Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is a pioneering initiative of Prime Minister Modi to ensure that poor and vulnerable population is provided cover against serious health conditions that require hospitalisation. It provides a cover up to Rs. 5 lakh per eligible beneficiary family, per year for secondary and tertiary hospitalization through a network of empanelled hospitals. All pre-existing conditions are covered from day 1 of implementation of the Yojana. Services under this scheme will be cashless, paperless and available across the country. All eligible family members will be covered, with no cap on number, age and gender. Most states and UTs have partnered with PMJAY to implement the scheme.
PMJAY primarily targets the poor, deprived rural families and identified occupational category of urban workers‟ families as per the 2011 SocioEconomic Caste Census (SECC) data both rural and urban areas (listed below) as well as the active families under the Rashtriya Swasthya Bima Yojana (RSBY). More than 10 crore families (about 44 percent) or 50 crore beneficiaries will be entitled to get the benefits under PMJAY.
RURAL – Deprived families as per the six deprivation criteria
D1: Only one room with kucha walls and kucha roof
D2: No adult member between age 16 to 59
D3: Female headed households with no adult male member between age 16 to 59
D4: Disabled member and no able-bodied adult member (D4)
D5: SC/ST households (D5)
D7: Landless households deriving major part of their income from manual casual labour
RURAL - Automatically included
Households without shelter
Destitute/ living on alms
Manual scavenger families
Primitive tribal groups
Legally released bonded labour
URBAN – Occupational Categories (11)
Rag picker
Beggar
Domestic worker
Street vendor/ Cobbler/hawker / Other service provider working on streets
Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and another head-load worker
Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller
Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter
Electrician/ Mechanic/ Assembler/ Repair worker
Washer-man/ Chowkidar
The scheme does not have a specified time period.
PMJAY will subsume the functional Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS) currently operational in 13 states (as of March 31, 2018). State specific schemes will be synergized along with PMJAY. If the caller seeks information on state specific scheme then check if information is available in the state health scheme database and then redirect the call to the respective state. If a particular state is not covered then inform the caller
You can check eligibility for PMJAY based on name/family search using the below parameters:
Have you received the letter from Prime Minister Modi? Yes/No. If Yes, ask the number and confirm in the Am I eligible database
Whether during the Gram Swaraj Diwas held in April / May, was your ration card and mobile number recorded? Yes/ No
If yes check on the Am I eligible portal. If available, you can search via mobile number or ration card.
If RSBY is operational in the state then can ask for RSBY card details and check in the RSBY list running in states as of March 2018.
Check for inclusion in the state health scheme database.
If no document is available, ask for full name including father/husband, name of village, block, district, State.
The individual may also visit an empanelled hospital (private or public) to check their eligibility. IF name found in any of the above list beneficiary list, the beneficiary will need to visit an empanelled hospital with preferably Aadhaar Card or any other photo based individual Government ID like Voter ID card, PAN card etc. along with family ID like Ration Card to authenticate the beneficiary and details will be submitted to an approving authority. Once this is validated and approved, the approved beneficiary will get his/her e-card and record will get inserted into the PMJAY database under a „verified‟ beneficiary list and treated as a „golden‟ record. The beneficiary will also be informed through SMS and the beneficiary can then avail of the services in any of the empanelled hospitals only after that.
You need to visit either an empanelled hospital.
You need to carry Aadhaar Card (preferable) or any other photo based individual Government ID like Voter ID card, PAN card etc. as well as family ID like Ration Card.
The Arogya Mitra or Kiosk Operator will search the beneficiary name/family using different ways/parameters.
After identification of beneficiary, you will be asked to submit either Aadhaar Number (preferable) or any Govt. ID card for individual identification/verification.
They will perform online authentication and also validate your mobile number (in case you don‟t have a mobile phone, you can provide the mobile number of any known person). Your photo will also be collected (in case of non-Aadhaar verification)
You will also have to submit a proof of family ID card (Ration Card)for establishing your relation in the family.
Record will then be submitted for approval and you will receive an acknowledgement slip.
If there is a match the record will be approved. You will be informed about the decision by SMS within 30 minutes.
Approved beneficiary record will get inserted into the PMJAY database under a „verified‟ beneficiary list. This will get treated as a "golden" record.
You can then avail services under PMJAY once the scheme is launched in your state.
