Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is India’s largest publicly funded health insurance scheme, yet misinformation persists. Here, we debunk some common myths with facts to ensure beneficiaries and stakeholders have accurate information.
Myth 1: Only BPL (Below Poverty Line) Families Are Eligible
Fact: Eligibility is determined by the Socio-Economic Caste Census (SECC) 2011.
PM-JAY does not solely cover families classified as BPL. Instead, it follows SECC 2011 data to identify economically vulnerable households across both rural and urban areas.
The scheme automatically covers families meeting specific deprivation criteria such as those without a proper house, landless laborers, and households with no adult earning member.
Myth 2: Only Government Hospitals Provide Treatment Under PM-JAY
Fact: Private hospitals are actively participating in the scheme.
Over 24,000 hospitals, including thousands of private healthcare institutions, are empaneled under PM-JAY to provide cashless treatment.
Beneficiaries can choose from a vast network of public and private hospitals across India.
Myth 3: PM-JAY Covers Only Basic Treatments
Fact: The scheme covers over 1,500 medical conditions, including advanced surgeries.
Treatments under PM-JAY include major surgeries such as cardiac bypass, knee replacement, and cancer treatments.
It covers hospitalization expenses, pre- and post-hospitalization care, diagnostics, and follow-up treatments.
Myth 4: The Scheme Requires Beneficiaries to Pay Upfront and Get Reimbursed Later
Fact: PM-JAY provides cashless and paperless treatment at empaneled hospitals.
Beneficiaries do not need to pay any amount upfront; hospitals claim expenses directly from the government.
A dedicated IT system ensures real-time processing of claims and seamless hospital transactions.
Myth 5: Only Rural Families Benefit from PM-JAY
Fact: The scheme covers both rural and urban families based on SECC data.
PM-JAY covers economically weaker sections from urban areas, including ragpickers, domestic workers, street vendors, and daily wage laborers.
Many low-income urban households benefit from free medical care under the scheme.
Myth 6: There’s a Limit on the Number of Family Members Covered
Fact: There is no cap on family size under PM-JAY.
Unlike other health insurance schemes, PM-JAY does not restrict the number of members covered in an eligible family.
This ensures that large families receive adequate healthcare protection.
Myth 7: Ayushman Card is Required to Avail Benefits
Fact: Beneficiaries can access services using any government ID linked to PM-JAY.
While an Ayushman card simplifies the process, beneficiaries can use Aadhaar or any other approved identification for verification at empaneled hospitals.
Myth 8: Pre-existing Conditions Are Not Covered
Fact:All pre-existing diseases are covered under PM-JAY.
Beneficiaries are entitled to treatment for ailments they had prior to enrollment.
This ensures better access to healthcare for individuals suffering from chronic conditions such as diabetes, hypertension, and heart disease.
Myth 9: The Quality of Treatment Under PM-JAY is Subpar
Fact: Hospitals under PM-JAY undergo strict empanelment and quality checks.
The government monitors hospitals to ensure standard treatment and patient safety.
NABH (National Accreditation Board for Hospitals & Healthcare Providers) accredited hospitals are preferred for empanelment.
Myth 10: Enrolling in PM-JAY Requires Paying a Registration Fee
Fact:Enrollment is completely free.
There is no need to pay any amount to register for PM-JAY.
Beware of fraudsters demanding money for Ayushman cards.
Conclusion
Dispelling these myths is crucial to ensuring maximum utilization of Ayushman Bharat PM-JAY. The scheme is designed to provide equitable, cashless, and high-quality healthcare to India’s most vulnerable populations. By spreading accurate information, we can ensure that more eligible families take full advantage of this transformative health initiative.
