Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is India’s largest health assurance scheme, launched by the Government of India, aimed at providing financial protection for secondary and tertiary healthcare needs. In Arunachal Pradesh, AB PM-JAY is implemented in convergence with CMAAY, ensuring comprehensive health coverage for eligible beneficiaries.

Coverage and Benefits:

• Sum Assured: Each eligible family is covered for up to ₹5 lakh per year for hospitalization and medical treatment.
  • Ro ₹1 lakh per year for secondary ailments.
  • Ro ₹1 lakh per year for secondary ailments.
• Cashless Healthcare Services: Beneficiaries can avail of cashless treatment at empanelled hospitals without the need for upfront payments.
• Pre-Existing Diseases Covered: The scheme provides immediate coverage for pre-existing conditions from the day of enrollment.

Scope of Coverage :

AB PM-JAY provides comprehensive risk cover for hospitalization and surgical procedures, ensuring beneficiaries receive quality healthcare without financial burden. The coverage includes:

• Hospitalization Expenses: Costs related to in-patient care and surgeries.
• Day-Care Procedures: : Treatment that does not require a prolonged hospital stay.
• Pre and Post-Hospitalization Costs: Diagnostic tests, consultations, and medicines before admission and up to 15 days post-discharge.
• Follow-Up Treatment: Ensuring continued medical care and recovery support.
• Emergency Care & Critical Illness Coverage: Covers life-saving treatments, surgeries, and intensive care.

Inclusions Under AB PM-JAY :

The scheme eliminates out-of-pocket expenses for a wide range of medical needs, including:

• Hospital Admission Charges
• Surgical and Medical Treatments
• Doctor’s Fees (Surgeons, Specialists, Anesthetists, etc.)
• Diagnostic Tests (X-ray, MRI, CT Scan, Blood Tests, etc.)
• Medical Procedures, Implants & Therapies
• Hospital Stay (Bed Charges, Nursing Care, etc.)
• Post-Treatment Follow-Up & Medications