PM-JAY: Step-by-step guide on how to apply for Ayushman card
Explore government health insurance in India and find out how to apply for ayushman card under the PM-JAY scheme.
10 min read
August 21, 2024
Simmran Sharma
The Ayushman Bharat scheme, also known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), is a health insurance initiative launched by the Government of India. It aims to provide free healthcare to the financially underprivileged in the country. Let us understand how it works, who qualifies for the scheme, and how to apply for ayushman card.
How is Ayushman Bharat implemented?
The implementation of the Pradhan Mantri Jan Arogya Yojana (PM-JAY) involves a collaborative effort between the central and state governments, ensuring widespread access to healthcare. It operates through a network of empaneled hospitals and insurance providers, offering cashless treatment to eligible beneficiaries. The scheme’s success relies on effective coordination, regular updates to hospital lists, and robust administration by participating insurance companies, all aimed at delivering accessible and affordable healthcare across India.
a) Coverage
PM-JAY scheme covers over a thousand procedures in secondary and tertiary healthcare. The scheme ensures cashless treatment, covering up to ₹5 lakh per family annually, and aims to provide comprehensive medical care without any out-of-pocket expenses.
i) No coverage for primary care
Primary care is the first point of contact for individuals seeking healthcare. It includes basic health services such as preventive care, routine check-ups, immunizations, and management of common illnesses and minor injuries. PM-JAY does not provide coverage for primary care.
Tip: If you are seeking such care you may visit the nearest Health and Wellness Centres (HWCs) set up by the government. These centers provide comprehensive primary healthcare services, preventive care, and health awareness programs at the grassroots level.
ii) Secondary care covered
Secondary care is an intermediate level of care that deals with more complex health issues than primary healthcare and thus requires specialist care. It includes specialized medical services such as surgeries, diagnostics, and treatment for more serious conditions. The scheme covers all secondary care services including medical implantation services where required.
iii) Tertiary care covered
Tertiary healthcare is for complex and severe medical conditions, often requiring multi-disciplinary approaches and extensive medical resources. The scheme covers the cost of tertiary care including any complications arising during the medical treatment.
iv) Exclusions
The following treatments in secondary and tertiary care are not covered under the scheme:
> Out-Patient Department (OPD) expenses
> Drug rehabilitation
> Fertility treatments
> Individual diagnostics
> Organ transplant
> Cosmetic surgeries
The scheme further pays for the pre-hospitalization expenses for up to 3 days post-hospitalization expenses for up to 15 days of those insured. Including food services.
b) Network & funding between state and central agencies
Although PM-JAY is a centrally sponsored scheme, it requires participation, financial support and help in the implementation framework from respective states and union territories. It is jointly funded by both the central and state governments. Further, participation of states in the Ayushman Bharat scheme is not mandatory. Some states can opt out for reasons such as already having a functional state health care programme. As of now, all 28 states and 8 union territories of India are covered under the Ayushman Bharat scheme. Each state and union territory manages the implementation of the scheme according to local needs and conditions.
c) Network of healthcare providers
Not all hospitals cover PM-JAY benefits. Ayushman Bharat scheme operates through a network of empaneled hospitals, which means that only selected hospitals provide benefits under the scheme. The list of empaneled hospitals can vary by state and region, as each state or Union Territory may have different hospitals enrolled in the scheme. This list is regularly updated to include new hospitals and remove those that no longer meet the criteria. Beneficiaries can check which hospitals are empaneled in their area by visiting the official PM-JAY website or app, or by contacting local health authorities. Both public and private hospitals are empaneled based on specific criteria including:
> Infrastructure.
> Quality of care.
> Capacity to handle various medical procedures.
Beneficiaries can avail cashless treatment at these empaneled hospitals. The costs of covered services are settled directly between the hospital and the insurance provider, relieving patients of out-of-pocket expenses.
d) Network of insurance companies
Several insurance companies offer coverage under the Pradhan Mantri Jan Arogya Yojana (PM-JAY) scheme. The specific list of participating insurers may vary by state and over time. As of the latest updates on official website, the following are some of the insurance companies involved:
> Icici prudential life insurance
> Cholmondeley ms general insurance
> ManipalCigna health insurance
> Aditya birla health insurance
> Kotak mahindra life insurance
> Royal sundaram general insurance
These companies collaborate with the government to play a crucial role in the Pradhan Mantri Jan Arogya Yojana (PM-JAY) scheme. Their responsibilities include the following:
> Providing health coverage
> Claim processing
> Networking hospitals
> Administration of policies, including enrollment, renewals, and customer support.
