PMJAY Scheme: ₹5 Lakh Health Coverage for Families

The Government of India launched the Pradhan Mantri Jan Arogya Yojana (PMJAY) in 2018 to provide financial coverage for medical expenses incurred by people belonging to poor families. The PMJAY, or Ayushman Bharat Yojana, is currently the biggest government-funded health insurance scheme in the world.

What is Ayushman Bharat Yojana?

The Ayushman Bharat Yojana provides healthcare coverage to crores of poor families. In 2024, this scheme was extended to cover all elderly citizens aged 70 and above. This scheme provides a health card for senior citizens and all eligible families. People can submit these cards at any network hospital and get treated without paying out op pocket.

Coverage/Services Covered Under the Scheme

The services covered under the Ayushman Bharat Yojana include:

• Medical examination, treatment and doctor’s fees

• Pre-hospitalisation charges for a maximum of three days

• Post-hospitalisation and follow-up charges for a maximum of 15 days

• Medicines

• Complications related to treatments

• Diagnostic procedures

• Intensive care and non-intensive care charges

• Expenses related to medical implants

• Costs room rent and related charges

• Food charges

Key Features

Here are the features of this scheme:

• Family floater plan category

• Private or public empanelled hospitals all over India enable cashless treatment

• PED (Pre-existing disease) coverage available from day 1 of the plan

• Pre-hospitalisation up to three days and post-hospitalisation up to 15 days

• Non-medical charges, such as transport and food costs

• Daycare expenses for no-hospitalisation treatments

• 1.5lakh health and wellness centres exclusively for the scheme all over India

Eligibility Criteria

You are eligible for medical coverage under the PMJAY scheme if you satisfy the following conditions:

Criteria for rural families

• Those living in Kuchha houses with one room

• No male members between 16 and 59 years in a family

• Families with a disabled member and no able-bodied adult for support

• SC/ST caste families

• Families with no land, and earning a living through casual labour

Criteria for urban families

• Should be one of these – ragpicker, beggar, domestic worker, street vendor/hawker, construction worker, sweeper, gardener, sanitation worker, artisan, tailor, shop worker, workers in small establishments, electrician, plumber, mechanic, washerman, watchman, etc.

Criteria for people aged 70 and above

• Eligibility criteria will be the same (for rural and urban senior citizens)

Conclusion

Thanks to the PMJAY scheme, healthcare is now accessible to families from economically backwards backgrounds across all parts of rural and urban India. Go through the eligibility criteria carefully and obtain your health card to enjoy cashless treatments and timely medical assistance.

Remember, health insurance is crucial for everyone. It offers financial security during medical emergencies and ensures peace of mind.

FAQs

1. If the family of senior citizens above 70 is already covered under the PMJAY scheme, what happens?

In this case, the senior citizens can get an additional ₹5lakh coverage for themselves in addition to the ₹5lakh coverage available for their family.

2. What documents are required to register for the PMJAY Scheme?

The documents required to register for the PMJAY scheme are ID proof, income certificate, caste certificate and address proof.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.