Do you know about the government Health Insurance scheme?

Pradhan Mantri Jan Arogya Yojana (PMJAY) is a health insurance scheme launched by the Government of India in September 2018. Aimed at providing financial protection to the underprivileged families including senior citizens in India and help them get access to quality healthcare services without worrying about the financial burden.

Under PMJAY, eligible families are provided with an insurance cover of up to Rs. 5 lakhs per family per year for secondary and tertiary hospitalization. The scheme covers both pre-existing and new illnesses and offers cashless treatment at empanelled hospitals. The scheme also provides coverage for pre-hospitalization expenses for up to 30 days and post-hospitalization expenses for up to 60 days.

PMJAY is an entitlement-based scheme, which means that beneficiaries are identified based on the deprivation and occupational criteria of the Socio-Economic Caste Census (SECC) 2011 data. The scheme aims to cover around 10 crore families or approximately 50 crore beneficiaries across the country.

PMJAY is implemented by the National Health Authority (NHA) and is funded by the central and state governments. The scheme is a flagship program of Ayushman Bharat, which is a comprehensive healthcare program aimed at improving the overall health of the Indian population.

Pradhan Mantri Jan Arogya Yojana (PMJAY) provides several benefits to senior citizens, who are among the most vulnerable segments of the population when it comes to healthcare. Here are some of the key benefits of PMJAY for senior citizens:

1. Health insurance coverage: Under PMJAY, senior citizens are eligible for health insurance coverage of up to Rs. 5 lakhs per family per year for secondary and tertiary hospitalization. This coverage can help senior citizens access quality healthcare services without worrying about the financial burden.
2. Cashless treatment: PMJAY offers cashless treatment at empanelled hospitals, which means that senior citizens can get treatment without having to pay upfront for medical expenses. This can be especially beneficial for those who may not have the resources to pay for medical expenses out of pocket.
3. Pre-existing conditions covered: PMJAY covers both pre-existing and new illnesses, which means that senior citizens with pre-existing conditions can also benefit from the scheme.
4. No age limit: There is no upper age limit for beneficiaries under PMJAY, which means that senior citizens can also enroll in the scheme and avail of its benefits.
5. Easy access to healthcare: PMJAY aims to provide easy access to healthcare services for all beneficiaries, including senior citizens. The scheme has a network of empanelled hospitals across the country, which ensures that beneficiaries can access quality healthcare services in their vicinity.

Who are eligible for PMJAY ?

Pradhan Mantri Jan Arogya Yojana (PMJAY), also known as Ayushman Bharat, is an entitlement-based scheme that provides health insurance coverage to the economically weaker sections of the society. Here are the eligibility criteria for PMJAY:

1. Socio-Economic Caste Census (SECC) 2011 data: Eligibility for PMJAY is based on the deprivation and occupational criteria of the SECC 2011 data. The scheme covers families that are identified as deprived and vulnerable based on these criteria.
2. Family income: PMJAY is targeted at families with an annual income of up to Rs. 1.5 lakhs. Families with income above this limit are not eligible for the scheme.
3. Family size: PMJAY covers families with up to 5 members. This includes the head of the family, spouse, and up to three dependents.
4. No age limit: There is no age limit for beneficiaries under PMJAY. This means that both children and senior citizens are eligible for the scheme.

It is important to note that the eligibility criteria for PMJAY may vary depending on the state and region. It is advisable to check the official website of PMJAY or contact your nearest Common Service Centre (CSC) to determine your eligibility for the scheme.

It is important to note that PMJAY is a government-sponsored scheme, and there is no fee to apply or enroll in the scheme.

It is important to note that the eligibility criteria for PMJAY may vary depending on the state and region. It is advisable to check the official website of PMJAY or contact your nearest Common Service Centre (CSC) to determine your eligibility for the scheme.

How to apply for PMJAY Benefits?

1. Check eligibility status by visiting the official website of PMJAY or by contacting nearest Common Service Centre (CSC).
2. Get enrolled: If eligible, the next step is to get enrolled in the scheme. This can be done by visiting the nearest empanelled hospital, CSC or Ayushman Mitra, who are trained professionals responsible for assisting beneficiaries in availing the benefits of the scheme. You will need to provide your Aadhaar card and other relevant documents to complete the enrollment process.
3. Receive e-card: Once the enrollment is complete, applicant will receive an e-card, which will contain their personal details, including name, photo, and PMJAY identification number. This e-card will be used to avail of the benefits of the scheme.
4. Avail of benefits: With the e-card, one can avail of cashless treatment at any of the empanelled hospitals across the country. You can also check the list of empanelled hospitals on the official website of PMJAY or by contacting Ayushman Mitra.

While Pradhan Mantri Jan Arogya Yojana (PMJAY) provides health insurance coverage for a wide range of medical conditions and treatments, there are certain exclusions to the scheme. Here are some of the key exclusions of PMJAY:

1. Cosmetic procedures: PMJAY does not cover cosmetic procedures, such as plastic surgery, except in cases where the procedure is medically necessary due to a congenital defect or as a result of an injury or illness.
2. Fertility treatments: PMJAY does not cover fertility treatments, including in vitro fertilization (IVF) and other assisted reproductive technologies.
3. Organ transplants for non-dependent relatives: PMJAY does not cover organ transplants for non-dependent relatives, such as siblings or cousins.
4. Psychiatric treatments: PMJAY does not cover psychiatric treatments, except in cases where the treatment is necessary due to a medical emergency or as a result of a physical illness.
5. Outpatient care: PMJAY does not cover outpatient care, such as consultations, diagnostics, and procedures that do not require hospitalization.
6. Unproven treatments: PMJAY does not cover unproven treatments, such as experimental or untested therapies that have not been approved by the government or professional medical bodies.

It is important to note that the above list is not exhaustive, and there may be additional exclusions based on specific circumstances and medical conditions. It is always advisable to check with the empaneled hospital or the National Health Authority (NHA) to determine whether a specific treatment or procedure is covered under PMJAY.