What is the process for an operation under the PMJAY scheme?

Dear ,

The PMJAY scheme, also known as Ayushman Bharat Yojana, is a government-funded health insurance scheme that provides cashless healthcare services to eligible beneficiaries for various medical treatments and operations.

Understanding the Process for PMJAY Scheme

To avail an operation or any medical treatment under the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme, here's a step-by-step process:

1. Check Your Eligibility:

• The first step is to confirm if you are eligible for the PMJAY scheme. Eligibility is primarily based on the Socio-Economic Caste Census (SECC) 2011 data for rural and urban areas.
• You can check your eligibility online by visiting the official PMJAY website (mera.pmjay.gov.in) or by calling the helpline numbers 14555 or 1800-111-565.
• Alternatively, you can visit any empanelled hospital or Common Service Centre (CSC) where an Arogya Mitra (health assistant) can help you check your eligibility.

2. Locate an Empanelled Hospital:

• PMJAY benefits can only be availed at hospitals that are empanelled under the scheme.
• You can find a list of empanelled public and private hospitals on the PMJAY website or through the helpline.

3. Visit the Hospital and Verification:

• Once you have identified an empanelled hospital, visit their Ayushman Mitra helpdesk.
• You will need to present your identity proof such as an Aadhaar card, ration card, or any other government-recognized ID.
• The Ayushman Mitra will verify your eligibility using your ID and the PMJAY database. If you are eligible and do not have an Ayushman Card (e-card), it will be generated for you on the spot.

4. Avail Treatment:

• After successful verification, the hospital will proceed with the necessary medical consultation, diagnosis, and if required, the operation.
• The treatment under PMJAY is entirely cashless for the beneficiary. The hospital directly coordinates with the scheme for all billing and payments.

5. Post-Treatment and Discharge:

• Once your treatment or operation is complete and you are discharged, the hospital will manage the claim submission process with the PMJAY authority.
• You do not need to pay anything for the covered procedures.

How HexaHealth Can Assist:

• Eligibility Check and Guidance: We can help you understand your eligibility for the PMJAY scheme and guide you through the initial steps.
• Hospital Selection: HexaHealth has a network of empanelled hospitals. We can help you find the best empanelled hospital for your specific operation or treatment requirement.
• Seamless Process: We assist in coordinating with the hospital's Ayushman Mitra desk to ensure a smooth verification and admission process, making your healthcare journey hassle-free.
• Treatment Support: From initial consultation to post-operative care, we provide end-to-end support, ensuring you receive quality treatment under the scheme.

We are here to help you navigate your healthcare journey with ease and ensure you receive the benefits you are entitled to under government schemes like PMJAY.