Confirm the caller's eligibility for PMJAY by following the steps listed in Q4 through Am I Eligible.
If the names and details are not a match on Am I Eligible, then s/he is not entitled to PMJAY.
If the person is not included, inform that for PMJAY, the beneficiaries are identified based on the Socio Economic Caste Census (SECC) survey conducted in 2011 for ranking households in rural & urban based on predefined criteria (details in Q.7).
Say that there is a possibility that a family unit was not present when the data collection drive was conducted and hence may not be in the database.
Mention that over time the scope is likely to broaden but right now the scheme is only available for families listed in the SECC 2011database.
In addition, RSBY beneficiaries in states where RSBY is active are also included.
If a beneficiary is not included under PMJAY, they could still be included under a state specific scheme. Ask for the state from which the person is calling, check if there is a prevalent state programme then redirect the call to the state
If the state is not part of PMJAY then inform the beneficiary.
If there are grievances regarding exclusion from the list of eligible beneficiary then the call centre can note the details.
In this phase, no additional new families can be added under this scheme. However, additional family members can be added for those families whose names are already included in the targeted SECC list of 2011 and have at least one member verified.
PMJAY covers 10.74 crore poor and vulnerable families across the country, identified as deprived rural families and occupational categories of urban workers‟ families as per the Socio-Economic Caste Census (SECC) 2011 data. A list of eligible families has been shared with the respective state government as well as ANMs/BMO/BDOs of relevant area. Only families whose name is on the list are entitled for the benefits of this scheme. Additionally, any family that has an active RSBY card as of March 31, 2018 is covered. Additional beneficiaries may also be included by a particular state under their state specific scheme/s.
SECC stands for Socio Economic Caste Census. It is a study of socio economic status of households in rural & urban India conducted in 2011. This data allows ranking of households based on predefined deprivation parameters and has been used for the PMJAY entitlement based scheme.
Rural areas- entitlement base on any one of the following 6 deprivation parameters:
Only one room with kuccha walls and kuccha roof (D1).
No adult member between age 16 to 59 (D2).
Female headed HHs with no adult male member between age 16 to 59 (D3).
Disabled member and no able bodied adult member (D4); SC/ST households (D5).
Landless HHs deriving major part of income from manual casual labour (D7).
Urban areas-11 occupational categories as follows:
Rag picker; Beggar; Domestic worker/Street vendor/ Cobbler/hawker / Other service provider working on the street; Construction worker/ Plumber/ Mason/ Painter/ Welder/ Security Guard/Coolie/Other head load worker; Sweeper/ Sanitation worker / Mali; Home-based worker/ Artisan/ Handicrafts worker / Tailor; Transport worker/ Driver/ Conductor/ Helper / Rickshaw puller; Shop worker/ Assistant/ Peon / Attendant/ Waiter; Electrician/ Mechanic/ Assembler/ Repair worker; Washer-man/ Chowkidar.
There were Additional Data Collection Drives in rural and urban areas that were carried out in April and May 2018 to identify the beneficiary families in the 2011 SECC list to develop the entitled SECC database for PMJAY.
Family members are entitled under the PMJAY scheme provided they are linked to a verified beneficiary from the SECC database.
There is no limit on the number of family members who can be liked to a verified beneficiary provided their names are listed in the Ration Card.
A family member may be linked to a verified beneficiary based on government ID proof furnished & authenticated by the Arogya Mitra.
List of individual ID proofs and family documents that are being used to establish eligibility. NHA has listed following Govt ID for Individual Identification: Aadhaar /Driving License/ PAN Card/ Adoption Certificate/ Birth Certificate / Certificate of Identity having photo issued by Gazetted officer/ Disability ID Card/ handicapped medical certificate issued by respective State/UT Governments/ Freedom Fighter Photo Card/ Kissan Photo Passbook/ Marriage Certificate Issued by the Government/ MNREGA Job Card/ Other government ID. The list of Govt ID for proof of relation: Adoption Certificate / Ration Card/ Marriage Certificate/ Birth Certificate or any such document as approved by the State.
The PMJAY is an entitlement based scheme & does not require a household or a beneficiary to formally enrol into the scheme. Even if the eligible family was not found during the drive and/or in Gram Sabha the family details shall continue to exist in the eligibility database. You can check your eligibility at nearest at an empanelled health care provider or am I eligible portal. Ask which state/district they belong to and then direct beneficiaries to nearest EHCP after informing them what documents/ID proofs they need to carry with them.
