The Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a component under Ayushman Bharat launched by the government to support the economically weaker section (EWS) to avail healthcare services. The PMJAY scheme was launched in September 2018 to provide health insurance coverage of ₹5 lakh to about 50 crore beneficiaries.

The Ayushman Bharat- PMJAY has received an allocation of ₹7,200 crore under the Union Budget 2023. The scheme was earlier known as the National Health Protection Scheme (NHPS). It subsumed the then-existing Rashtriya Swasthya Bima Yojana (RSBY), launched in 2008.

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Who is eligible?

The eligibility is based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas.

The families or individuals from rural areas eligible under the PMJAY scheme are:

  • Families with no male members in the age group of 16 to 59 years.
  • Families with no adults between the above mentioned age.
  • Families with disabled member and no able-bodied adult member.
  • Households belonging to Scheduled Caste (SC) and Scheduled Tribes (ST).
  • Primitive tribal group.
  • Manual scavenger households
  • Landless households deriving a major part of their income from manual casual labour; and
  • Families living in a single room with no proper walls or roofs.

Families covered in RSBY but are not present in the Socio-Economic and Caste Census (SECC) 2011 database are also eligible for PMJAY

In urban areas, the scheme shall benefit the following occupational categories of workers:

  • Ragpicker
  • Beggar
  • Domestic worker
  • Street vendor, cobbler, hawker, or other service providers working on streets
  • Construction worker, plumber, mason, labour, painter, welder, security guard, or coolie 
  • Sweeper or sanitation worker
  • Home-based worker, artisan, handicrafts worker, and tailor
  • Transport worker, driver, conductor, cart puller, or rickshaw puller
  • Shop worker, assistant, peon in small establishment, delivery assistant, attendant, or waiter
  • Electrician, mechanic, or repair worker
  • Washer-man or chowkidar

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Benefits of PMJAY

PMJAY provides coverage of ₹5 lakh health insurance per family, which can be availed for secondary and tertiary care hospitalisation across empaneled hospitals in the country.

Individuals can check the eligibility, and central and state hospitals empaneled under the scheme on Paytm.

The scheme of free of cost for the beneficiaries. The premium cost is borne by the Central and the State Governments.

The cover under the scheme includes expenses incurred on the following components of the treatment:

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

There is no cap on family size or the age of members, and pre-existing diseases are covered from the first day. 

How to avail

Individuals can check their eligibility and locate hospitals through the PMJAY portal. They do not have to enroll anywhere to claim the benefits of the scheme. However, they will have to provide their HHD Number (Household ID Number), provided to individuals identified under the SECC.

The benefits can be availed at the public and private empaneled hospitals identified under the PMJAY scheme. Nevertheless, individuals will have to provide their PMJAY health card to get the benefits of health cover at hospitals. Know how to create your ABHA health account

Also read: How to download Ayushman Bharat card online?