> Fraud prevention by verifying claims and ensuring adherence to the scheme's guidelines.
> Data management to ensure the scheme's effective implementation.
These roles ensure that the PM-JAY scheme delivers on its promise of accessible and affordable healthcare for eligible beneficiaries.
Who is eligible under the scheme?
To be eligible, applicants must fall into one of the specified categories: SC/ST, lower income group, or EWS. Government identifies qualifying families primarily based on the Socio-Economic Caste Census (SECC). However, this census was last conducted in the year 2011 which might lead to some discrepancies.
The scheme also includes pre-conditions to determine who can receive health coverage benefits. In rural areas, these pre-conditions typically assess factors such as lack of housing, low income, and other deprivations to establish eligibility. States may also conduct their own verification to ensure accuracy.
a) Rural households
Families in rural areas that fall under certain vulnerability criteria, such as land ownership and occupation. Rural households can qualify for the PM-JAY scheme if they meet any of the following six deprivation criteria or preconditions:
| Families without a pucca house | Households that do not have a permanent, durable house structure. |
| Landless families | Those without agricultural land or with very small landholdings. |
| Families engaged in manual labor | Households dependent predominantly on manual casual labor as their primary source of income. |
| Lack of guardianship | Households without any adult members or adult male members aged 16-59 years. Also, families without a capable adult member or those with a disabled member. |
| Vulnerable groups | Families belonging to marginalized communities, including Scheduled Castes (SCs) and Scheduled Tribes (STs). |
| EWS | Individuals or households within a low-income bracket are considered for support under various government schemes. Rural residents who qualify for employment under MGNREGA are likely to also meet the eligibility criteria for PM-JAY, as both schemes are designed to assist low-income and economically vulnerable groups. |
| Pre-Conditions | The scheme also considers additional factors. These can be lack of access to basic amenities such as clean drinking water, sanitation and other signs of economic deprivation.
|
b) Urban households
Urban households are eligible for the PM-JAY scheme if they fall into specific occupational categories. These occupations were chosen keeping in mind factors like income level, occupation, and asset ownership. The list of 11 occupational categories eligible to avail PM-JAY scheme are:
> Domestic workers
> Beggar
> Ragpickers
> Sanitation workers/sweepers/gardeners (mali)
> Construction workers/laborers/painters/welders/security guards/plumbers/load carriers/masons and other head-load workers
> Watchmen/washermen
> Electricians/mechanics/assemblers/repair workers
> Home-based workers/artisans/tailors/handicraft workers
> Transport workers/rickshaw pullers/conductors/cart pullers/drivers/driver helpers/conductor helpers
> Waiters/shop workers/assistants/attendants/helpers/peons in small establishments/delivery assistants
> Street vendors/hawkers/cobblers/other street service providers
c) Points of disqualification
Following conditions automatically disqualifies anyone from availing PM-JAY scheme.
> High ranking government employees
> Employees of government-run non-agricultural enterprises
> Monthly income exceeding ₹10,000
> Being in possession of more than 5 acres of agricultural land
> Holders of a Kisan card
> People in possession of farming machinery and equipment
> People in possession of motorized fishing boats
> Those residing in well-constructed houses
> Being in possession of refrigerators and landline phones in home
> Owners of any vehicles such as two-wheelers, three-wheelers, or cars
Checking eligibility is also part of the PM-JAY registration process. Beneficiaries can check eligibility over the official PM-JAY website or app using the ‘Am I Eligible’ option. To find out the full process of registration keep reading.
How to apply for ayushman card?
Ayushman card apply process begins with registration. To register for the Pradhan Mantri Jan Arogya Yojana (PM-JAY) offline, you can visit a government health facility or Common Service Center (CSC) with your Aadhaar card, income proof, and other necessary documents. You can also check eligibility and register online through the PM-JAY portal or mobile app for convenience. Here is a detailed step-by-step process to register under PM-JAY scheme:
> Visit the official National Health Authority (NHA) portal here.
