Navigating the Prime Minister’s Insurance Scheme: A Guide for Beneficiaries

Prime Minister's Insurance Scheme

Are you tired of filtering through endless Health insurance options, feeling lost and overwhelmed? Look no further! The Prime Minister’s Insurance Scheme is here to provide a helping hand. The scheme is designed to provide comprehensive coverage and benefits to its beneficiaries.

But what is this scheme about? What are the benefits it provides? This article will provide you with answers to all these questions. So let’s start!

What is Prime Minister Insurance Scheme?

The Prime Minister’s Insurance Scheme, called PMJAY, is a health insurance policy designed by the Government of India to give financial security to low-income families. The initiative seeks to relieve the financial stress on families unable to pay for medical treatment.

What are the Features of PMJAY?

The Prime Minister’s Insurance Scheme is a paradigm changer in Indian healthcare. To provide financial security to impoverished and marginalised families, PMJAY offers a plethora of features. Some of them are:

  • No limitations on family size, gender or age.
  • The scheme covers 1,393 medical treatments.
  • The policy offers coverage of up to ₹5 per family per year, guaranteeing that policyholders are not burdened financially by medical care.
  • Services are available nationwide at any of the accredited public and private hospitals.
  • Pre-Existing diseases are covered under the scheme.
  • Beneficiaries can utilise an easy-to-use online site to check their eligibility for the plan and access the rewards.

What are the Benefits of PMJAY?

These are the benefits of PMJAY (Prime Minister Insurance plan):

  • Offers qualified beneficiaries with cashless hospitalisation and medical care.
  • Beneficiaries may access quality healthcare services at accredited facilities.
  • Also covers secondary and tertiary care hospitalisation.
  • Seeks to provide access to healthcare services to all people, regardless of their financial or social status.
  • Covers Pre- and post-hospitalisation expenses.

What are the Eligibility Criteria to Avail of PMJAY?

To avail of the benefit of the Prime Minister Health Insurance Plans, you must fulfil the eligibility criteria. The following are the PMJAY qualifying requirements for both rural and urban areas:

Eligibility Criteria for Rural Areas

If you reside in a rural area in India, you must fulfil specific criteria to be eligible for the PMJAY scheme.

  1. You should be a resident of a rural area in India.
  2. Your family should have a valid ration card.
  3. The annual household income should be no more than ₹5 lakhs.
  4. You must belong to the following:
  • Families living in kutcha or dilapidated houses
  • Households without shelter
  • Families with no male member aged between 16 and 59 years
  • Families with a disabled member and no adult members who can work
  • Landless households who earn a living by working on other people’s land
  • Families with no adults between the ages of 16 and 59 years

Eligibility Criteria for Urban Areas

If you reside in an Urban area in India, you must fulfil specific criteria to be eligible for the PMJAY scheme:

  1. You should be a resident of an urban area in India.
  2. Your family should have a valid ration card.
  3. The annual household income should be no more than ₹ 5 lakhs.
  4. You must belong to the following:
  • Beggars or people living on alms
  • Domestic workers
  • Street vendors, hawkers, and other service providers
  • Construction workers and other manual labourers
  • Sanitation workers and sweepers
  • Home-based workers and artisans
  • People working in the informal sector with no job security or social security

What are the Exclusions and Inclusions Under PMJAY?

Having a clear understanding of the medical procedures covered by the Pradhan Mantri Jan Arogya Yojana (PMJAY) is essential to understand the coverage clearly. They are as follows:

Exclusions Inclusions
Cosmetic surgery Cancer treatment
Fertility treatments Cardiovascular surgeries
Organ transplant surgery Joint replacement surgeries
Dental procedures Dialysis treatment
HIV/AIDS treatment Maternity and newborn care
Treatment for drug and alcohol addiction Mental health care
Non-medical expenses such as attendant charges Critical illnesses such as kidney and live

How to Enrol Into PMJAY Scheme?

Enrolling in the Prime Minister insurance scheme is a quick process. Here’s how to enrol in the scheme:

Step 1: Check Your Eligibility

Before enrolling on the PMJAY scheme, you must check if you are eligible for it. You can do this by visiting the official website of PMJAY or the nearest Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) kiosk.

Step 2: Provide the Necessary Documents

Once you have confirmed your eligibility, you must provide certain documents to enrol in the scheme. These include your Aadhaar card or any other government-issued ID proof.

Step 3: Fill in the PMJAY Application Form

You can do this by visiting the official website of PMJAY or the nearest AB-PMJAY kiosk.

Step 4: Verification of Application

After submitting your application form, it will be verified by the authorities. After the verification, you will get a confirmation SMS or email from the plan.

Step 5: Receive your PMJAY Card

Finally, you will receive your PMJAY card, which you can use to get medical treatment at any empanelled hospital or healthcare facility.


PMJAY is a game-changing healthcare initiative improving healthcare results for millions of Indians. PMJAY helps to make healthcare more accessible and inexpensive for everybody by covering acute diseases, maternity and newborn care, mental health care, and various other medical procedures and treatments.

Despite the benefits, the PMJAY scheme’s scope is limited; hence, you should consider adding a supplementary converge. You can consider the best health insurance company in india Niva Bupa which offers a variety of health insurance plans that can provide you with peace of mind and keep you healthy and safe. Visit their website to understand more about their plans.

I am a full-time professional blogger from India. I like reading various tech magazines and several other blogs on the internet.

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