Pradhan Mantri Jan Arogya Yojana (PMJAY) – Complete Details

आयुष्मान भारत - प्रधान मंत्री जन आरोग्य योजना (पूरी जानकारी)

Check complete Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana complete details are now available, see modes of implementation, beneficiaries list, process to avail treatment, payments, claim settlement & package rates

Dated: August 27, 2018 | Updated On: September 24, 2018 | Category: Central Government, Pradhan Mantri Yojana List | By Ministry of Health and Family Welfare | Beneficiary of Scheme: Everyone |
आयुष्मान भारत - प्रधानमंत्री जन आरोग्य योजना भारत सरकार द्वारा शुरू की गयी एक बहुत ही महत्वाकांक्षी योजना है जिसके तहत 10.74 करोड़ परिवारों को 5 लाख रूपये तक का स्वस्थ्य बीमा दिया जाएगा। पाएं प्रधानमंत्री जन आरोग्य योजना की पूरी जानकारी जैसे की पात्रता इत्यादि

Prime Minister Narendra Modi has launched Pradhan Mantri Jan Arogya Yojana (PMJAY) on 23 September 2018. This PMJAY Scheme is a mega National Health Protection Scheme (NHPS) for poor people. PMJAY will provide Rs. 5 Lakh health insurance for secondary and tertiary hospitalization. This Ayushman Bharat Yojana will benefit around 50 crore poor people and provide them cashless and paperless treatment in hospitals.

All the insured people can make claims for treatment in all empanelled hospitals and avail treatment at NHPM Treatment Package Rates. Pradhan Mantri Jan Arogya Yojana is applicable for all Rural and Urban Beneficaries whose name appears in SECC-2011 Data. There will be No Ayushman Bharat Yojana Online Application Forms and anti fraud guidelines are also framed against people who demand money to provide insurance benefits.

People can visit any Health and Wellness Center to avail PMJAY benefits. All the AB-NHPM beneficiaries will be given Ayushman Family Cards and Arogya Mitras will be trained for assistance. Check complete details regarding PMJAY Scheme here.

About Pradhan Mantri Jan Arogya Yojana (PMJAY)

The important features and highlights of Pradhan Mantri Jan Arogya Yojana are as follows:-

  • Health Insurance cover of Rs. 5 lakh per family per year.
  • Around 10.74 crore poor and vulnerable families whose name appears in the SECC-2011 Data are eligible. There is no cap on family size and age.
  • States are given the flexibility to decide the mode of implementation.
  • Benefits will be portable across the country.
  • Around 85% of rural families and 60% of urban families have already been identified.
  • To be launched on 25 September 2018 – on the birth anniversary of Pandit Deendayal Upadhyay.
About Pradhan Mantri Jan Arogya Yojana PMJAY

About Pradhan Mantri Jan Arogya Yojana PMJAY

Key Milestones in PMJAY Implementation

Here we are providing you the key milestones in the PMJAY Implementation:-
— It was announced on 1 February 2018 in Union Budget 2018.
— State Level Consultation was held on 15 Feb and 16 February 2018.
— Cabinet Approves Ayushman Bharat Yojana on 21 March 2018.
— Ayushman Bharat Diwas – Starting Date of Beneficiary Identification) on 30 April 2018.
— National Health Agency (NHA) incorporated on 11 May 2018.
— First MoU was signed on 14 May 2018.
— Ministers Conclave was held on 14 June 2018.
— Hospital Empanelment Portal was live on 4 July 2018.
— Pradhan Mantri Jan Arogya Yojana (PMJAY) was announced on 15 August 2018.
— Proposed launch of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana is on 25 September 2018.

Key Milestones PMJAY Implementation

Key Milestones PMJAY Implementation

AB-PMJAY Modes of Implementation

State can chooese in which mode they want to implement this Ayushman Bharat – Pradhan mantri Jan Arogya Yojana (AB-PMJAY). There are 3 modes – Insurance Mode, Trust Mode and Mixed Mode. The name of the states along with the PMJAY mode of implementation chosen is shown below:-

AB-PMJAY Modes Implementation

AB-PMJAY Modes Implementation


7 states have choosen to implement this AB-PMJAY Scheme in Insurance Mode, 18 in Trust Mode, 9 in Mixed Mode and 2 states have still not decided.

Strict Action Against Fake PMJAY Websites

All the people should clearly note the following points regarding Ayushman Bharat – PMJAY:-

  1. No enrollment is required for beneficiaries to avail benefits of National Health Protection Scheme.
  2. He / She must not make any payment to obtain services at empanelled hospitals.
  3. Criminal cases will be charged at fraudulent websites and agents trying to collect money from the beneficiaries.
  4. Strict Action Fake PMJAY Websites

    Strict Action Fake PMJAY Websites

Informing the Pradhan Mantri Jan Arogya Yojana Beneficiaries

The complete procedure to inform the Pradhan Mantri Jan Arogya Yojana Beneficiaries is given below:-

  • Family letter would be given to the Identified families.
  • Call Centre “14555” will be open for the Pradhan Mantri Jan Arogya Yojana beneficiaries.
  • Website and App will be launched on 5 September 2018.
  • People can get info. on Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana through 10,000 hospitals, 3 lakh Common Service Centers and by Mass Media.
  • Informing Pradhan Mantri Jan Arogya Yojana Beneficiaries

