Pradhan Mantri Jan Arogya Yojana (Ayushman Bharat) | Modicare Health Insurance Scheme

Pradhan Mantri Jan Arogya Yojana Ayushman Bharat Program (Modicare Health Insurance Scheme)

The central government of India has launched a lot of health schemes for the weaker section of the society. The government launched yet another health scheme in the Union Budget of the country this year which will complement the schemes which were launched previously. The government has named this scheme Pradhan Mantri Jan Ayushman Bharat Scheme which will also be called as Modicare scheme.

Pradhan Mantri Jan Arogya Yojana - Ayushman Bharat

Scheme Name Pradhan Mantri Jan Arogya Yojana Ayushman Bharat Program
Short Form PM-JAY
Announced By Arun Jaitley (Finance Minister)
Announcement Date February 2018
Launching Date Sep 2018
Scheme Type Health Insurance [Bima] Yojana
Target Audience BPL [SECC 2011 Data]
Insurance Coverage  5 Lakh 
Premium Amount Free 
Toll Free Number 14555
Ayushman Bharat Website abnhpm.gov.in
Beneficiaries List Name In Portal  mera.pmjay.gov.in

Insurance Money:

Under the scheme, all the registered beneficiaries will be able to get a sum of 5 lakh INR. The insurance money will be provided to the beneficiaries on a yearly basis.

Family Coverage:

 Already, 85% of rural people and 60% of urban people has been listed under the scheme that is eligible to avail the benefits.

Number of Family Members:

The Scheme will provide health care facilities to five members per family. This procedure will ensure that the maximum number of members of each family is able to receive health care facility.

Premium:

 The beneficiaries will have to register for the scheme and renew the health facilities for them and their family members each year. For this the beneficiaries will need to pay 1100-1200 INR on a yearly basis as a premium of the insurance.

Premium Amount Under PM-JAY

Renewal:

The beneficiaries will have to pay a specific amount of money which will be counted as a premium amount of money every year to renew their schemes and avail the facilities of the scheme.

Claim Settlement Process  

Ayushman Mitra :

There would be Arogya Mitras who would assist the people applying to avail the benefits of the scheme.

Role Of Ayushman Mitra

Golden Card :

A family card would be provided to the people and they need to carry to the health centers which are enlisted under the scheme.

How to get Golden Card Under The PM-JAY Yojana

Cashless Medical Facility:

Ayushman Bharat Scheme will ensure that the poor and needy people are able to get treatment and health care facilities without cash and thus the medical foundation of the will become stronger.

Pradhan Mantri Jan Ayushman Bharat Scheme Important Factors

Eligibility Criteria

  • Underprivileged Members: Only the underprivileged members of the society will be eligible for the Modicare Health Insurance Scheme. The individuals will have to ensure they don’t have any kind of medical insurance and they are weak financially to be eligible for this scheme.
  • Number of Family Members: The government has stated that 5 members will be allowed per family but this policy was created to cover all the members of a family. So, it still remains to be seen what the committee finally decides.
  • SECC 2011: Only the individuals, who are registered under the Socio-Economic Caste Census 2011 of India, will be eligible to avail the facilities of the Modicare Health Scheme.

Pradhan Mantri Jan Ayushman Bharat Scheme Eligibility Criteria

Age Limit Under Pradhan Mantri Jan Ayushman Bharat Scheme

SECC-2011

SECC or Socio-Economic Caste Census is a special category of the government census. This category consists of the list of all the underprivileged people of India. This category is helpful for the government as they are able to use it in terms of welfare schemes and now the government will use it to properly implement the Ayushman Bharat Scheme.

 How to check Your Name In Beneficiary List ?

Documents

The central government of India hasn’t provided the official list of documents which will have to be submitted by the applicants. But in below link we will provide the list of documents which may be necessary in this case.

What are documents required Under Pradhan Mantri Jan Ayushman Bharat Scheme

Implementation Process

How people would be cared under the scheme?

  • Some of the steps have been mentioned in For the beneficiaries to avail the benefits of the National Health Protection scheme, it is not required to enroll for the same.

