AB PM-JAY is a health insurance scheme for low-income families in rural and urban areas. The scheme aims to provide affordable healthcare facilities to the Poor. It is the largest...
Department: · Level: central
AB PM-JAY provides cashless cover of up to ₹ 5,00,000/- to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment: 1. Medical examination, treatment, and consultation 1. Pre-hospitalization 1. Medicine and medical consumables 1. Non-intensive and intensive care services 1. Diagnostic and laboratory investigations 1. Medical implantation services (where necessary) 1. Accommodation benefits 1. Food services 1. Complications arising during treatment 1. Post-hospitalization follow-up care up to 15 days The benefits of ₹ 5,00,000/- are on a family floater basis which means that it can be used by one or all members of the family. Under AB PM-JAY, there is no cap on family size or the age of members. In addition, pre-existing diseases are covered from the very first day. Any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.
> **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: 1. Only one room with kucha walls and kucha roof 1. No adult member between ages 16 to 59 1. Households with no adult male member between ages 16 to 59 1. Disabled member and no able-bodied adult member 1. SC/ST households 1. Landless households deriving a major part of their income from manual casual labour > **Urban Beneficiaries** For urban areas, the following 11 occupational categories of workers are eligible for the scheme: 1. Ragpicker 1. Beggar 1. Domestic worker 1. Street vendor/ Cobbler/hawker / other service provider working on streets 1. Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and other head-load worker 1. Sweeper/ Sanitation worker/ Mali 1. Home-based worker/ Artisan/ Handicrafts worker/ Tailor 1. Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Ricks...
**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,...