1. What is Ayushman CAPF ?
Ayushman CAPF is a convergence scheme being implemented on Ayushman Bharat PM-JAY IT platform. This scheme is initiated to provide cashless or reimbursement based healthcare services to serving personnel of all seven CAPFs and their dependent family members.
2. When is the Ayushman CAPF launched ?
Ayushman CAPF has been launched in Assam on 23rd January 2021. The scheme will be rolled out across the country in a phased manner.
After the pan India roll-out of the scheme, the benefits under the scheme can be availed across all hospitals empanelled with CGHS and PM-JAY in the country.
3. Who can get benefits of this scheme ?
All the officials/serving personnel and their dependents from seven forces, viz. Assam Rifles, Border Security Force ( BSF), Sashastra Seema Bal (SSB), Central Reserve Police Force (CRPF), Central Industrial Security Force (CISF), National Security Guard (NSG), and Indo-Tibetan Border Police (ITBP) will be covered under the scheme.
4. Where can I get my the Ayushman CAPF card from ?
Ayushman CAPF cards will be provided to all beneficiaries at their respective forces/units. The card may be activated at empaneled private hospital after authentication. Alternatively, Ayushman CAPF e-card can be obtained at empaneled private hospital. Copy of Force ID and Aadhaar or Government approved photo ID card is required for the authentication.
5. What all documents do I need to produce to get e-card at empaneled hospitals ?
Serving CAPF personnel or their dependent would be required to submit the copy of the Force ID along with any Government approved Photo ID/Aadhaar card for issuance of Ayushman CAPF e-card at the hospital.
6. How can I get my Ayushman CAPF card activated ?
The Ayushman CAPF e-card obtained from the empaneled hospital is activated by default. However, the physical cards would need to be activated at empaneled private hospital, using a copy of Force ID and Aadhaar or Government approved photo ID.
7. What should I do if the details on the Ayushman CAPF card / E-Card, such as name, date of birth, are wrong ?
You need to contact designated officials at your respective force to get such details corrected. The AB-PMJAY IT platforms do not allow any such change.
8. What should I do if I lose my Ayushman CAPF Card ?
Ayushman CAPF e-card can be obtained from any PM-JAY empaneled private hospitals. A detailed list of the empaneled hospitals is available at PM-JAY website. (https://hospitals.pmjay.gov.in/Search/empnlWorkFlow.htm?actionFlag=ViewRegisteredHosptlsNew)
9. Do I need a new Ayushman CAPF card if my force or state is changed ?
No. Your Ayushman CAPF card will remain the same.
10. What is the process for adding a newborn baby or a newly wedded spouse in the beneficiary database ?
Family members will be added/ updated in the beneficiary database by the respective forces. Therefore, beneficiaries need to contact the respective forces.
11. Can I use the Ayushman CAPF card to avail medical treatment ?
Yes, you can avail medical treatment using active Ayushman CAPF ID.
12. Is the benefit available for all CAPF employees across the country ?
This scheme is currently being launched as a pilot project in Assam. It will be extended to other parts of the country in a phased manner.
13. What documents are required to avail the benefits under this scheme ?
You need to have your active Ayushman CAPF ID or Ayushman CAPF card/ e-card, along with Aadhar Card or any Government approved photo ID proof for verification. A dependent beneficiary would additionally require a copy of Force ID.
14. How can I get registered for treatment in a hospital ?
The Pradhan Mantri Arogya Mitra (PMAM) at the empaneled private hospitals will help you with all your queries related to the beneficiary verification and hospitalization related transactions. The key responsibilities of the PMAM are as follows:
- Operating the Beneficiary Identification System (BIS) to identify and verify the beneficiaries entitled under Ayushman CAPF
- Undertaking transaction management such as submitting requests for pre-authorization and claims
- Guiding the beneficiary about the overall benefits under Ayushman CAPF and providing information about receiving prompt treatment at EHCP.
