Who is Eligible for PMJAY?

PMJAY Eligibility Criteria & Benefits – Are You Covered?

PMJAY, or Pradhan Mantri Jan Arogya Yojana, is a health scheme under the Ayushman Bharat Scheme. It is the largest health assurance scheme that provides up to ₹5 Lakhs in health coverage for each family registered under the program. This scheme supports the health needs of more than 12 crores of families in the poor and vulnerable section.

It includes households listed under the Socio-Economic Caste Census 2011's deprivation and occupational criteria. Families getting coverage under the RSBY (Rashtriya Swasthya Bima Yojana) are also included under PMJAY.

Here’s more on the eligibility criteria, features and benefits of PMJAY!

What are the Eligibility Criteria for PMJAY?

The following beneficiaries are eligible for the Pradhan Mantri Jan Arogya Yojana:

Rural Beneficiaries

There are a total of seven deprivation criteria in rural areas. Families who come under any of the following deprivation criteria and automatic inclusion criteria are eligible for PMJAY coverage in rural areas:

● Families without any adult male members between the ages of 16 and 59 years

● Households with a single room with a kucha roof and walls

● Families with disabled members who do not have any able-bodied adult members

● Landless households whose primary income comes from casual manual labour

● SC and ST households

Automatic inclusions are as follows:

● Primitive tribal group

● Destitute

● Individuals or families living on alms

● Manual scavenger households

● Legally released bonded labour

Urban Beneficiaries

Here are the occupational categories that are eligible for the PMJAY scheme in urban areas:

● Cobbler

● Beggar

● Street vendor

● Ragpicker

● Domestic worker

● Hawker

● Construction workers

● Mason

● Painter

● Any service provider who works on streets

● Sweeper

● Security guard

● Coolie or any other worker who carries a headload

● Welder

● Home-based worker

● Sanitation worker

● Artisans

● Tailor

● Transport worker

● Handicrafts worker

● Conductor

● Driver

● Helper, etc.

What are the Features of Pradhan Mantri Jan Arogya Yojana?

The features of Pradhan Mantri Jan Arogya Yojana are as follows:

● It is the world’s largest government-financed health insurance scheme.

● PMJAY aims to cover the health needs of approximately 55 crores of poor and vulnerable families.

● Under this scheme, insured families can avail of health coverage of up to ₹5 lakhs annually for tertiary and secondary care hospitalization across the empanelled hospitals (private and public) in India.

● At the point of service, which is the hospital, PM-JAY gives the beneficiary cashless access to medical services.

● Any family size, gender, or age group can avail of this scheme upon meeting the given eligibility criteria.

● Policyholders can get a maximum of 3 days of coverage for pre-hospitalization and 15 days for post-hospitalization costs, including medicines and diagnostic expenses.

● The goal of PM-JAY is to assist in reducing the crippling costs of medical care, which force about 6 crore Indians into poverty annually.

● This scheme even covers all your pre-existing medical conditions from day one.

● Beneficiaries can avail cashless treatment benefits under this scheme from any of the empaneled private or public hospitals across the country.

● Public hospitals receive payment on par with private hospitals for medical services provided.

● Approximately 1,929 procedures are included in the services, which cover all treatment-related expenses, such as medications, supplies, diagnostic services, doctor's fees, hotel and surgeon fees, OT and ICU fees, etc.

What are the Benefits of Pradhan Mantri Jan Arogya Yojana?

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) provides cashless health coverage of up to ₹5,00,000 per family annually for secondary and tertiary care. It covers various treatment components, ensuring comprehensive healthcare access. Below are the benefits:

● Medical Examination, Treatment, and Consultation: Covers all medical evaluations and consultations during treatment.

● Pre-Hospitalization Expenses: Includes costs incurred before hospital admission.

● Medicines and Medical Consumables: Provides coverage for necessary medications and supplies.

● Non-Intensive and Intensive Care Services: Covers ICU and other care services.

● Diagnostic and Laboratory Investigations: Includes tests required for diagnosis.

● Medical Implantation Services: Covers implants if needed during treatment.

● Accommodation Benefits: Provides hospital stay coverage.

● Food Services: Covers meals during hospitalization.

● Treatment Complications: Addresses complications arising during treatment.

● Post-Hospitalization Follow-Up Care: Includes follow-up care up to 15 days after discharge.

The scheme operates on a family floater basis, meaning any or all family members can utilize the ₹5,00,000 coverage. It has no family size or age cap and covers pre-existing conditions from day one, ensuring accessible healthcare for eligible families.

What are the Documents Required to Apply for PMJAY?

The following documents are necessary to register under the PMJAY scheme:

● Address proof

● ID and age proof (PAN or Aadhaar card)

● Caste certificate

● Contact number or e-mail address

● Proof of the current family status, i.e., nuclear or joint

● Income certificate

If you meet the eligibility criteria and provide the mentioned documents, you can register under Pradhan Mantri Jan Arogya Yojana. However, if you don't meet the eligibility criteria, contact reputed health insurance providers like Star Health and get a policy that suits your health needs.