NHA has listed following Govt ID for Individual Identification Aadhaar /Driving License/ PAN Card/ Adoption Certificate/ Birth Certificate / Certificate of Identity having photo issued by Gazetted officer/ Disability ID Card/ handicapped medical certificate issued by respective State/UT Governments/Freedom Fighter Photo Card/ Kissan Photo Passbook/ Marriage Certificate Issued by the Government/ MNREGA Job Card/ Other government ID. The list of Govt ID for proof of relation: Adoption Certificate / Ration Card/ Marriage Certificate/ Birth Certificate
Any government approved ID that proves the family relationship (e.g. ration card) will need be furnished for linking a new member to an already verified beneficiary.
See the list of approved proofs for addition of new members and check what proofs may be available.
Direct the caller to the nearest empanelled hospital for help in adding new members after informing them what documents they need to carry with them.
If an entitled family member has died, then the name of the deceased family member should be deleted.
In this case, it will be a death certificate of deceased family member.
Yes, her name could be retained if her husband‟s family is not eligible under PMJAY
Alternatively, her name can be added to her husband's family.
However, she can claim benefit under one family only.
Her marriage certificate can be used as ID proof to make the necessary modifications. Give the list of approved Govt. ID for Individual Identification and for proof of relation.
You can check your eligibility at a public hospital or empanelled private hospital. Call centre to direct beneficiaries to nearest EHCP.
The name and/or other details may be rectified based on government issued ID produced by the verified beneficiary.
You can check your eligibility at nearest an empanelled health care provider.
Give the list of approved Govt. ID for Individual Identification and for proof of relation.
Call centre to direct beneficiaries to nearest EHCP.
In this case mobile number of any other member of the family can be provided. If that is also not available, then member can provide an alternate number of any relative or known person as it is a mandatory field that is required during Identification and authentication of a verified beneficiary.
You can access services under PMJAY across the country at any empanelled hospital, irrespective of your home state. All benefits under the scheme will remain the same. Members of a family can avail services in different places/hospitals as e-cards are made individually.
The unique feature of PMJAY is that if your state is part of PMJAY then you can access hospitalization in any empanelled hospital in any state in India. The care will be free and cashless and available at empanelled public hospitals and private hospitals. If such a scenario were to rise, please call 14555 to get details about nearest empanelled hospital or details can also be found on the www.abnhpm.gov.in.
PMJAY is an entitlement based scheme. There is no formal enrolment process. Families who are identified by the government on the basis of the SECC database both in rural and urban areas are entitled for benefits under this Mission. Rs. 5 lakh cover will be provided per year per family.
If your family is eligible as per the SECC database then all family members - children, women, senior citizens will be covered for inpatient hospital care. There is no limit on the number of family members or age or gender to avail benefits under PMJAY. There is no formal enrolment, if eligible you are automatically entitled to the benefits of PMJAY from day 1 of the roll out of the scheme.
This scheme is entitlement based. No requirement for changing members as there is no limit on number of family members. Family members can be deleted only if proof of death is furnished. Additional family members can be added anytime based on any government approved ID that proves the family relationship (e.g. ration card) for linking a new member to an already verified beneficiary.
Direct the caller to the nearest public hospital or empanelled private hospital for help in adding new members.
PMJAY is an entitlement based mission. There is no formal enrolment process. Families who are identified by the government on the basis of the SECC database both in rural and urban areas are entitled for benefits under this Mission. Rs 5 lakh cover will be provided per year per family. It is recommended to carry Aadhaar as it is a preferred ID to verify if a beneficiary is eligible under PMJAY. However, no services will be denied to any eligible beneficiary if they do not have an Aadhaar card. An eligible beneficiary can also provide other government ID proofs.
This scheme is entitlement based. Once the eligible beneficiary is verified, an individual e-card will be given. The e-card can be made free of cost at the empanelled hospital. A dedicated family identification number will also be allotted to eligible families.
Once you have an e-card. You can use the e-card to avail services across the country, irrespective of which state you belong to. Every time you will not have to go through the process of authentication of whether you are entitled to the scheme or not.
A printout of the e-card can be obtained at empanelled health care provider. The Arogya Mitra can help you obtain a duplicate card in case of loss or damage.
