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

🏥 Ayushman Bharat Yojana – विवरण (Overview)

Ayushman Bharat, a flagship scheme of the Government of India, was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC). This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to "leave no one behind."

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 inter-related components:

Health and Wellness Centres (HWCs)
Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) was launched on 23rd September 2018 in Ranchi, Jharkhand by the Hon’ble Prime Minister of India, Shri Narendra Modi.

AB PM-JAY is the largest health assurance scheme in the world which aims at providing a health cover of ₹5,00,000 per family per year for secondary and tertiary care hospitalization to over 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries) that form bottom 40% of the Indian population.

The households included are based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively. PM-JAY is fully funded by the Government and the cost of implementation is shared between the Central and State Governments.

💰 Ayushman Bharat – फायदे (Benefits)

AB PM-JAY provides cashless cover of up to ₹5,00,000/- to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment:

Medical examination, treatment, and consultation
Pre-hospitalization
Medicine and medical consumables
Non-intensive and intensive care services
Diagnostic and laboratory investigations
Medical implantation services (where necessary)
Accommodation benefits
Food services
Complications arising during treatment
Post-hospitalization follow-up care up to 15 days

The benefits of ₹5,00,000/- are on a family floater basis, which means that it can be used by one or all members of the family. Under AB PM-JAY, there is no cap on family size or the age of members.

In addition, pre-existing diseases are covered from the very first day. Any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.

📚 स्रोत और संदर्भ (Sources and Guidelines)

Guidelines
Guidelines for Beneficiary Identification
Guidelines on Payment for Special Cases
Guidelines on Claim Settlement
UMANG

📝 पात्रता – Eligibility

Eligibility under PM-JAY is determined separately for Rural and Urban beneficiaries.

🏡 Rural Beneficiaries (ग्रामीण लाभार्थी)

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

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

🏙 Urban Beneficiaries (शहरी लाभार्थी)

For urban areas, the following 11 occupational categories are eligible:

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

🚫 अपवाद – Exceptions

The following families are not eligible for AB PM-JAY:

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

🏢 आवेदन प्रक्रिया – Application Process

ऑफलाइन आवेदन

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 PM-JAY 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: Submission of Details

Potential AB-PMJAY beneficiaries submit the PM letter / RSBY URN / RC Number / Mobile Number. The operator (Arogya Mitra) searches the available list using these details.

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

If the name is found, the identification process is carried out using Aadhaar or any government ID along with Ration Card or alternative family ID. Scanned documents are uploaded.

Step 4: Family Identification

The Arogya Mitra identifies family records through the ration card, uploads scanned documents, and submits the records to the trust/insurance company for approval.

Step 5: Approval or Rejection

The Health insurance company or trust may approve or recommend rejection. Cases recommended for rejection are verified by the State Health Agency (SHA) for final approval or rejection.

Step 6: E-card Issuance

On approval by SHA/insurance company/trust, an e-card is issued to the beneficiary.

🗂️ आवश्यक दस्तावेज़ – Required Documents

Age & Identity Proof (Aadhaar Card / PAN Card)
Proof of Address
Contact details (Mobile, e-mail)
Caste Certificate
Income Certificate
Document Proof of the Current Status of the Family (Joint or Nuclear)
Aadhaar Card

❓ अधिकतर पूछे जाने वाले सवाल – FAQs

1. क्या लाभार्थियों को कोई शुल्क देना होगा?

No. All eligible beneficiaries can avail free services for secondary and tertiary hospital care for identified packages under PM-JAY at public hospitals and empaneled private hospitals. Beneficiaries will have cashless and paperless access to health services under PM-JAY.

2. Enrollment process और समय अवधि?

PM-JAY is an entitlement based mission. Families identified by the government on the basis of deprivation and occupational criteria using the SECC database are entitled automatically.

3. क्या कार्ड दिया जाएगा?

A dedicated PM-JAY family identification number will be allotted, along with an e-card at the time of hospitalization.

4. क्या पहले से मौजूद रोग/बीमारी कवर हैं?

Yes, all existing medical conditions / illnesses are covered.

5. New born child के लिए लाभ?

Yes, newborns can be provided treatment and added to the family after providing necessary documents.

6. RSBY cardholders इस योजना में शामिल?

Any family with active RSBY card as of 28 Feb 2018 is covered.

7. Aadhaar card के बिना लाभ?

Yes, Aadhaar card is not mandatory.

8. Arogya Mitra कौन है?

Certified frontline health service professional at each EHCP to assist in beneficiary identification and claim processing.

9. Claim submission process?

Once patient is discharged, EHCP raises request online with discharge summary and clinical notes. Claims must be submitted within 24 hours.

10. PM-JAY क्या है?

Pradhan Mantri Jan Arogya Yojana is a pioneering initiative to provide health coverage for poor and vulnerable populations.

11. Health services under PM-JAY?

Hospitalization, daycare surgeries, follow-up care, pre and post-hospitalization expenses, newborn services.

12. Services कहाँ प्राप्त करें?

At all public hospitals and empaneled private healthcare facilities. Info available on portal, app, helpline 14555, and through ASHA/ANM.

13. Beneficiaries की पहचान?

Deprivation categories D1-D7 (rural), 11 occupational criteria (urban), plus RSBY beneficiaries.

14. Names not on list?

New families cannot be added; only additional members to listed families can be added.

15. Maximum approval time for claim submission?

All claims approved within 15 days by SHA after document authentication.

16. Grievance committees?

Three-tier: DGRC (District), SGRC (State), NGRC (National) – final appellate authority at national level.

✅ यह पूरा Ayushman Bharat PM-JAY आर्टिकल अब SEO फ्रेंडली हेडिंग्स के साथ, किसी भी टेक्स्ट को काटे बिना, सभी सेक्शन के साथ तैयार है।

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