A Guide to PMJAY-MA Yojana in Gujarat

The Gujarat government operates the Pradhan Mantri Jan Arogya Yojana - Mukhyamantri Amrutam (PMJAY-MA) scheme to provide significant financial protection against healthcare expenses for eligible families. This scheme is an integrated version of the central government's Ayushman Bharat PM-JAY and Gujarat's own legacy health schemes, namely the Mukhyamantri Amrutam (MA) and Mukhyamantri Amrutam Vatsalya (MAV) Yojana.

The primary goal of PMJAY-MA is to offer cashless treatment for critical illnesses, surgeries, and tertiary care procedures, reducing the out-of-pocket expenditure for vulnerable families. In a major update effective from July 2023, the state government increased the health coverage from ₹5 lakh to ₹10 lakh per family per year, significantly enhancing the financial security for beneficiaries. This guide provides detailed information on the scheme's coverage, eligibility criteria, enrolment process, and how to avail its benefits at empanelled hospitals across Gujarat.

PMJAY-MA Gujarat: At a Glance

• Coverage Amount — Up to ₹10 lakh per family, per year
• Previous Names — Mukhyamantri Amrutam (MA) & Mukhyamantri Amrutam Vatsalya (MAV) Yojana
• Integration with PM-JAY — 2019
• Coverage Increased to ₹10 Lakh — July 2023
• State Helpline — 1800-233-1022
• National Helplines — 14555, 1800-111-565
• Health Helpline — 104

Rates shown are as per the Gujarat Health and Family Welfare Department (2023) and are subject to periodic revision. Always verify the latest approved rates on the official source.

What Does the PMJAY-MA Scheme Cover?

The PMJAY-MA scheme provides extensive health coverage for serious medical conditions, ensuring that families do not face a financial crisis due to high treatment costs. The scheme offers cashless coverage of up to ₹10 lakh per family per year on a family floater basis. This means the total amount can be used by one or more members of the family for multiple hospitalizations until the limit is reached.

The benefits cover a wide range of medical needs associated with hospitalization for tertiary and secondary care. Pre-existing diseases are covered from the first day of enrolment. The package includes:

The scheme covers approximately 2,700 procedures. Some of the major critical illnesses and treatments covered under PMJAY-MA include:

In addition to treatment costs, the scheme also provides a transportation allowance of ₹300 for each visit to an empanelled hospital to help cover the patient's travel expenses.

• Hospitalization expenses (room and board)
• Surgeon and doctor consultation fees
• Diagnostic procedures (tests and imaging)
• Cost of medicines and medical consumables
• Post-hospitalization follow-up care
• Cardiovascular diseases and surgeries
• Cancer treatments (chemotherapy, radiation, surgery)
• Kidney and liver diseases, including transplants
• Neurological conditions and neurosurgery
• Severe burns
• Neonatal (newborn) diseases and treatments
• Organ transplants for kidney, liver, and pancreas

Who is Eligible for PMJAY-MA in Gujarat?

Eligibility for the PMJAY-MA scheme in Gujarat is broader than the national Ayushman Bharat PM-JAY scheme. It includes beneficiaries identified by the central government as well as additional categories defined by the state government. An applicant must be a resident of Gujarat to be eligible.

The criteria are divided into two main groups:

1. **PM-JAY Beneficiaries (SECC 2011 Data):** Families identified through the Socio-Economic Caste Census (SECC) of 2011 based on specific deprivation and occupational criteria. This includes categories such as households without shelter, destitute families, manual scavengers, primitive tribal groups, legally released bonded labourers, and households with specific vulnerabilities (e.g., no adult male member between 16-59, SC/ST households, landless households deriving a major part of their income from manual casual labour).

2. **State-Specific MA/MAV Beneficiaries:** Gujarat has expanded the eligibility to include a larger section of its population. These categories include:

This inclusive approach ensures that a larger number of families in Gujarat can access the benefits of the health insurance scheme.

• Families with a total annual income of up to ₹4 lakh.
• Senior citizens (aged 60 and above) belonging to families with an annual income of up to ₹6 lakh.
• Fixed-pay Class 3 and Class 4 employees of the state government.
• Accredited Social Health Activists (ASHA workers).
• Accredited reporters.
• Holders of a U-WIN (Unorganized Workers Identification Number) card.

How to Enrol and Get a PMJAY-MA Card

The enrolment process for the PMJAY-MA scheme is conducted in person at designated centres across the state. It is important to note that online registration is not available for this scheme. Beneficiaries must visit a designated enrolment kiosk to get their PMJAY-MA card.

These kiosks are typically located at Taluka offices, civic centres in municipal corporation areas, and sometimes through mobile kiosks set up at the local level. At the kiosk, an operator will capture the required information and biometrics of the family members.

