Mukhyamantri Amrutam (MA) Yojana & PMJAY-MA in Gujarat

Overview of MA Yojana and its Evolution to PMJAY-MA

The Mukhyamantri Amrutam (MA) Yojana was a landmark initiative by the Gujarat government to provide free medical treatment for critical illnesses. Its success led to the introduction of MA Vatsalya Yojana to cover lower-middle-class families (annual income up to ₹4 Lakh). Recognizing the need for a unified and comprehensive healthcare safety net, Gujarat integrated these state schemes with the national flagship health assurance scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

This integration resulted in the PMJAY-MA Yojana, providing a co-branded card and significantly increasing the financial cover. As of July 2023, the health cover under PMJAY-MA Yojana in Gujarat was doubled from ₹5 Lakh to ₹10 Lakh per family per year for secondary and tertiary care hospitalization.

The scheme is 100% government-funded, meaning beneficiaries do not pay any premium or enrollment charges.

Eligibility Criteria for PMJAY-MA Yojana in Gujarat

The PMJAY-MA Yojana targets a wide range of vulnerable and lower-income families in Gujarat. Eligibility is generally based on income criteria, BPL status, and specific occupational categories:

• BPL Families: All families officially listed in the Below Poverty Line (BPL) census by the State Government. All members of the BPL family must be listed to avail benefits.
• MA Vatsalya Beneficiaries (Annual Income up to ₹4 Lakh): Families whose annual income is up to ₹4,00,000 (Four Lakh Rupees). This includes families slightly above the BPL line.
• Senior Citizens: Senior citizens from families with an annual income of up to ₹6,00,000 (Six Lakh Rupees).
• Government Employees: Class 3 and Class 4 fixed-pay employees appointed by the State Government.
• Accredited Social Health Activists (ASHAs): All urban and rural ASHA workers and their families.
• Accredited Media Personnel: Authorized media personnel (Journalists) and their families.
• Construction Workers: Families of construction workers registered with the Maharashtra Building & Other Construction Worker Welfare Board.
• Other Vulnerable Groups:
  • Households without shelter.
  • Households with no adult male member aged 16-59.
  • Households with disabled members and no able-bodied adult member.
  • Landless households deriving income from manual casual labor.
  • SC/ST households.
  • Residents of government Mahila Ashram, senior citizens of government old age homes, students from government Ashram Shala, and children from government orphanages.
  • U-Win cardholders.

The family's income certificate is a crucial document for non-BPL beneficiaries.

Benefits and Coverage under PMJAY-MA Yojana

The PMJAY-MA Yojana offers significant financial protection against catastrophic health expenditures, providing cashless treatment at empanelled hospitals.

Key Benefits:

• Cashless Treatment: Beneficiaries receive cashless treatment at government and empanelled private hospitals. There's no need for premium payments or enrollment charges from the beneficiary.
• High Coverage Limit: Up to ₹10 Lakh per family per year for secondary and tertiary care hospitalization (increased from ₹5 Lakh in July 2023).
• Family Floater: The coverage is on a family floater basis, meaning all eligible family members (up to 5, with newborns automatically covered as the 6th member from day one) can avail the benefits within the annual limit.
• Comprehensive Package Coverage: Covers over 2,471 defined medical and surgical procedures across various specialties, including:
  • Cardiovascular surgeries
  • Renal diseases (including kidney transplants)
  • Neurological diseases/surgeries
  • Cancer (Surgical Oncology, Chemotherapy & Radiation Oncology)
  • Burns
  • Poly-trauma (not covered by Motor Vehicle Insurance)
  • Neo-natal diseases
  • Knee and Hip Replacement surgeries
  • Liver and Pancreas + Kidney Transplants (with specific higher limits, e.g., up to ₹5 Lakh)
  • Paediatric surgeries
  • General surgeries and medical management
• Pre-existing Diseases Covered: All pre-existing diseases are covered from day one.
• Pre- and Post-Hospitalization Expenses: Covers diagnostic tests, hospital registration, admission charges, cost of medicines, patient's food, and follow-up consultations.
• Transport Allowance: Provision for transport allowance of ₹300 per visit, subject to an annual ceiling (often ₹3000), to cover travel charges to and from the hospital.
• No Middlemen: The scheme operates with direct financial transfers and no intermediaries.

The MA Amrutam Card acts as a cashless health card for beneficiaries.

