Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana

Financial Health Insurance Cover:

Annual Hospitalization Coverage: Cashless coverage up to ₹5,00,000/- per family per year.

Comprehensive Treatment Costs: Covers consultation, medicines, diagnostics, surgery, ICU, implants, accommodation, and food.

Pre and Post Hospitalization Support: Covers 3 days pre-hospitalization and 15 days post-hospitalization expenses.

Treatment Complication Coverage: Covers complications arising during treatment.

Coverage Features:

Pre-Existing Disease Coverage: Covers all pre-existing diseases from day one.

No Family Size Limit: No restriction on age, gender, or family size.

Nationwide Portability: Benefits available across India in empanelled hospitals.

Wide Procedure Coverage: Covers approximately 1,929 medical procedures.

Rural Beneficiaries

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

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

Automatically includedHouseholds without shelter

Destitute/ living on alms,

Manual scavenger families,

Primitive tribal groups,

Legally released bonded labour.

Urban Beneficiaries

For urban areas, the following 11 occupational categories of workers are eligible for the scheme:

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

Offline

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 PMJAY 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: Potential AB-PMJAY beneficiaries are to submit the PM letter/ RSBY URN/ RC Number/ Mobile Number - The operator (commonly known as the Arogya Mitra) searches the available list of beneficiaries. The operator does this by entering details such as name, location, Ration Card number, mobile number, or even RSBY URN of the beneficiary.

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 - The identification process is carried out if the name is found in the list. For this, documents like Aadhaar or any government ID and a Ration Card or an alternative family ID are required to validate against the details available in the system. Scanned documents are then uploaded.

Step 4: Family Identification - The Arogya Mitra then identifies the family records through the ration card and the scanned documents are then uploaded. The Arogya Mitra then submits the individual and family records to the trust/insurance company for approval.

Step 5: Approval or Rejection - The Health insurance company or trust may then approve or recommend rejection for the submitted beneficiaries. The cases that are recommended for rejection will be finally verified for approval or rejection by the State Health Agency (SHA).

Step 6: E-card Issuance - On approval by SHA/insurance company/trust, an e-card will be issued to the beneficiary.







Apply Now

1. Age & Identity Proof (Aadhaar Card / PAN Card).
2. Proof of Address.
3. Contact details (Mobile, e-mail).
4. Caste Certificate.
5. Income Certificate.
6. Document Proof of the Current Status of the Family (Joint or Nuclear).
7. Aadhaar Card.