Ayushman Bharat Yojana

The Ayushman Bharat Yojana, also known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), is a flagship healthcare initiative launched by the Government of India in 23 September 2018. This scheme aims to provide comprehensive and affordable healthcare services to over 100 million underprivileged families in the country.

Key Features of Ayushman Bharat PM-JAY

• Covers up to 5 lakh (500,000 INR) per family per year for secondary and tertiary healthcare services.
• Provides cashless and paperless access to healthcare services at empaneled public and private hospitals across the country.
• Offers portability, allowing beneficiaries to access services in any empaneled hospital, regardless of their home state.
• Covers pre-existing conditions, ensuring that no one is left behind due to pre-existing medical conditions.

10 Benefits Covered Under PM-JAY (Pradhan Mantri Jan Arogya Yojana)

• Hospitalization expenses: Covers expenses related to hospitalization, including room charges, doctor’s fees, and other medical expenses.
• Pre and post-hospitalization expenses: Covers expenses incurred before and after hospitalization, such as diagnostic tests and follow-up consultations.
• Day-care treatments: Covers specific day-care treatments that do not require hospitalization.
• Ambulance services: Covers the cost of ambulance services for emergency medical transportation.
• Organ transplants: Covers the cost of organ transplants, including pre and post-transplant expenses.
• Dialysis: Covers the cost of dialysis treatment for patients with kidney-related diseases.
• Cancer treatment: Covers the cost of cancer treatment, including chemotherapy and radiation therapy.
• Maternity benefits: Covers maternity-related expenses, including normal and caesarean deliveries.
• Mental health: Covers mental health-related treatments, including counseling and therapy.
• Secondary and tertiary care: Covers a wide range of secondary and tertiary healthcare services, including surgeries and specialized treatments.

PMJAY Critical Illness Coverage

The scheme covers expenses related to the treatment of various critical illnesses, including but not limited to:

• Heart diseases: Covers expenses related to heart surgeries, angioplasties, and other cardiovascular treatments.
• Organ failure: Covers expenses related to organ transplants and dialysis for kidney failure.
• Cancer: Covers expenses related to cancer treatment, including chemotherapy, radiation therapy, and surgeries.
• Neurological disorders: Covers expenses related to the treatment of neurological disorders, such as strokes, Parkinson’s disease, and multiple sclerosis.
• Trauma care: Covers expenses related to trauma care, including accidents and emergency surgeries.

List of Critical Diseases covered under Ayushman Bharat Health Scheme

• Cardiovascular diseases (heart attacks, heart failures, and other heart-related conditions)
• Cancer (breast, lung, cervical, and other types of cancer)
• Neurological disorders (strokes, Alzheimer’s, Parkinson’s, and other neurological conditions)
• Kidney diseases (chronic kidney disease, end-stage renal failure)
• Liver diseases (cirrhosis, liver failure, and other liver-related conditions)
• Respiratory diseases (asthma, COPD, and other respiratory conditions)
• Endocrine disorders (diabetes, thyroid disorders, and other endocrine-related conditions)
• Rheumatic diseases (rheumatoid arthritis, lupus, and other autoimmune disorders)
• Trauma and injuries (accidents, burns, and other traumatic conditions)

Ayushman Bharat Health Scheme has limited exclusions, which are as follows

While the Ayushman Bharat PM-JAY scheme provides comprehensive coverage, there are a few exclusions that beneficiaries should be aware of:

• Cosmetic surgeries: Cosmetic surgeries not related to medical emergencies or necessities are not covered.
• Infertility treatments: Infertility treatments, such as IVF and other assisted reproductive technologies, are not covered.
• Alternative therapies: Alternative therapies, such as Ayurveda, homeopathy, and unani, are not covered under the scheme.
• Substance abuse: Expenses related to substance abuse, such as alcohol or drug addiction treatment, are not covered.
• Congenital diseases: Congenital diseases diagnosed within the first three months of birth are not covered.
• Occupational injuries: Injuries or illnesses resulting from occupational hazards are not covered.