Application Process for MA Amrutam Card (PMJAY-MA)

The enrollment process for the MA Amrutam Card (PMJAY-MA Yojana) is designed to be accessible and straightforward:

1. Visit Registration Centers:
   • Eligible families should visit designated enrollment centers such as:
     • Taluka Civic Centers (ATVT centers)
     • Civic Centers in Municipal Corporation areas
     • E-Gram centers in rural areas
     • Mobile Kiosks (often facilitated by ASHA workers in remote areas)
     • Empanelled Government and Private Hospitals (some may have enrollment kiosks)
2. Verification of Eligibility:
   • Authorities at the kiosks maintain lists of eligible families (BPL lists or lists based on income certificate data).
   • For income-based eligibility, ensure you have a valid income certificate from a competent authority.
3. Provide Biometric Data & Documents:
   • All family members seeking coverage must be present for biometric data collection (fingerprints, iris scans) and photograph.
   • Submit self-attested copies of required documents.
4. Fill Application Form:
   • Complete the Mukhyamantri Amrutam card application form (often available in Gujarati) with accurate family information.
5. Document Verification:
   • The submitted documents and biometric data will be verified by the designated officer.
6. Receive MA Amrutam Card:
   • Upon successful verification and enrollment, you will receive your PMJAY-MA (MA Amrutam) card, a pamphlet about the scheme, and a list of empanelled hospitals.
   • The enrollment is generally instant after verification.

There is no specific enrollment period; beneficiaries can enroll throughout the year.

Required Documents for MA Amrutam Card

To apply for the PMJAY-MA (MA Amrutam) Card, ensure you have the following documents (original for verification, and self-attested copies for submission):

• Aadhaar Card: Mandatory for all family members.
• Proof of Identity: (Any one of) Voter ID, PAN Card, Driving License, Passport.
• Proof of Address: (Any one of) Ration Card, Electricity Bill, Water Bill, Domicile Certificate.
• Income Certificate:
  • For BPL families: BPL Certificate from the competent authority.
  • For MA Vatsalya (annual income up to ₹4 Lakh) & Senior Citizens (annual income up to ₹6 Lakh): Latest Income Certificate issued by the Talati-cum-Mantri/Mamlatdar/Collector.
• Caste Certificate: If applicable (for SC/ST/OBC categories to confirm additional eligibility).
• Family Photograph: Passport-sized photographs of family members (though photos are often taken at the kiosk).
• Mobile Number: For communication and OTP verification.
• Relevant Supporting Documents: For specific groups like construction workers, fixed-pay employees, ASHA workers, or disabled individuals (e.g., identity card, disability certificate).

It is advisable to carry original documents for verification at the enrollment center.

Empanelled Hospitals and Claim Process

The PMJAY-MA Yojana operates on a cashless basis through a vast network of empanelled public and private hospitals across Gujarat.

Hospital Network:

• As of recent updates, over 2,027 state-run hospitals, 803 private hospitals, and 18 Central Government hospitals in Gujarat are authorized to provide treatment under PMJAY-MA.
• A list of empanelled hospitals is provided to beneficiaries upon card issuance and is also available on the official scheme websites.

Cashless Claim Process:

1. Visit Empanelled Hospital: The beneficiary with the MA Amrutam Card visits an empanelled hospital.
2. Card Presentation: The MA Amrutam Card (or PMJAY-MA Card) is presented at the hospital counter.
3. Verification: Hospital staff verifies the beneficiary's identity and eligibility using the QR code on the card and biometric authentication.
4. Pre-authorization: For surgical procedures or advanced treatments, the hospital sends a pre-authorization request to the Third-Party Administrator (TPA) or State Health Agency (SHA).
5. Cashless Treatment: Upon approval, the beneficiary receives cashless treatment. The hospital directly settles the costs with the scheme.
6. Discharge: After treatment, the beneficiary is discharged, and the hospital raises the claim.

Arogyamitras or Ayushman Mitras are available at empanelled hospitals to guide beneficiaries through the process.

Official Resources & Contact Information

For the most accurate and up-to-date information regarding PMJAY-MA (Mukhyamantri Amrutam) Yojana in Gujarat, always refer to the official government portals:

• Official Gujarat Health Department Portal: gujhealth.gujarat.gov.in
• MA Amrutam Yojana Portal: While dedicated `magujarat.com` may have existed, current information often points to consolidated portals. Look for specific MA/PMJAY-MA sections on health department sites.
• Ayushman Bharat PMJAY Official Portal: pmjay.gov.in (for national scheme details)
• Helpdesk & Toll-Free Numbers:
  • MA Yojana Helpline: 1800-233-1022 (Toll-Free)
  • PMJAY National Helpline: 14555 / 1800-111-565
• Mobile App: "MA Amrutam" app may be available for services like finding empanelled hospitals or checking scheme details.

Always verify information from official sources to ensure accurate details.