The process involves the following steps:

Beneficiaries need to carry specific documents for verification during the enrolment process. While the exact list may vary slightly, the following are generally required:

• The operator verifies the family's eligibility using their ration card and other documents.
• Biometric information, including fingerprints and iris scans of all family members, is captured.
• A family photograph is taken.
• After successful verification of all documents and biometrics, a co-branded PMJAY-MA e-card with a unique QR code is printed and issued to the beneficiary.
• Aadhaar Card
• Valid Ration Card
• Income Certificate (issued by a competent authority, required for income-based eligibility)
• Proof of residence (such as an electricity bill or rent agreement)
• BPL (Below Poverty Line) certificate, if applicable

Relationship with Ayushman Bharat PM-JAY

The PMJAY-MA scheme is not a separate entity but an integrated health protection program that combines the central Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) with Gujarat's state-run Mukhyamantri Amrutam (MA) and Mukhyamantri Amrutam Vatsalya (MAV) schemes. This merger took place in 2019 to create a single, more powerful health scheme for the residents of Gujarat.

The integration works by using the PM-JAY framework as a base and enhancing it with state-specific benefits. Beneficiaries receive a single co-branded "PMJAY-MA" card, which is valid for availing benefits under the scheme.

The key aspects of this integration are:

Essentially, the Gujarat government has expanded upon the central scheme to offer more comprehensive protection to a wider population within the state. For the beneficiary, this means a single point of access to a larger pool of benefits.

• **Increased Coverage:** While the national PM-JAY scheme provides coverage of ₹5 lakh per family, Gujarat has topped this up to provide a total coverage of ₹10 lakh per family per year.
• **Expanded Eligibility:** The PMJAY-MA scheme includes all beneficiaries eligible under the national PM-JAY (based on SECC 2011 data) and adds several other categories of beneficiaries based on state-defined income limits and occupations, such as families with an annual income up to ₹4 lakh.

Using the PMJAY-MA Card at Hospitals in Gujarat

The PMJAY-MA scheme is designed to be completely cashless, meaning the beneficiary does not have to pay any money for covered treatments at an empanelled hospital. The process is straightforward and aims to be hassle-free during a medical emergency.

When a beneficiary needs treatment, they must visit a hospital that is empanelled under the scheme. They need to present their PMJAY-MA card and a valid photo ID (like an Aadhaar card) at the hospital's help desk. A dedicated staff member, often called a 'Arogya Mitra', will assist the patient. The hospital verifies the patient's identity and eligibility using the card's QR code or beneficiary number. Once the verification is complete and the required treatment is pre-authorised, the hospital provides the necessary medical services without charging the patient. The hospital later settles the expenses directly with the implementing agency or the insurance company.

Treatment under the scheme can be availed at a wide network of hospitals across Gujarat. As of July 2023, the network included:

Patients can find the list of empanelled hospitals on the official PM-JAY portal or by calling the helpline numbers.

• 2,027 state-run government hospitals
• 803 empanelled private hospitals
• 18 central government hospitals

Frequently Asked Questions

What is the difference between PM-JAY and Gujarat's PMJAY-MA scheme?

PMJAY-MA is an integrated scheme that combines the national Ayushman Bharat PM-JAY with Gujarat's own Mukhyamantri Amrutam (MA) scheme. The key differences are that PMJAY-MA offers a higher coverage of ₹10 lakh per family (compared to PM-JAY's ₹5 lakh) and has broader eligibility criteria, including families with annual incomes up to ₹4 lakh, which covers more people than the central scheme alone.

Are pre-existing diseases covered under the PMJAY-MA scheme?

Yes, all pre-existing diseases and critical illnesses are covered from day one of enrolment in the PMJAY-MA scheme. There is no waiting period for pre-existing conditions.

How can I check if I am eligible for the PMJAY-MA scheme?

You can check your eligibility for the national PM-JAY component online through the official portal 'mera.pmjay.gov.in'. For state-specific eligibility criteria (like the income-based category), you can visit a designated enrolment kiosk at a Taluka office or civic centre with your ration card and income certificate for verification.

Is there any cost to enrol or get a PMJAY-MA card?

The enrolment for the PMJAY-MA scheme is conducted at designated government kiosks. The research notes do not specify if there is a fee for card generation. Beneficiaries should confirm any applicable charges at the enrolment centre.

Can I use the PMJAY-MA card for treatment outside Gujarat?

The Ayushman Bharat PM-JAY scheme offers portability, which allows beneficiaries to receive cashless treatment at any empanelled hospital across India. As PMJAY-MA is co-branded with the national scheme, benefits should be available nationwide. It is advisable to confirm this facility with the helpline before seeking treatment outside Gujarat.

What should I do if my PMJAY-MA card is lost?

The research notes do not specify the exact procedure for a lost card. However, you should immediately contact the scheme's helpline numbers (1800-233-1022 or 14555) for guidance. You may also need to visit an enrolment kiosk to apply for a duplicate card.

Does the scheme cover OPD consultations or only hospitalisation?

The PMJAY-MA scheme primarily covers expenses related to hospitalisation (in-patient care) for secondary and tertiary treatments, including surgeries and critical illnesses. It generally does not cover routine Out-Patient Department (OPD) consultations.

Related

• Government hospital OPD guides in Gujarat
• How to find an Ayushman Bharat (PM-JAY) hospital near you
• Ayushman Bharat PM-JAY eligibility check
• Government health schemes in India: a guide

Medical Disclaimer

The information provided in this article is for general informational and educational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.