Ayushman Bharat (PM-JAY)

Name of the Scheme

Ayushman Bharat (PM-JAY)

Aim & Objective

To ensure cashless access to health care services for the beneficiary at the point of service (hospital).

Features

It is a flagship scheme of the Government of India. It was launched as recommended by the National Health Policy 2017 with a vision to achieve Universal Health Coverage (UHC). This initiative has been designed to meet Sustainable Development Goals (SDGs) with its underlining commitment of “leaving no one behind.”

Eligibility & Target Groups

The patients having PM-JAY Ayushman card or patients having Ration card as per SECC data.

Treatment Coverage & Benefits

A treatment coverage of up to ₹5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India. It is a package-based financial assistance for different diseases.

Procedure to Apply & Documents Required

  • After admission, the patient has to report to the PM-JAY (Ayushman Bharat) Cell within 3 days of admission for registration in the online portal.
  • After registration, the patient will be given a Pre-authorization form to be filled in by the treating Doctor mentioning the procedure code.
  • Filled in Pre-auth along with other hospital documents have to be uploaded online to get approval from the Ministry.
  • On approval, the treatment can be started.

*In emergency cases, the procedure may be performed and intimated to the PM-JAY (Ayushman Bharat) Cell within 24 hours of the procedure to get post-approval.

Documents

  • Ayushman Card.
  • A copy of Ration Card.
  • A copy of Aadhaar Card.
  • Filled in Pre-authorization form with procedure code.
  • Bedside file containing all the investigation reports.