No. You can directly approach an EHCP to verify your entitlement and avail services
No, there is no penalty but a new card will have to be printed at the empanelled hospital.
The e-card is a onetime verification of identity and does not expire. No need to get it renewed.
It provides an insurance cover up to Rs 5 lakh per family, per year for inpatient hospital care (secondary and tertiary care). These services are free of charge/cashless and paperless. After you explain the benefits, the call centre can then redirect the beneficiary or the caller to visit nearest EHCP based on their pin code to confirm their eligibility & further process.
PMJAY provides free inpatient hospital care at empanelled secondary and tertiary hospitals, both in government and private sector.
The health services covered under the programme include hospitalization expenses, day care surgeries, follow-up care, pre and post hospitalization expense benefits and new born child/children services.
The comprehensive list of packages is available on the website- www.abnhpm.gov.in.
All pre-existing conditions are covered from day 1 of implementation of the Mission in respective States/UTs.
Broadly national NHA packages can be classified as General Surgery; Otorhinolaryngology; Ophthalmology; Obstetrics & Gynaecology; Orthopaedics; Polytrauma; Urology; Neurosurgery; Interventional Neuroradiology; Plastic & reconstructive; Burns management; Cardiology; Cardio-thoracic & Vascular Surgery; Paediatric surgery; Surgical Oncology; Oral and Maxillofacial Surgery; General Medicine; Paediatric medical management; Neo-natal; Paediatric cancer; Medical Oncology; Radiation Oncology; Emergency Room Packages (Care requiring less than 12 hrs stay) and Mental Disorders Packages.
No money will be deposited in your account. PMJAY will provide a coverage up to Rs. 5,00,000 per family per year, for secondary and tertiary care hospitalization required by the family members. These services will be provided at all public hospitals and empanelled hospitals and will be completely free of charge /cashless and paperless.
All eligible beneficiaries can avail free services for secondary and tertiary inpatient hospital care as per identified packages under PMJAY at all public/government hospitals and empanelled private hospitals.
Beneficiaries will have cashless and paperless access to inpatient hospital care under PMJAY. You do not have to pay at any of the empanelled hospitals for inpatient hospital care. The government will bear all the costs for PMJAY.
Ask which State and which Scheme. Check the list of State-wise Schemes being implemented in alliance with PMJAY and accordingly redirect the call to State call centre or SHA as per details available.
Check the state that the beneficiary belongs to. If the state is listed in the state health scheme database and has a state run call centre then the call is to be redirected to that state. If there is no state call centre then the SNA can be approached to define a workflow to address these queries.
The scheme will be rolled out at national level on 25 September 2018.
Different states may roll out the scheme on different dates on/after 25 September 2018.
Ask which state the caller is from and check if the state is part of PMJAY and the rollout date.
If information is available provide the date of launch to the caller, else inform that currently this information is not available.
You could ask them to call closer to 25th Sept and also direct them to speak with their ASHA/ANM/Front line worker for more information.
You can say that once the scheme is rolled out in your state, you can immediately avail of services from day 1 of launch of the scheme.
There will be a PMJAY help desk/kiosk at every public and empanelled private hospital.
This help desk will have a Pradhan Mantri Arogya Mitra to guide you.
S/he is a certified frontline health service professional who shall be present at each of the empanelled health care provider (both in government and private hospital) and shall serve as a first contact point for beneficiaries.
They will also have uniform with a PMJAY logo so that you are able to recognize them.
The Arogya Mitra shall help you by:
Identifying and verifying the beneficiaries entitled under PMJAY through the Beneficiary Identification System.
In case of hospitalization, by submitting requests for Pre-Authorization and Claims through the Transaction Management System so that you are registered in the hospital for accessing the services.
Guide you about the overall benefits under PMJAY and providing information about receiving prompt treatment at the empanelled hospital. Emphasize that any beneficiary can approach the Arogya Mitra for any queries or assistance that you need.
The contact details (names and nos) for Arogya Mitra will not be provided to the caller. The caller can be directed to approach the nearest hospital if they need a service in case they need assistance with checking their eligibility or getting their details verified.
Right now: Say that the national roll out of the scheme is scheduled for 25th September 2018. Based on the pincode caller is calling from check information about state roll out and guide accordingly.
Once PMJAY has been rolled out: Say that at the time of first admission / visit to the hospital, beneficiaries should carry ration card or any other government recognized photo identity document like voter id etc. Recommend to carry Aadhaar as it is the preferred ID document.
