CMAAY

What is Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) & Chief Minister Arogya Arunachal Yojna (CMAAY)?

Government of Arunachal Pradesh, along with the Government of India has launched both these schemes to provide cashless treatment to eligible beneficiaries requiring hospitalization. This initiative is part of the Government’s vision to ensure that its citizens – especially the poor and vulnerable groups, have universal access to quality healthcare services.

What is the objective of these schemes and what are the benefits under the schemes?

To reduce out of pocket expenses for the identified poor & deprived families of the state, other indigenous population and State Government Employees.
To provide quality treatment for various defined illnesses, requiring hospitalization.
The schemes provide coverage for predefined hospitalization procedures which includes surgical & medical ailments, to members of eligible families up to Rs.5 Lakh with a capping for secondary care up to Rs.1 Lakh and for tertiary care for Rs.4 lakh per family per year.
"Cashless hospitalization” is the benefit given under the scheme, which means the facility extended by the Government to the assured family where the payments, of the costs of treatment undergone by the assured beneficiary in accordance with the scheme terms and conditions, are directly made to the network hospital by the Government to the extent pre-authorization approved.

Who is eligible to avail its benefits?

Under AB PM-JAY, beneficiaries identified as deprived rural families and occupational categories of urban workers’ families as per pre-defined Socio-Economic Caste Census (SECC) data of 2011. A list of eligible families has been shared with the respective state government as well as ANMs / Medical Officer I/Cs of PHC &CHC/ BDOs of all concerned areas.
Under CMAAY, beneficiaries identified are Arunachal Pradesh Scheduled Tribe (APST) members / Non-Tribal families with Resident Certificate (RC) of Lohit, Namsai & Changlang districts and State Government employees & their dependents.

Do I need to enroll again if I already have a SMART card from the previous scheme?

Yes, all eligible beneficiaries need to get enrolled again
Previously issued SMART card is not valid anymore

What is the process for new enrolment and what are the documents required?

CMAAY will have a dedicated enrollment kiosk in each district.
Beneficiary families can also enroll themselves through the CMAAY web portal by logging in at www.cmaay.com or through a mobile app.
Mandatory Documents are :
- Aadhaar Card
- APST Certificate.
- Resident Certificate(RC) for Non - APST families of Lohit, Namsai and Changlang districts.
- Family declaration form countersigned by DDO/HOO for state Govt. employees.

Is there a defined time period for enrolment?

No, the enrolment would be conducted at fixed District Kiosks, during all official working days.

Are there any charges that are required to be paid at the time of enrolment?

Enrollment under the schemes is completely free of cost.

Is there any identity card issued to the beneficiary under the CMAAY scheme?

Yes, an e-card can be downloaded & printed by the beneficiary, once enrolled.

What are the Diseases / Ailments / Procedures covered under the scheme?

There are 1300 + procedures covered under the scheme which are categorized under secondary & tertiary ailments.
Coverage is offered for 23 specialties.
For detailed information, with respect to the procedures covered under the scheme please contact the toll free number 18002335558 or visit the website www.cmaay.com.

Where can the beneficiaries avail services under the schemes?

Services under the schemes can be availed at various empanelled public and private health care facilities.
Empanelment of the hospitals under the scheme will be conducted through an online portal by the State Government.
Information about empaneled hospitals will be made available on the website www.cmaay.com.

Who should an eligible beneficiary first approach for initiating treatment under the scheme? Can a beneficiary go directly to a private empanelled hospital?

Treatment can be initiated only after successful enrollment under the scheme.
There would be an Arogyamitra placed in all the empanelled Hospital, who the beneficiary can approach for any assistance.
If the procedure is available in the empaneled hospital, treatment can be availed
If the treatment is not available, Arogyamitra will facilitate the referral to the nearest available hospital
For any treatment to be done outside Arunachal, Referral from a Government Hospital (PHC/CHC/DH/General Hospital, etc.) would be mandatory except for State Government employees posted outside the state and students studying outside Arunachal Pradesh.
These do not apply in cases of emergencies.