    Informing Pradhan Mantri Jan Arogya Yojana Beneficiaries

Candidates can also check their name in PM Jan Arogya Yojana list of beneficiaries at mera.pmjay.gov.in

Obtaining Care under Pradhan Mantri Jan Arogya Yojana

The following steps would be followed to obtain care under Pradhan Mantri Jan Arogya Yojana:-
Patient Hospitalization – Firstly, the hospitalization of Patients would be done.
Beneficiary Identification & Registration – To confirm person is an eligible beneficiary under PMJAY using software. Moreover, confirmation of identity preferably through Aadhaar.
Pre-Authorization Request & Approval – Hospitals will select package and will check balance in the card. Then they will submit the supporting evidences necessary for treatment.
Treatment – Then patient would be given appropriate treatment.
Discharge – After appropriate treatment, discharge would be given to the patients.
Claim Request & Settlement – Discharge summary and post treatment evidence would be submitted. Electronics payment would be made by the govt. to the banks. After getting treatment, hospitals will ask for feedback from the patients.

Obtaining Care Pradhan Mantri Jan Arogya Yojana

Obtaining Care Pradhan Mantri Jan Arogya Yojana

How will the Ayushman Bharat-PMJAY Beneficiary be Identified at the Hospital

Firstly Beneficiary will have to Hospital Help-Desk at which Identity verification needs to be done. For this, Aadhaar Card or an other ID needs to be provided. Next, the individual will be verified and it will be checked whether he / she is eligible or not. For this, A Beneficiary Identification System (BIS) using letter with family card. Then e-card will be given to the beneficiaries and shown to doctor for treatment.

Ayushman Bharat PMJAY Beneficiary Identification Hospital

Ayushman Bharat PMJAY Beneficiary Identification Hospital

Timely Payments for Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana

All the hospitals will be ensured timely payments for treatment. Timely payments are ensured and will be done as follows:-

  • Funds to be transferred directly through National Health Agency (NHA) / State Health Agency (SHA).
  • Each SHA will have to open a dedicated ESCROW account.
  • There are penal provisions for delay in release of grant by Center / State in ESCROW Accounts.
  • Banking triggers for release of payments to hospitals.
  • Key Performance Indicators for timely settlement of hospital claims.
  • Timely Payments Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

    Timely Payments Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

Anti Fraud Guidelines for AB-Pradhan Mantri Jan Arogya Yojana

NHA Methodolog for Guidelines has been released now. This includes Prevention, Detection and Deterrence. Prevention will include Beneficiary Identification, Provider Emapanelment and Pre-Authorization. Detection will include Data Analytics, Social Monitoring, Audits etc. Deterrence will include Contract Management, Anti-Fraud Cells and De-empanelment & exemplary penalties.

Anti Fraud Guidelines AB PMJAY

Anti Fraud Guidelines AB PMJAY


Vigilance of public and social audit will also be essential for detection and prevention of fraud.

NHA Information Security & Data Privacy Policy

Information policy would be based on international best practices and India specific regulations. 94 controls set at various levels for secure handling of sensitive personal data. Strong measures have been taken to ensure and obtain, store and use Data Privacy. It would be based on International best practices and India specific regulations.

NHA Information Security Data Privacy Policy PMJAY

NHA Information Security Data Privacy Policy PMJAY

Pradhan Mantri Jan Arogya Yojana (PMJAY) Packages Rates

Around 1300 packages have been approved and 20+ specialities have been covered. Initial draft by DGHS, Peer reviewed by NITI Aayog and extensive stakeholder consultation. Around 50% package mandated for pre-authorization. There are outcome based incentives for hospitals like NABH Entry Hospitals to get 10% incentives, NABH Full Accrediation to get 15% incentives, Aspirational Districts to get 10% incentives.

Package Rates Pradhan Mantri Jan Arogya Yojana PMJAY

Package Rates Pradhan Mantri Jan Arogya Yojana PMJAY

Pradhan Mantri Arogya Mitra (PMAM) Training

Pradhan Mantri Arogya Mitra (PMAM) training is being conducted in collaboration with Ministry of Skill Development. Training has been initiated in 15 States / UTs.

Pradhan Mantri Arogya Mitra PMAM Training

Pradhan Mantri Arogya Mitra PMAM Training

PM Jan Arogya Yojana Pilot Launch

National Health Agency (NHA) has developed 3 important IT tools for PMJAY. These includes Sinple Registration process for Hospitals Empanelment, Demographic & Bio-metric based verification of beneficiaries, Real Time & Secure Transactions at hospitals. Pilot project has been started in 16 States / UTs to test and help the platform to evolve a foolproof, transparent and user friendly IT system.

PM Jan Arogya Yojana Pilot Launch

PM Jan Arogya Yojana Pilot Launch

PM Jan Arogya Yojana Golden Cards

Beneficiaries are entitled to get Golden Cards to avail treatment in any govt. / private empanelled hospitals. This golden card will appear as follows:-

PM Jan Arogya Yojana Golden Cards

PM Jan Arogya Yojana Golden Cards

The government’s ambitious Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana, that will pay up to Rs five lakh in hospitalisation costs to poor and vulnerable families, will also cover drugs and diagnostic expenses three days prior to and 15 days post hospitalisation.

ASK A QUESTION? DISCUSS ON SARKARI YOJANA FORUMS WITHOUT REGISTRATION
Related Content