All government hospitals that have in-patient capacity like CHC, civil hospital, District Hospital, Medical College Hospital and empanelled private hospitals that provide secondary and tertiary care or multi-speciality care.
Empanelment of the hospitals is being conducted through an online portal by the state government.
Information about empanelled hospitals will be made available through different means such as government website, mobile app and the call centre.
Services under the scheme can be availed at all government hospitals and empanelled private health care facilities.
Empanelment of the hospitals is being conducted through an online portal by the state government.
Information about empanelled hospitals will be made available through different means such as government website, mobile app, regular updates will also be provided through ASHAs, ANM and other specific touch points.
The call centre based on the pincode of the caller can direct them to the nearest empanelled hospitals (Public and private).
Yes, a verified beneficiary may visit an empanelled private hospital with the card & seek treatment. We at the call centre can help you find the nearest empanelled private hospital.
Once the scheme is rolled out, more than one family member from eligible beneficiaries can seek treatment.
Emergency treatment has to be provided by every hospital without any consideration. If patient/attendant claims to be PMJAY beneficiary then they will get the treatment and the hospital will get the ETI Number (Emergency Telephonic Intimation Number) from the call centre. Two scenarios are possible thereafter:
If the beneficiary provides required PMJAY identity proof within specified time of initiation of treatment and is verified, he will be registered and formal pre-authorisation process will be initiated.
In case the patient fails to provide required identity proof, the scheme will cover the costs of stabilizing the patient and thereafter the patient can decide where to seek further treatment.
This scheme is implemented by the state government in partnership with the central government. Ask for state of caller and provide details about district implementing authority.
A package includes end to end treatment for the entire episode of care required. i.e. Diagnosis, doctor and nursing charges, pre-hospitalization investigation, bed charges, consumables, medicines, food for the patient and post-surgery investigations and medicines up to 15 days after discharge, if needed.
As per PMJAY, you will get treated for inpatient hospital care. This can include day care procedures.
This includes for instance, treatment for ailments for maternal care, neonatal and paediatrics, cancer treatment, congenital disorders and all pre-existing conditions and diseases.
Any outpatient care, drug rehabilitation, cosmetic treatments, organ transplants and fertility treatment are not covered.
Any surgery that is not in the package will need to be pre-authorised after which the price will be negotiated between the hospital and SHA/IC and then the procedures can be planned. This is capped to an amount of Rs 1 lakh. This option is available for surgical procedures.
No - OPD services are not covered under PMJAY. Hence any cost incurred for treatment under OPD will be necessarily borne by the patient. Explain that beneficiaries can avail of PMJAY for secondary and tertiary hospitalization at all empanelled public hospitals and private hospitals across the country.
Yes. PMJAY benefits will be available from Day 1 of the roll out of the scheme for inpatient hospital care. Any inpatient hospital care for pre-existing diseases will be covered. However, OPD will not be covered.
No. Under PMJAY, medicines will be included in the package for the duration of treatment, including up to 15 days after discharge from hospital, as needed.
Yes. it includes investigations before, during and after treatment.
Yes. If you want an upgrade you will to pay for all the expenses and this treatment will be outside the PMJAY scheme.
Yes. Normal Labour and delivery, including high risk deliveries, C-sections and associated treatments are covered under PMJAY. But JSY and another voucher scheme benefits are not given under PMJAY.
Yes. There are specific packages for new-born that includes care up to 28 days after birth for neonates. You can discuss this further at an empanelled hospital
Yes. There is no limit of family size. The neonate will be provided care provided the benefit is not exhausted.
No. You are not required to pay for hospitalization for defined packages under PMJAY. These services are available free of charge in both public hospitals and empanelled private hospitals.
There is no provision for paying transportation changes under PMJAY
Day care surgeries are treatments linked to technological advancements that do not require hospital stay such as cataracts, chemo/ radio therapy, dialysis, lithotripsies etc. Day care surgery and hospitalization for less than 24 hours is same
No. Under PMJAY food will only be provided to the patient.
Currently, this information is not available through call centre.
At the time of hospitalization, during the pre-authorization stage the hospital will be able to verify if adequate balance/cover is available.
Communicate to beneficiary that stringent action will be taken against any grievance.
PMJAY has a defined three-tiered grievance redressal system.
