" tab. Select the service you want to apply for. You will be taken to the Online Application Form.

Step 5:****** Completing the Application

• In the application form, fill in all the mandatory fields and upload all the required documents in the specified format and size.

Step 6:****** Review and Confirmation

• Carefully review all the information provided and the documents uploaded. Make any necessary corrections, if required. Acknowledge and agree to the terms and conditions, declaration, and privacy policy, if any.

Step 7:****** Submitting the Application

• Click the "Submit" or "Apply" button to submit your application. You'll receive a confirmation message upon successful submission of the application.