Top Benefits of the PM Modi Health Insurance Scheme for Low-Income Families

Have you ever been in a situation where someone known to you or your family needs immediate medical attention, but due to lack of money, you are not able to get him or her treated in the hospital? Terrifying, isn’t it?

This is the story of millions of low-income families in India for whom quality healthcare is a far-fetched reality. Many suffer, and some even lose their lives because they cannot afford treatment.

But wouldn’t it be great, if you could avail free cashless medical treatment in some of the best hospitals across the country? Well, that’s exactly what you can do with the PM Insurance Scheme – Pradhan Mantri Jan Arogya Yojana (PMJAY) – for economically deprived families.

Sounds intriguing, right? Let us simply explain how this scheme can be a game changer for the people who really need it.

Key Highlights

• Rs. 5 lakh free treatment per family/year: Covers hospitalisation, surgeries, ICU, diagnostics & medicines.  
• Cashless & paperless at any empanelled hospital: Just show your Ayushman Card, get treated, and go home.  
• No age, gender, or family size limits: Everyone in the eligible household is covered from day one.  
• Covers pre-existing diseases & post-hospitalisation: No exclusions, plus expenses covered before & after hospitalisation.  
• Nationwide portability: Use it in any PMJAY-approved hospital, anywhere in India.  

What is the PM Insurance Scheme?

PMJAY, also known as Ayushman Bharat Yojan, is a government-sponsored health insurance scheme introduced to provide financial security to more than 12 crore deprived and vulnerable families all over India. 

It offers cashless hospitalisation for secondary and tertiary care so that a family does not have to stress about high medical bills while getting themselves or their loved ones treated.

Under the scheme, beneficiaries are given an Ayushman Card, which they can use to get free treatment at any empanelled government or private hospital anywhere in India. 

So, if someone in your family falls sick and has to be hospitalized, you can just go to a participating hospital, show your Ayushman Card and get treated for free.

Benefits for Low-Income Families

Let’s discuss what makes PMJAY among the most important and helpful health schemes in India:

• Financial Coverage: Provides a cover of up to Rs. 5 lakh per family per year for secondary and tertiary care hospitalisation.
• Eligibility: The deprived rural families determined by the recent Socio-Economic and Caste Census (SECC), both in rural and urban areas, will be eligible for the scheme.
• Nationwide Reach: The scheme reaches the public and private empanelled hospitals nationwide. 
• Hassle-Free Process: It is a paperless, cashless, hassle-free transaction without complicated cash memos or reimbursement forms.
• Largest Health Insurance Scheme in the World: PMJAY will cover around 55 crore people, making it the largest government-funded health insurance scheme in the world.
• Covers Pre- and Post-Hospitalisation Expenses: It will include pre-hospitalisation expenses for 3 days and post-hospitalisation expenses for 15 days, covering diagnostics and medicines.
• No Restrictions: No limits based on family size, age or gender.
• Covers Pre-Existing Diseases: Enrollees are covered starting day one, including pre-existing conditions.
• Pan-India Portability: The scheme is applicable all over the country. You can get treated anywhere in India under the PMJAY network.
• Comprehensive Medical Services: Covers 1,929 medical procedures, including medicines, diagnostics, primary care services, specialist services, day care surgeries and 3 days of pre-hospitalisation and post-hospitalisation expenses.
• Doctor Consultations & Treatment – Visit empanelled hospitals for medical consultations and treatment at ZERO cost to your pocket.
• Essential Medicines & Supplies – Free access to prescribed medicines, surgical tools, and medical consumables required during treatment
• Diagnostic & Lab Tests – The cost of Blood tests, X-rays, MRI and other such tests required to diagnose an ailment or monitor the treatment would be covered.
• Medical Implants & Procedures – Surgeries and medical implants if required, such as pacemakers, joint replacements, and stents.
• Hospital Stay & Accommodation – The scheme would cover hospital room charges to make sure patients get the right care during their stay.

Easy Claim Process and Cashless Facilities

This is probably one of PMJAY's best features: it is completely hassle-free and is totally cashless. 

Here's what you'd do:

Visit an empanelled hospital (either public or private) with your Ayushman Card.

The hospital verifies your details in the PMJAY system, and if it all checks out, you have surgery free of charge under this scheme. 

The rest will be paid directly from government funds to reimburse hospitals, with no out-of-pocket costs to you. You wouldn't have to go through the hassle of filing reimbursements or handling lengthy claim processes. All of it will take place there and at that moment.

How to Apply For The PM Medical Insurance Scheme?

It is very easy to apply for PMJAY; you can do it online as well as offline.

Online Application Process

1. Visit the official website of PMJAY. Click on ‘Am I Eligible?’
2. Enter your mobile number and OTP to log in to the Beneficiary NHA portal.
3. Enter your state and district, then select the PMJAY scheme.
4. Enter your Aadhaar to check if you are a beneficiary.
5. If eligible, visit the nearest Ayushman Bharat Kendra or Common Service Center (CSC) to complete the registration. Carry valid ID proof (Aadhaar Card, Ration Card, or Voter ID) for verification.

Note: PMJAY does not have a direct online application process. If your name appears in the eligible list, you need to visit the nearest CSC or hospital empanelled under PMJAY to complete the process.

Offline Application Process

1. Visit any empanelled hospital or Ayushman Mitra Centre.
2. Carry essential documents, including your Aadhaar card and income proof.
3. The hospital staff will guide you through the application process.
4. Once approved, you’ll receive your Ayushman Bharat Card for future use.

Documents Required

• Aadhaar Card for biometric verification
• Income certificate
• Ration card (if applicable)
• Caste certificate (if applicable) 
• Bank account details (for records)

PM Insurance Scheme is a lifesaver for low-income families. Health facilities in the most remote corners with cashless hospitalisation, coverage for pre-existing diseases and financial protection against medical emergencies are ensured under this scheme. 

If you or someone close to you stands in for eligibility, registering for the Ayushman Bharat Card must be done to safeguard a better, healthier future.