> To login, enter mobile number, OTP and captcha in the shown fields.
> Select scheme name, state name, sub-scheme from drop down menu.
> Select an appropriate verification option available in the ‘search by’ field. Depending on the scheme options could be between ‘individual’ or ‘family’.
> In the newly displayed field enter an identification number from a relevant document that could list you under the scheme.This could be your mobile number, aadhaar number, ration card number etc.
> If you are covered under the scheme your name will be displayed in the results
> Otherwise a pop-up would be displayed saying ‘No beneficiaries found in given search criteria.’
The Ayushman Bharat Digital Mission (ABDM) app or other government health apps also provide eligibility verification. You can call on the PM-JAY toll-free number on 14555 to contact their customer care and ask them to check your name on the beneficiary list.
b) Gather required documents
The following documents will be required at the time of registration:
> Aadhaar card/ PAN card
> Income certificate/ Other proof of income
> Caste certificate (applicable for SC/ST categories)
> Address proof
c) Visit nearest government health facility
Documents of registration will be verified by government personnel in-person. Like so:
> Visit the nearest government hospital or a Common Service Center (CSC) in your area
> Provide the necessary documents and details to the registration officer.
> Fill out a registration form with personal and family details.
> Submit your documents for verification.
Ensure all provided information is accurate to avoid any delays or issues with your registration. Some but not all areas allow beneficiaries to register online through the PM-JAY portal or mobile apps. In these places applicants can follow the instructions on the website or app to complete the registration process. Once verification is successful, you will receive an Ayushman Bharat card (PM-JAY card) which can be used to access healthcare services.
d) Download ayushman card online
now that you've understood how to apply for ayushman card online. You can download a soft copy of your allotted ayushman card online at any point. To download your ayushman bharat card online, follow these steps:
> Visit the PM-JAY official website or the National Health Authority (NHA) website.
> On the homepage, find and click on the "Download eCard" or "Generate Card" option. This may be listed under a section like "Beneficiary Services" or "eCard Services."
> Enter required details such as linked aadhaar or mobile number
> Enter the captcha code
> Receive and enter OTP sent to your registered mobile number
> Click on the "Download" button to save the card to your device. You can print the card directly or save it as a PDF file on your device for future reference.
> Contact PM-JAY helpline (if needed) or visit a local government health center for assistance.
This process allows you to easily access your Ayushman Bharat card, which can be used for availing healthcare services under the scheme.
Beneficial features
The government of India has embedded several useful features to the scheme keeping in mind the needs of the general population. Some of the key features of the scheme include:
> Zero premium and no co-payment - There are no premiums or co-payments required from beneficiaries, making healthcare completely free at the point of service.
> Portability - Beneficiaries can avail services at any empaneled hospital across the country, irrespective of their state of residence.
> Cashless treatment - Beneficiaries can avail of cashless treatment at empaneled hospitals, reducing the financial burden of medical expenses.
> Health awareness and preventive care - Promotes preventive healthcare and health awareness programs, improving overall health outcomes.
These features collectively enhance the accessibility and affordability of healthcare for millions of low-income families across India.
Ayushman Bharat Vs Private health insurance
Government health insurance can have some benefits over private health insurance such as zero premiums. But, it is only available to smaller lower-income groups that are eligible under the scheme. This is why some may prefer getting health insurance directly from the networked insurance companies. It is important to stay informed about the benefits private health insurance companies may have over government schemes to get the best deal. Few such advantages are listed below:
> Higher sum insured amount
> Broader coverage
> Paid primary health care services
Private health insurance also provides medical expenses tax deduction under section 80D. This balances out financial limitations for some policyholders to a small extent. Find out more about tax deduction on medical expenses here.
Bottomline
The Ayushman Bharat scheme represents a major advancement in making healthcare more accessible and affordable for India's underprivileged communities. While it continues to evolve to better meet the diverse medical needs of individuals across the country, staying updated on related insurance topics can provide further insights. For more information, continue reading here. To find the best health insurance deals head over to Oneassure and book a free consultation.