PMJAY is the world’s largest health insurance scheme fully financed by the government. It provides a cover of up to ₹5 lakh per family per year for secondary and tertiary care hospitalization across public and private empaneled hospitals in India. The scheme is a significant step towards universal health coverage, aiming to reduce out-of-pocket medical expenses for the underprivileged and vulnerable.
Key Features of PMJAY
- Scope of Coverage: Covers up to ₹5 lakh per family per year for hospitalization, with no restrictions on family size, age, or gender.
- Cashless and Paperless Access: Beneficiaries can avail of cashless services at any of the empaneled healthcare providers across the country, ensuring swift, effective, and transparent healthcare delivery.
- Pre-existing Diseases Covered: From the day of policy inception, all diseases are covered under the scheme, including pre-existing conditions, which is a significant advantage for many.
- Portability: Beneficiaries can avail themselves of the benefits in any part of the country, making it particularly beneficial for migrant workers and their families.
Eligibility Criteria
The eligibility for PMJAY is based on deprivation criteria as per the Socio-Economic Caste Census (SECC) 2011 for rural and urban areas. It includes families with no adult male member aged between 16 to 59, disabled members, SC/ST households, landless households, manual scavenger families, living in one-room makeshift houses, and more.
Implementation and Impact
Since its launch, PMJAY has significantly impacted the lives of millions, providing them access to necessary surgeries, treatments, and healthcare services that were previously out of their financial reach. It has been pivotal in saving lives through timely medical interventions and reducing the financial burden of healthcare on India’s poorest populations.
How to Avail Benefits
To avail the benefits of PMJAY, an eligible individual must visit any empaneled hospital, where they can verify their eligibility using an approved ID. The hospital’s ‘Ayushman Mitra’ helps beneficiaries through the process, ensuring that the scheme’s benefits are seamlessly provided.
Conclusion
Ayushman Bharat Yojana (PMJAY) represents a monumental step towards achieving health equity by providing comprehensive healthcare to the needy. As the scheme evolves, it promises to continue enhancing the health security of India’s most vulnerable groups, thereby contributing to the broader goal of an aatmanirbhar (self-reliant) India.