Are pre & post hospitalization expenses covered under the scheme?

Pre-Hospitalization charges from 3 days prior to admission and Post-Hospitalization charges up to 10 days post discharge will be covered, which include cost of medicines and diagnostic tests.

Will any part of the treatment cost be reimbursable directly to the beneficiary?

No

Will OPD prescription / Consultation and diagnostic be admissible?

No

What if the total cost of treatment is above Rs.1 Lakh for secondary care, can the sum assured under tertiary care i.e. Rs.4 lakh be utilized?

No, the Sum Assured cannot be clubbed

Will beneficiaries with pre-existing diseases be eligible to be enrolled under the schemes?

Yes

Can the E-card be utilized for availing any future treatment under the CMAAY scheme?

Yes

Does the beneficiary incur any additional cost for treatment?

No

Is the sum assured separate for each individual member of the family?

No, since the scheme is a family floater, the sum assured for secondary / tertiary care is fixed for the family.

Does the scheme cover transportation to and from the hospital / medical center?

No

What is the eligible room category covered under the scheme?

Package is designed for providing treatment in General wards

What is the treatment mechanism in case of multiple procedures required by an individual?

In case of multiple procedures the highest package rate will be paid at 100%, the subsequent higher package will be paid at 50% and the remaining will be paid at 25% respectively depending on the balance sum assured for secondary and tertiary care.

What happens if the total cost of treatment exceeds Rs. 5 Lakh at one time or if the Rs.5 Lakh gets exhausted before one year for a beneficiary?

The scheme covers only an amount up to Rs. 5 Lakh per beneficiary family per year. Any expenditure over and above the given limit is to be borne by the beneficiary

Are there any age restrictions / family member restrictions for availing the benefits under this scheme?

There are no age restrictions under this scheme.
All eligible family members can avail the benefits stated under this scheme.

Where can I get additional information regarding these schemes?

Additional information about the scheme can be obtained by calling the toll free no. 18002335558 and by visiting the website www.cmaay.com.

Which department is looking after the schemes?

A separate society (Chief Minister Arogya Arunachal Yojana) has been set up under the aegis of Health & Family welfare Department, Government of Arunachal Pradesh for proper implementation of both the schemes which is responsible for the administration of both the schemes.

What does package include?

For the purpose of hospitalization, package rates shall include all the costs associated with the treatment, such as:
- Registration charges
- Bed charges (General Ward).
- Nursing and boarding charges.
- Surgeons, Anaesthetists, Medical Practitioner, Consultants fees etc.
- Anaesthesia, Blood Transfusion, Oxygen, O.T. Charges, Cost of Surgical Appliances etc.
- Medicines and drugs.
- Cost of prosthetic devices, implants etc.
- Pathology and radiology tests: radiology to include but not be limited to X-ray, MRI, CT Scan, etc.
- Diagnosis and Tests, etc
- Food to patient.
- Pre and Post Hospitalization expenses: Expenses incurred for consultation, diagnostic tests and medicines before the admission of the patient in the same hospital and cost of diagnostic tests and medicines and up to 10 days of the discharge from the hospital for the same ailment/ surgery.
- Any other expenses related to the treatment of the patient in the hospital.

For Government Employees, who are ‘Dependent’, and what is the meaning of the word “Family”?

The term ‘family’ means and includes:-
- Husband or wife as the case may be and other dependent family members.
- . Dependent Family Members: parents (female employee can have either her parents or her parents-in-law as dependents) sisters, widowed sisters, widowed daughters, minor brothers and minor sister, children and stepchildren wholly dependent upon the Government Servant and are normally residing with the Government Servant (son up to the age of 25 or till his marriage whichever is earlier and daughter till she gets married). Also now included, dependent divorced / separated daughters (including their dependent minor children) and step-mother.

CHIEF MINISTER AROGYA ARUNACHAL YOJANA

AYUSHMAN BHARAT PRADHAN MANTRI JAN AROGYA YOJANA

CMAAY

ABPMJAY

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