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

Procedure

  • Patient admitted to the Ward/ Daycare
  • File preparation for the Patients with all documents
  • Treating Doctor fills the Pre-authorization form, Medicine & consumable form and implants form with mentioning the package code
  • Patient visits Ayushman Bharat Counter along with bed side file for identification as PM-JAY beneficiary and registered with biometric verification
  • Preauthorization applied as per selected package code
  • Preauthorization approval received from NHA and the patient/NOK is informed
  • The Medicine/ Consumables/ Implants forms are to be signed PMAM and the Nodal Officer
  • Forms are to be submitted to the AMRIT pharmacy for supply of the necessary medicines/ consumables or implants
  • Upon completion of treatment, Patients are advised for discharge and discharge summary prepared by the Doctor
  • At the time of Discharge, the patient shall visit Ayushman Bharat Counter for biometric authentication and discharge from the ABPM-JAY portal
  • Subsequently, the patient shall get discharged from the hospital discharge counter at ground floor.

N:B:- If a patient is seriously ill or unable to physically visit the Ayushman desk (e.g., bedridden, ICU patient, immobile), Biometric authentication (fingerprint/iris) may not be possible. In such cases, a Biometric Waiver Form is required.

Documents

  • Ayushman Bharat 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.

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UPDATED-INFORMATION-RELATED-TO- AYUSHMAN BHARAT (PM-JAY)