At district level, there will be a dedicated District Grievance Nodal Officer (DGNO).
Grievances can be registered through call centre, letter, web, social media etc.
The call centre will register the grievance through a Web-based Central Complaints and Grievance Management System (CCGMS).
This will help categorize the grievances and ensure speedy redressal through established escalation pathways.
A dedicated Grievance Redressal Committee will be appointed at district, state and national level and all grievance will be addressed within a period of 30 days.
Communicate to beneficiary that stringent action will be taken against any grievance.
PMJAY has a defined three-tiered grievance redressal system.
At district level, there will be a dedicated District Grievance Nodal Officer (DGNO).
Grievances can be registered through call centre, letter, web, social media etc.
The call centre will register the grievance through a Web-based Central Complaints and Grievance Management System (CCGMS).
This will help categorize the grievances and ensure speedy redressal through established escalation pathways.
A dedicated Grievance Redressal Committee will be appointed at district, state and national level and all grievance will be addressed within a period of 30 days.
Communicate to beneficiary that stringent action will be taken against any grievance.
PMJAY has a defined three-tiered grievance redressal system.
At district level, there will be a dedicated District Grievance Nodal Officer (DGNO).
Grievances can be registered through call centre, letter, web, social media etc.
The call centre will register the grievance through a Web-based Central Complaints and Grievance Management System (CCGMS).
This will help categorize the grievances and ensure speedy redressal through established escalation pathways.
A dedicated Grievance Redressal Committee will be appointed at district, state and national level and all grievance will be addressed within a period of 30 days.
Communicate to beneficiary that stringent action will be taken against any grievance.
PMJAY has a defined three-tiered grievance redressal system.
At district level, there will be a dedicated District Grievance Nodal Officer (DGNO).
Grievances can be registered through call centre, letter, web, social media etc.
The call centre will register the grievance through a Web-based Central Complaints and Grievance Management System (CCGMS).
This will help categorize the grievances and ensure speedy redressal through established escalation pathways.
A dedicated Grievance Redressal Committee will be appointed at district, state and national level and all grievance will be addressed within a period of 30 days.
Communicate to beneficiary that stringent action will be taken against any grievance.
PMJAY has a defined three-tiered grievance redressal system.
At district level, there will be a dedicated District Grievance Nodal Officer (DGNO).
Grievances can be registered through call centre, letter, web, social media etc.
The call centre will register the grievance through a Web-based Central Complaints and Grievance Management System (CCGMS).
This will help categorize the grievances and ensure speedy redressal through established escalation pathways.
A dedicated Grievance Redressal Committee will be appointed at district, state and national level and all grievance will be addressed within a period of 30 days.
Yes – Grievances against the Arogya Mitra can be escalated to the District Grievance Nodal Officer.
Please refer to list of empanelled hospitals
The hospital will help in nation building and help in providing hospitalization services to the poor and vulnerable sections of the society who may not have otherwise been able to access services. The empanelled hospital will be reimbursed as per the prevailing package costs for the services.
Hospital should check eligibility criteria and submit its application online for empanelment at hospitals.abnhpm.gov.in, the District Empanelment Committee (DEC) will visit the hospital for facility and document verification and decision for approval/rejection shall be taken by competent authority. Hospital can visit PMJAY website for further details.
Yes. Based on the information filled out by you, there will be a physical verification by the SHA or its designated representatives to ensure that hospital has the necessary facilities meeting required standards
Pass on District Nodal Officer contact information or any SHA official contact information.
Go to the portal (hospitals.abnhpm.gov.in) and select the specializations hospital offers, the „Check eligibility‟ tab on would show all the mandatory requirements required to empanel under the scheme
Refresh the page and try again or contact the call center (14555/1800111565) if issue persists.
Focus on the fields marked in red star. they are mandatory. Alternatively, on the bottom of the page there is a button “Check eligibility” which, when clicked, will show which fields are mandatory.
Check eligibility is a section wise summary of the entire form where all the incomplete mandatory information is highlighted in red. This tab helps you understand what else to fill to ensure successful submission of form
With the help of an Arogya Mitra (explain functions of Arogya Mitra) who will check eligibility through software called BIS (explain functionality)
You can edit information before save and submit and not after the same.
Focus on the fields marked in red star. they are mandatory.
