Benefits of PM-JAY
- • PM-JAY is the world’s largest health insurance/assurance scheme fully financed by the government.
- • It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
- • Over 10.74 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
- • PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
- • PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.
- • The cover under the scheme includes all expenses incurred on the following components of the treatment:
- o Medical examination, treatment and consultation
- o Pre-hospitalization up to 3 days
- o Medicine and medical consumables
- o Non-intensive and intensive care services
- o Diagnostic and laboratory investigations
- o Medical implantation services (where necessary)
- o Accommodation benefits
- o Food services
- o Complications arising during treatment
- o Post-hospitalization follow-up care up to 15 days
- • There is no restriction on the family size, age or gender.
- • All pre–existing conditions are covered from day one.
- • Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
- • Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician's fees, room charges, surgeon charges, OT and ICU charges etc.
- • Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
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