The following part of the article that would help the beneficiaries to obtain care under the scheme.

  • Patient admission – First of all the patients should be admitted to the empanelled hospitals.
  • Identification and registration – Following the admission, the patient would be identified eligible for the scheme with the help of the software. The identification of the candidate would be done with the help of Aadhaar card.
  • Authorization and approval – The hospitals can check for the packages available for any particular candidate and would also check for the balance in the card. Following this, supporting evidence would be required to avail the treatment.
  • After proper treatment, the patients would be discharged from the hospitals.
  • The discharge summary and post-Treatment details should also be submitted to the hospital management. The hospitals would be paid by the government through banks and after the completion of the treatment procedure, the hospitals would ask for feedback from the patients.

Application Form and Process Under PM-JAY

Online Registration Via CSC Center

Health Wellness Centers:

The government will select 1.5 lakh health care centers and hospitals for the successful implementation of the schemes and these centers will work as a wellness center. The government will allocate 1200 crore solely to develop and activate such centers.

Hospital Registration Process Under Impaneled Hospital List

How will the beneficiaries be identified at the empanelled hospitals?

The beneficiaries need to visit the hospitals where they would go through identification through the help of hospital officials. It would help to make sure whether they are eligible to avail the benefits of the scheme or not. For the same, Aadhaar card and other identification proof need to be provided to the hospital management. Also, a BIS or Beneficiary Identification System with the help of a letter along with family card would be required. From this, e-card would be generated which would be required during further process of treatment. 

Timely payments of hospitals

Most of the hospitals enlisted under this scheme would get timely payments and would be following certain steps.

  • Funds pertaining to the treatment would be transferred directly with the help of State Health Agency or SHA or National Health Agency or NHA.
  • Each of these SHA would have an ESCROW account in which the amount would be transferred.
  • Banks would take care of the payments made to the hospitals.
  • The timely settlement of the hospital claims should be taken care of.

Mobile Number as identification – 

It is obvious that the Beneficiaries will now be able to get make use of their registered mobile phone numbers as their ID number under the NHPM (National Health Protection Mission). So the moment beneficiaries need to get any family member admitted in the hospital, he or she will have to provide only with their registered mobile number to the hospital authorities.The officials have also mentioned that the users are in present time not able to alter their mobile phone numbers very often so this is one factor that they have considered to use them as ID under the scheme. Apart from this, he also stated that today most FMCG companies and cable service providers are also following a similar trend.

What are the anti-fraud guidelines for the scheme?

The guidelines for the methodology include detection, deterrence and prevention under the scheme. Pre-authorization and prevention would be required by the beneficiaries and provide required identification proof to the hospital management to ensure that they are suitable to avail the benefits of the scheme. This would also include data analysis and social monitoring o the candidates. In addition, deterrence includes anti-fraud cells, contract management and de-empanelment.

How to Find Impaneled Hospital List?  

New Tax System

To manage the expenditure of the scheme, the taxpayers of the country have been levied a health tax which will be charged at 1%. This tax will be levied on the taxpayers from 2018 and the government expects it to generate as much as 11, 000 crore INR. The money generated from the tax will be used to manage the costing of Ayushman Bharat Scheme.

Toll Free Number Under PM-JAY

On the September 2018, the Pradhan Mantri Jan Arogya Yojana would be launched under the leadership of Prime Minister Narendra Modi. As per the benefits of the scheme, it would implement the process for the betterment of health related issues among the rural mass.On account of National Health Protection, the scheme has promised to provide Rs. 5 Lakh insurance for the hospitalization of the needy people. In addition, the scheme would cover almost 50 Crore people and ensure them cashless treatment in good hospitals.