Mandatory requirements must be furnished. You may contact the Hospital Empanelment nodal officer of your State. Provide details
Based on your speciality, mandatory fields cannot have a no option. You must have those facilities to qualify for the empanelment process.
Both of those are the same things. Meaning the number of beds in your hospital.
Yes
Go to add manpower tab, fill out details and then save the information. Now check view manpower tab, the details should appear.
Recheck type of medical expertise and type of expertise fields and then cross verify the exact degree
Filling out details of a duty doctor / specialist of the speciality that you have selected is enough to move ahead. Filling out other staff details is not mandatory.
One doctor can be mapped as duty doctor to one hospital only. Specialists can be mapped to multiple hospitals.
Basic minimum skill sets/educational requirements are mentioned for registering the hospital under the provider network, they need to be fulfilled under the empanelment process.
You may leave it empty. It is a non-mandatory field.
Depending on your specialty, some have blood bank tie ups as non-mandatory. For all others, either tie up or in-house bank is necessary.
Depends on your specialty.
If your specialty needs you to have diagnostics in house, you must have it to be eligible for empanelment.
Hospital cannot pick and choose specialties, all have to be included.
No. Only in case of Madhya Pradesh, NABH accreditation is mandatory for application.
Refer them to the relevant accreditation process and stakeholders.
Mention list of accreditations and relevant incentive percentages.
Missing out on filling mandatory information or not satisfying the basic criteria for application (explain basic criteria - minimum number of beds, etc.)
Yes. the application goes for approval of all the information and documents filled out by you. You will receive a mail confirmation for the same.
In case of public hospital, it moves to SHA login, and for private hospitals it moves to DHA login for physical verification.
District Empanelment Committee (DEC) will visit the hospital for physical verification of online submitted details
The hospital might not be empaneled if it doesn‟t meet the minimum requirements.
You need one of these documents for any of the owners of hospital. In addition, you also need an Income Tax PAN Card.
No
Try to arrange for scanned copy of a blank cheque or approach the bank for a scanned copy.
Once you enter IFSC code, you must click on the search icon next to it. This will auto populate the bank name and branch field.
IFSC code helps identify bank name and branch number. You may confirm your IFSC code by calling your bank branch.
Click on forgot password option and check.
Try to log in once again. In case this is still happening ask the hospital to email a screenshot and raise a ticket for the IT Help-Desk.
You need to make sure that you click on save before clicking next. It is very important to click save.
Ask to click a low-resolution picture or refer to the links for online file compression (share a few links that can be used to compress file size like compressor.io)
Add new member will refresh the page and allow you to add new member‟s details. After adding the details, one must click the save button to make sure.
Yes. Saving your information is the most important step. You must save information before clicking the next button.
You should receive payment for claims submitted within a period of 15 days.
The entire process will be completed within 30 days.??
This will be handled on a case to case basis and the required process will be escalated for resolution within the grievance framework.
Request the hospital to reach out to District Grievance Nodal Officer. Log the grievance in the Web-based Central Complaints and Grievance Management System (CCGMS). This will help categorize the grievances and ensure speedy redressal through established escalation pathways. A dedicated Grievance Redressal Committee will be appointed at district, state and national level and all grievance will be addressed within a period of 30 days.
You should contact the District Nodal Officer. If not satisfied, contact District Grievance Committee. Check state/district and provide details. Log the grievance in the Web-based Central Complaints and Grievance Management System (CCGMS). This will help categorize the grievances and ensure speedy redressal through established escalation pathways.
Hospital should be informed that scheme covers benefit up to the limit of Rs.5 lacs. If the balance is not sufficient then the hospital should inform the SHA and seek direction from them on a case to case basis.
Benefits under PMJAY will be available across the country. This means that a beneficiary will be able to get treatment outside the home State in any empanelled hospital in a cashless manner. An empanelled hospital will not be allowed to deny services to any PMJAY beneficiary. To enable portability under the scheme, each of the State participating in PMJAY will sign MoU with Central Government and each other which will allow any hospital empanelled under PMJAY to provide services to beneficiaries from across the country. This will also enable participating insurance companies/ trusts to make payment to hospitals empanelled beyond the boundaries of State where they are providing services. Allpackages will be subject to pre-authorization in the event of portability.
The package rates of the treating state will be applicable in such a situation as per the empanelment conditions.
The claims will be settled by the home state i.e. the state where the beneficiary belongs to or is registered under. For the beneficiary the service will be cashless.
