General FAQ

1. What is the objective of Pradhan Mantri Jan Arogya Yojana?

The objective of PMJAY is to reduce the financial burden of poor and vulnerable groups arising out of catastrophic hospital episodes and ensure their access to quality health care services.

2. What is the Amount covered under the Scheme?

₹5 lakhs covered per eligible family per year for Secondary and Tertiary care as cashless treatment on family floater basis.

3. Who is eligible to avail the benefits of this Scheme?

All families listed inthe SECC-2011 database as per defined criteria will be covered.

4. What are the diseases PMJAY Card holders beneficiary can avail in private hospitals in these Scheme?

Currently 1394 packages covering surgery, medical and day care treatments, along with medicine and diagnostics will be covered under PMJAY as per norms and guidelines of the Scheme.

5. Are there any reserved Packages for Government Hospitals?

Yes. Altogether 221 procedures are reserved for Government hospitals only.

6. Do beneficiaries need to pay any fee for obtaining the card?

No, the card is free and no fee is to be paid for obtaining the card.

7. What are the documents given to beneficiaries upon enrolment into this Scheme?

Government will issue a family Card, authorizing the beneficiary to use the same for cashless treatment of all the family members at the empanelled hospitals under this Scheme.

8. How will the Beneficiary family get card for Cashless treatment ?

Government has issued the card to the beneficiary family directly as per SECC data of the year 2011 for availing Cashless Treatment.

9. How many cards will be issued to a family?

Only one single card will be issued to particular eligible family.

10. How a beneficiary will get this PMJAY card, in case of lost or theft?

Beneficiary family will approach the Joint Director, Health with relevant proof of FIR to issue Duplicate Card, in their respective Districts.

11. What is an empanelled hospital ?

Hospitals which have signed MoU for providing patients with healthcare facilities under PMJAY both inthe Government and Private sectors.

12. Where shall the beneficiary first approach for initiating treatment under the Scheme ? Can a Beneficiary go directly to a private empaneled hospitals ?

For availing treatment under these scheme, a beneficiary can go directly to any empanelled hospital, both Government & Private sector or call the toll free number 18001027480 for guidance or for referral. The reserved procedures for Government hospitals will only be available in Government hospitals.

13. Where shall the beneficiary approach for supportin empanelled hospitals?

Beneficiary should approach Ayushman Mitra help desk at each of the empanelled hospitals, who will be there 24 x 7 for supporting and hand holding the beneficiaries and ensuring their treatment experienceisinaseamlessand cashless manner.

14. Will any part of the treatment costs be reimbursable directly to the beneficiary?

No, patient will get cashless treatment in empanelled hospitals up to ₹5 lakhs per annum per family and the amount will be reimbursed to the hospitals directly. No cash will be paid to patients.

15. What will happen if the total cost of treatment is above ₹5 lakhs per family at any time or if ₹5 lakhs get exhausted before one year for a beneficiary family ?

  • In case if the amount of ₹5 lakhs is exhausted under PMJAY, then the following will occur:
    • Additional cost will switch over to Atal Amrit Abhiyan Scheme (AAA) if the beneficiary is eligible under AAA and procedure is found covered under the Scheme with an additional amount of ₹2 lakhs per person.
    • Otherwise additional amount hasto borne by the Beneficiary.

16. Is there any restriction to family size for PMJAY?

No cap on family size and age of members.

17. What additional supportis there is for the beneficiaries in case of any grievance?

In case of any queries or grievance, a beneficiary can always call toll free number 18001027480 at any time 24 x 7. Additionally, one can also send mail at grievance.snc@gmail.com

18. Are pre-existing diseases covered under PMJAY?

Yes, all pre-existing diseases are covered under the Scheme and empanelled hospitals cannot deny treatment to the beneficiaries.

19. Can the hospitals charge any money from beneficiaries for treatment under PMJAY?

No, hospitals cannot charge any additional amount until ₹5 lakhs is completely exhausted by the beneficiary, if it gets exhausted it will get top up if covered in critical care under “AAA” card up to ₹2 lakhs. Hospitals will not be allowed to charge any additional money from beneficiaries for the treatment within the sum assured of ₹5 lakhs.

20. What will be covered within ₹5 lakhs annually?

  • The amount of ₹5 lakhs for the beneficiary family per annum can be used by any enrolled member ofthe family on a floater basis as and when needed. This will cover the following:
    • Treatment: As per agreed package rates which will include pre and post hospitalization
    • Investigations, cost of surgery, medicine, implants, consumables and food for the patient.
    • Travel Allowance and Daily Allowance: TA and DA will be paid to the patients as per State norms to the beneficiaries which are eligible under both Atal Amrit Abhiyan and Pradhan Mantri Jan Arogya Yojana.
    • Travelling Expenditure and Daily Allowance for treatment outside Assam will be paid only to those patients who are referred to outside Assam hospitals for treatment through the referral system of SHA, Assam.

21. What are the documents required at the time of Hospitalization?

At the time of Hospitalization within and outside Assam, the Beneficiary will need to show his/her PMJAY Card along with one ID Proof ( Voter ID / PAN card / Licence etc.)

22. Are Government employees eligible for this card ?

Government employees (Central or State / Serving or Retired) are not eligible for benefit under the Scheme “PMJAY” or “Atal Amrit Abhiyan”

23. “AAA” Card holder who are eligible but have not received PMJAY card. How they will get this card?

They can approach District Kiosk in every district to know about their status of PMJAY card or call the toll free number 1800 102 7480.

24. SECC Beneficiary who have not received “AAA” card, how will they get the “AAA” Card.

They can approach directly to the District Kiosk of the respective Districts or get it from Mobile enrolment kiosk.

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