State Involved Under the Scheme

Name Official Portal
1 Ayushman Bharat ‘Niramayam’ Yojana Madhya Pradesh ayushmanbharat.mp.gov.in/
2 Mukhyamantri Aam Aadmi Swasthya Bima Yojana In Delhi 
3 Atal Ayushman Uttarakhand Yojana
4 Ayushman Bharat Arogya Karnataka Yojana
5 Ayushman Bharat Yojana Haryana ayushmanbharatharyana.in 
6 PM-JAY In Punjab 

 

31 comments

  1. Abhinav Pandey

    Please help me sir

  2. Subhash Chandra Mahato

    sir Modi care scheme is best for poor people but renewal of 1100 to 1200 on yearly basis is not possible to pay for poor and needy people,
    low income group+ private worker works they do to take benefit,
    All over India we know 70℅ people live in village as farmer, we have to choose low farmer, Labours, private workers,daily wages people, to give benefits without any renewal fees, people having 20000 plus income to above must have to pay must pay for renewal is justify in my view.

  3. Puspendrarajpoot20@gmail.com

    Ku logo ko eskabhi labh

  4. Suresh Balu Rabad

    Modi sir hamare ayushyman ki list me village me sab families ka naam hair or sirf hamare family me kisika bhi naam nahi hai or to ham log poor, jobless hai
    To ham kya kare
    At Bahare, Talk -Dahanu Dist- Palghar in maharashtra

  5. Triken rajbongshi

    Very good pm modi was great his thinking is brealint i proud our pm was modi

  6. subash bhambri

    I am Subash Bhambri from Delhi at present,dislocated from Baramulla Kashmir.I am 70 years. I have kidney problem and my iccnomical condition is not to go under treatment.please let me know how I can avail this scheme.

  7. What is the exact cretria for selection of beneficery for this scheme, can all the bpl family living in rural area be selected as the beneficeries of this scheme…. As per my concern all does person who belongs from bpl family might have right to avail this scheme… Please do clarify..

  8. Dr vinod s tambe

    What is critaria to gate empanelment for private hospital in modicare insurance scheme ?

    • The scheme is really good but it has not percolated to the real beneficiaries . Gov’t. Should gear up grass root level functionaries to provide awareness to the intended beneficiaries. The renewal premium of Rs.1100-1200 is very nominal and should get public support. .

  9. Sir please tell me how can I applh

  10. Kishor Ku. Meher

    I am kishor Ku Meher, Barabazar ,sambalpur splay of ayusman bharat health insurance.

  11. Sir, it’s toogood for all.when we will get application form for this

  12. 2011 k srabe ko aadhar banana galat he sabhe ko yojna ka labh milna chahiye or aap primium bhi le rahe he to jo bhe primium jama kare bah yojna me shamil ho

  13. aayusman bharat

  14. Chandrashekhar Yande

    Is this scheme only for the sick people

  15. Dr.Gangadhara Rao potluri

    Please clarify if thr beneficiary has to remit the premium amount to get benefit from the scheme?

  16. Gautam Bhardwaj

    how will the processing of medical claims be done ? As in how much amount needs to be given for a particular ailment. Who will decide the same ?? will a third party be hired by insurance company as insurance company does not have expertise of doctors and auditors.

  17. Balasubramanian S

    What are the terms of coverage in terms of any quantum limit, deseases covered etc may be informed. What is the income criteria for coverage under the scheme. Whether a eligible citizen can choose the hospital.

  18. Anitha Ravi Shankar

    I want to know the details of this insurance,
    As my brother needs kidney transplantation
    He and his wife work, stay in rented house
    Because of his health and daiylsis , he is not going to work regularly
    Please help us with the insurance
    Details needed

  19. Dr Tariq afzal siddiqui

    When the selection of pvt hospitals will be made ,means service providers Pvt.hospital.for this government will select self or online application will be there to apply for the services

  20. Mine is a eye hospital in Punjab. I want to empanel my hospital with this scheme. How to do it ?

  21. Kindly let us know how to apply…I am 63 yrs old with no pension or SPL income…living on my son’s support…I would like to have the scheme…as of now I do not have any major health problem but minor only ..help us to apply for the above…venugopal k

  22. How to apply for this. We need that very much our home is run by my mother after death of m father

  23. all are receive all in the central government and this only for poor.in future in india no poor people because most people are spend money for medical so hearafter we need not that thank you sir

  24. How to apply for this scheme, what is the process for taking insurance for all filters members

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