The timelines for processing of portability claim and payment to the hospital would not be the same as other claims, i.e. within 30 days of receiving the claim instead of 15 days for other claims.
In case of any dispute or grievance, with respect to treatment sought or taken in another State, will be taken up the with the District Grievance Committee of the State where hospital is located. Except in case of National Institute of Eminence, where grievances would be raised to NHA.
This needs to be raised as a grievance by the first hospital to the SNA/IC along with supporting documents.
The national roll out of the scheme is scheduled for 25th Sept 2018. Different states may roll out the scheme on different dates.
For information on state specific schemes, the call centre should redirect the calls to respective state contact number/call center number
The states are implementing the scheme in different ways- Trust, insurance company or a combination of the two. The premium for PMJAY will vary from state to state and is only relevant if an insurance company is engaged. It is an internal matter between Trust and Insurance company.
This is the responsibility of the State Government and each of the states is laying down clear guidelines for this purpose.
The Government is committed to ensuring that sufficient funds are available for effective implementation of PMJAY. For any specific query you are requested to reach out to NHA or SHA as may be appropriate.
All key functions relating to delivery of services under PMJAY shall be performed by the State Health Agency or SHA viz. data sharing, verification/validation of families and members, awareness generation, monitoring etc. For more details, you can visit the PMJAY website which has details on role of SHA.
The Arogya Mitra/Operator at Kiosk shall conduct an Individual Identification (based on Aadhaar / non- Aadhaar KYC), Verify Mobile No & Family Identification (Ration Card), Enter name of the family & upload a search on the Beneficiary Identification System (BIS) based on government issued ID proofs furnished by the potential beneficiary. Similarly, beneficiary will also have to submit a proof of family ID card (Ration Card) for establishing his relation in the family. Once the beneficiary is identified it is further sent for approval to the Trust/Insurance company. If the Insurance company recommends for rejection it is the State that will make the final decision about eligibility.
The Arogya Mitra will be selected based on the following criteria:
Completed 10+2 from a recognized institution
Basic proficiency in computer operations
Completed the Arogya Mitra Training Course and passed the respective course exam/certification
Possessing fluent communication skills in Hindi/ English and Local language of the State/ region
Having adequate functional computer literacy which shall include understanding of Microsoft Office Suite and navigating through Internet Portals.
Preference to be given to Female Candidates for the position of Arogya Mitra. Qualified ASHA workers may be given preference for the position of AM (if interested).
Public hospitals will depute/ designate or hire through a third-party agency or hire through any other means. Private hospitals will hire directly.
NHA is collaborating with Ministry of Skill Development and Entrepreneurship (MSDE) to use platform of Pradhan Mantri Kaushal Kendra (PMKK) to train and certify Ayushman Mitra at each district. NHA will communicate details of empanelled PMKKs to the States. Arogya Mitra shall be trained for effectively carrying out his/her job. Beneficiaries can provided feedback if Arogya Mitra‟s services are found lacking.
After the initial placement, State Government may also consider shuffling AMs every 6/12 months within the same city/town. Other mechanisms including IT based mechanisms, field monitoring, whistle blowing and grievance mechanisms are being put in place to monitor the functioning of various functionaries including Arogya Mitras. Besides internal mechanisms, beneficiaries can raise grievance or any other member of public can report misdoings on the part of Arogya Mitra.
The ultimate responsibility to effectively prevent, detect, and deter fraud lies with the State Health Agencies (SHA). An anti-fraud cell will be established at each state Robust fraud/abuse control procedures have been put in place under PMJAY to prevent, detect and deter fraud and abuse. The guidelines are available on the website https://www.abnhpm.gov.in/sites/default/files/2018-08/Anti-fraud-PMJAY-Guidelines.pdf
Information about PMJAY is available through the website www.abnhpm.gov.in.
PMJAY follows a three-tier grievance redressal mechanism at national, state and district level.
The grievances may be registered through Call centre, Website, Letter, Email, Social media etc.
The call centre will register the grievance through a Web-based Central Complaints and Grievance Management System (CCGMS).
The TAT for redressal of grievance is 30 days at each level, but, it is recommended to reduce the TAT as much as possible.
A dedicated District Grievance Nodal Officer (DGNO) will be appointed at each district.
Please reach out to NHA or SHA of respective states for details.