Analyzing The Cost-Effectiveness Of Pmjay Vs Other Health Insurance 

Analyzing The Cost-Effectiveness Of Pmjay Vs Other Health Insurance 
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Analyzing the cost-effectiveness of PMJAY compared to other health insurance schemes in India.

Launched by the Honorable Prime Minister of India, the PMJAY scheme was released in 2017 as a part and segment of the national health policy of 2017 and aimed for universal health coverage. Soon after the scheme’s launch, PMJAY became the largest healthcare scheme globally. The scheme was designed mainly for the healthcare of the lower segment of society and provided care during emergency conditions. There are different health card benefits of the 

PMJAY scheme, which you will not get on the normal health insurance schemes. 

The scheme provides coverage of up to five lakh rupees per year for secondary and tertiary care hospitalization. It covers pre-existing and newly acquired diseases, allowing monetary assistance to individuals for their medical needs. It also covers the cost of medicines, food, diagnostics and other expenses related to medical care, which the government will bear.

Premium Features of the Pradhan Mantri Jan Arogya Yojana Scheme

The PMJAY health insurance scheme has several benefits for customers. 

  • Sum insured for health facilities of up to five lakhs for every family.
  • The scheme offers eligibility to more than fifty crore beneficiaries.
  • Allows cashless hospitalization for individuals.
  • Coverage of pre and post-hospitalization expenses.
  • Offers over 1350 medical procedures.
  • Every pre-existing condition is covered within the scheme.
  • Covers the expenditures for diagnosis, physician fees, room charges and others.

Multiple benefits of the PMJAY medical insurance scheme

Shortly, the Indian government aims to spread the Pradhan Mantri Jan Arogya Yojana scheme to more customers through different insurance companies. To provide adequate healthcare services to more customers, irrespective of their financial health condition, the government offers multiple benefits, mainly to the lower section of people, through the PMJAY insurance scheme. The detailed benefits of the PMJAY scheme are as follows.

  • The prime benefit of the Pradhan Mantri Jan Arogya Yojana scheme is to protect families and beneficiaries from the hassle of challenging paperwork and arrange a cashless payment mode for their betterment. Moreover, registration for this plan is entirely free and does not require any paperwork.
  • Another benefit of the pmjay card is for families listed in SECC or the Socio Economic Caste Census of 2011 to get insurance coverage for this scheme.
  • In the list of benefits, the card also offers special privileges to the girl child, women and older people. There is no capping limit on the age, gender or family size registered under the Pradhan Mantri Jan Arogya Yojana scheme.
  • Another benefit of enrolling for the PMJAY card is that there is no restriction on the coverage of pre-existing diseases. It covers all pre-existing illnesses, and no beneficiary can be turned away in such a case.
  • Moreover, the PMJAY scheme also benefits critical illnesses like Covid 19, prostate cancer and other complicated diseases requiring financial backup.
  • The PMJAY scheme offers the best insurance plan to those living in rural regions without the need for any out-of-pocket expenses. They can get effective healthcare treatments from the facilities registered under this scheme.
  • The Pradhan Mantri Jan Arogya Yojana scheme also covers pre-hospitalization medical expenses for up to 3 days and post-hospitalization medical expenses for up to 15 days for a follow-up treatment.
  • There are more than 1350 medical packages under the PMJAY scheme, and it aims to cover the expenses of surgical treatments, medicine costs, diagnosis and various other things.
  • With so many benefits available, we must remember that the PMJAY scheme has a vast network and can reach out even in rural areas to treat poor people better.

Eligibility criteria advantages of the PMJAY scheme over other health insurance schemes

The Indian government aims to provide health benefits to both people living in rural and urban areas. However, the eligibility criteria for rural and urban people vary.

The Rural People

  • Families without any earning members.
  • Families are living in single-room houses.
  • Families led by a female member.
  • Families of the SC and ST categories.
  • Families have disabled members in their houses.
  • Families of the bonded labour.
  • Families without any proper shelter for living.
  • Families of the manual scavengers.

The urban people

  • Electricians.
  • Artisans.
  • Peons.
  • Street vendors.
  • Domestic workers.
  • Coolies.
  • Washermen.
  • Watchmen.
  • Mechanics.

And others.

The benefits of the Pradhan Mantri Jan Arogya Yojana scheme over other health insurance schemes are more significant in terms of coverage, affordability and availability. The PMJAY scheme covers a wide range of secondary to tertiary care treatments with no capping limit on family size, age or gender. It also covers pre-existing diseases and provides cashless payments to registered hospitals through the card. Furthermore, the scheme also provides freedom from paperwork for registration. This makes it one of the best health insurance schemes for people across all sections of society.

Furthermore, the PMJAY scheme also benefits those living in rural regions deprived of quality and affordable health insurance coverage. It helps them access quality treatment and also bears their medical expenses. All these benefits make the PMJAY scheme better than other insurance plans regarding coverage, affordability and availability. It is a great initiative taken by the Indian government to bring healthcare within reach of everyone.

Final Words

The PMJAY card’s benefits can be availed only by those who perform the pmjay registration. People can also use Ayushman Bharat Health Card to reap heath benefits from PMJAY. They must be enrolled under the pmjay scheme to be eligible for the insurance benefits. They can avail of all the medical benefits of the scheme in case of any medical emergency or during any critical medical condition. People in rural and urban areas can register for the pmjay scheme. All the families registered under this scheme can avail of insurance of up to five lakh rupees on a roaster basis. Therefore, the scheme is designed for the weaker sections of society living in the villages and the poor people who live in the urban areas. 

The Pradhan Mantri Jan Arogya Yojana is a great initiative and will greatly impact the lives of people living in rural and urban areas. It will provide better access to health care for those who cannot afford private health insurance. This scheme is well structured and has brought healthcare within reach of everyone. 

James Gilbert

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