Ayushman Bharat PM-JAY SEHAT Scheme in Jammu and Kashmir: A Guide

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana SEHAT (AB-PMJAY SEHAT) scheme was launched on December 26, 2020, to provide universal health coverage to the residents of Jammu and Kashmir. The term SEHAT stands for Social Endeavour for Health and Telemedicine.

This initiative extends the benefits of the central government's flagship Ayushman Bharat PM-JAY program to every family in the Union Territory, regardless of their income level or socio-economic status. It aims to reduce out-of-pocket health expenditure by providing cashless access to healthcare services for secondary and tertiary care needs.

AB-PMJAY SEHAT Scheme: At a Glance

• Health Cover Amount — ₹5 lakh per family per year (on a floater basis)
• Launch Date — December 26, 2020
• Implementing Agency — State Health Agency (SHA), Jammu and Kashmir
• Insurance Partner — Bajaj Allianz General Insurance Company
• Helpline Number — 14555

Rates shown are as per the J&K State Health Agency, Official Scheme Portal (2020) and are subject to periodic revision. Always verify the latest approved rates on the official source.

What is Covered Under the AB-PMJAY SEHAT Scheme?

The SEHAT scheme provides a significant health insurance cover of ₹5 lakh per family, per year. This amount operates on a floater basis, which means the entire sum can be used by a single member or shared among multiple members of the family for their treatment needs within the policy year.

The coverage is focused on secondary and tertiary care hospitalization. This includes a wide range of medical and surgical procedures across various specialties such as cardiology, oncology, nephrology, and more. The scheme also includes financial protection for expenses incurred before and after hospitalization.

• **Pre-hospitalization:** Expenses for up to 3 days before admission to the hospital are covered.
• **Post-hospitalization:** Expenses for diagnostics and medicines for up to 15 days after discharge are covered.
• **Pre-existing Conditions:** A key feature of the scheme is that all pre-existing diseases are covered from the very first day of the policy.
• **Cashless Access:** Beneficiaries receive cashless services at empanelled hospitals, meaning they do not have to pay for covered treatments out of pocket.

Who is Eligible for the SEHAT Scheme?

Unlike the national Ayushman Bharat PM-JAY, which targets beneficiaries based on the Socio-Economic Caste Census (SECC) 2011 data, the AB-PMJAY SEHAT scheme offers universal eligibility.

All residents of the Union Territory of Jammu and Kashmir are eligible to enrol in the SEHAT scheme. This inclusive approach ensures that every family in the UT can access the scheme's benefits. The scheme covers approximately 15 lakh additional families who were not included under the central PM-JAY. There are no restrictions based on family size or the age of its members.

How to Enrol and Get the Golden Card

The enrolment process for the SEHAT scheme is straightforward. Residents need to visit their nearest Common Service Centre (CSC) to register. The government has made efforts to ensure these centres are widely accessible.

To complete the registration, individuals need to provide specific documents for verification. The primary documents required are an Aadhaar card for identity verification and a ration card as proof of residence in Jammu and Kashmir.

Upon successful verification of the documents, a 'Golden Card' is generated for each eligible member of the family. This card is the primary proof of beneficiary status and must be presented at the hospital to avail cashless treatment. The Golden Card is provided to all beneficiaries free of cost.

Relationship with Ayushman Bharat PM-JAY

The AB-PMJAY SEHAT scheme is a co-branded, operational extension of the central Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. While the national PM-JAY provides health coverage to the most vulnerable sections of the population across India, the SEHAT scheme was specifically designed to expand this coverage to the entire population of Jammu and Kashmir.

It effectively adopts the framework and benefits of PM-JAY and makes them universally available within the UT. The scheme is implemented in an insurance mode, with Bajaj Allianz General Insurance Company serving as the partner responsible for managing the claims and service delivery.

Using the SEHAT Scheme at Hospitals

Beneficiaries can use their Golden Card to receive cashless treatment at a large network of hospitals. The scheme has empanelled numerous public and private healthcare facilities within Jammu and Kashmir. All public hospitals in the UT are considered deemed empanelled under the scheme.

A major advantage of the SEHAT scheme is its national portability. This feature allows beneficiaries to seek treatment at any empanelled hospital not just within J&K, but anywhere across India. This is particularly useful for patients who may need to travel for specialized care.

At each empanelled hospital, a dedicated desk with an 'Ayushman Mitra' is available to assist beneficiaries. These representatives help with the admission process, verification, and other formalities, ensuring a smooth experience for the patients and their families.

Frequently Asked Questions

What is the full form of SEHAT in the AB-PMJAY SEHAT scheme?

The full form of SEHAT is Social Endeavour for Health and Telemedicine.

Is there any cost to get the J&K SEHAT Golden Card?

No, the Golden Card is issued free of cost to all eligible beneficiaries upon successful enrolment at a Common Service Centre (CSC).

Are pre-existing diseases covered under the J&K SEHAT scheme?

Yes, one of the significant benefits of the scheme is that it covers all pre-existing conditions from day one of the policy.

Can I use my SEHAT Golden Card for treatment outside Jammu and Kashmir?

Yes, the scheme offers national portability. This allows beneficiaries to avail cashless treatment at any empanelled hospital across India.

What is the main difference between the national PM-JAY and J&K's SEHAT scheme?

The national PM-JAY scheme is targeted at families identified through the SECC 2011 database. The J&K SEHAT scheme extends these benefits to all residents of the Union Territory, irrespective of their income or inclusion in the SECC list.

What documents are needed to apply for the SEHAT scheme?

To enrol for the AB-PMJAY SEHAT scheme, you need to provide an Aadhaar card and a ration card at a Common Service Centre (CSC).

Related

• Government hospital OPD guides in Jammu and Kashmir
• 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.