15. What services are covered under Ayushman CAPF scheme?
The following ae the service covered under Ayushman CAPF scheme as per the hospital type
|#||Hospital Type||Referral Required||Services
|1||Public hospitals, including MHA and CAPF owned facilities||No||OPD / IPD||Free services||-|
|2||Private hospitals empaneled under CGHS or by CAPF (may or may not be empaneled under AB PM-JAY)||Yes*||OPD/IPD/ Diagnostics||Cashless||CGHS|
|3||Private hospitals NOT empaneled under CGHS or by CAPF but empaneled under AB PM-JAY||Yes*||IPD||Cashless||PMJAY#|
|4||Private hospitals NOT empaneled under CGHS or by CAPF or under AB PM-JAY||Only in Emergency Cases||All||Self-paid/ Reimbursement||CGHS|
* In Emergency cases, referral is NOT mandatory for private hospitals (empaneled or non-empaneled).
# Under AB PM-JAY guidelines, ward entitlement (as per the pay scale) is NOT applicable.
16. How Can I avail the medical treatment ?
- For the self-paid services at CAPF or the government owned facilities (diagnostics, implants, medicines etc.), the beneficiary may submit a reimbursement request.
- CAPF or the government owned facilities may refer the beneficiary to the CGHS and /or PM-JAY empaneled private hospital. In this case, the beneficiary may avail cashless medical treatment by registering at the hospital using the activated Ayushman CAPF card or Ayushman CAPF ID.
- In case of emergency, the beneficiary may avail self-paid services at non-empaneled hospital and submit a reimbursement request. Referral slip would NOT be mandatory in such cases.
Please note that the reimbursement, when approved, will be as per CGHS rates.
17. Is there any limit for availing treatment under this scheme ?
There is no cap on the cost of medical services for CAPF beneficiaries. The claim reimbursement will be as per the CGHS guidelines.
18. What is my entitlement ?
Ward entitlement is as per the basic monthly pay in the 7th CPC. Details below:
|S. No.||Ward Entitlement||Corresponding Basic pay drawn by the officer in 7th CPC per month|
|1||General Ward||Upto Rs. 47,600/-|
|2||Semi Private Ward||Rs. 47,601 to 63100/-|
|3||Private Ward||Rs. 63101 and above|
The ward entitlement as per basic pay is not applicable at private hospitals empaneled under only PMJAY (not-CGHS). General ward would be provided at these hospitals.
19. Will I be able to avail medical services in States (such as Odisha, West Bengal and Delhi) which are currently not covered under PM-JAY ?
Yes, you may avail the services at CAPF/ CGHS owned/public facilities or private hospitals empaneled under PM-JAY or CGHS in these states. In the first phase, the scheme is being launched in Assam. So, the private hospitals empaneled under PM-JAY and CGHS would be providing cashless treatment. The scheme will be extended in a phased manner across the country and the portability functionality will be available, thereafter.
20. Can I go to a non-empaneled hospital for medical services and get the reimbursement later ?
In emergency cases, you can go to a non-empaneled hospital. In that case, there is a provision for reimbursement as per CGHS rates.
21. What is the role of ISA and where is it situated ?
Implementation Support Agency is known as ISA. It is a third-party administrator (TPA) associated with NHA.
22. Can I get any transplant done in a hospital empaneled under PM-JAY only ?
No. Transplants are not covered in hospitals empaneled under PM-JAY only as of now. You need to visit any other hospital empaneled with CGHS where the facility of transplant is available.
23. What is the process for reimbursement for availing emergency treatment at a non-empaneled hospital ?
You can pay first and then submit the claim for reimbursement with prescription, referral and invoice on the AB-PMJAY Reimbursement portal at https://tms.pmjay.gov.in/OneTMS/loginnew.htm The claims will be scrutinised and processed by ISA and accordingly approved or rejected. It will be paid to you by UPI as per CGHS rate.
24. Is post-hospitalization expense covered ?
Yes. the post-hospitalization expenses are covered as per the CGHS guidelines.
25. How will a patient traveling to another state get to know whether the PM-JAY empaneled hospital provides a relevant treatment ?
You can find the empaneled private hospitals details online at https://hospitals.pmjay.gov.in/Search/empnlWorkFlow.htm?actionFlag=ViewRegisteredHosptlsNew You can also call our toll-free number 14588.
26. How can I raise a grievance ?
You can raise a grievance by calling on toll-free helpline number 14588. The call center team will register the grievance on the Central Grievance Redressal Management System (CGRMS). Alternatively, you can go to CGRMS (https://cgrms.pmjay.gov.in/GRMS/loginnew.htm) and register the grievance at “Register your grievance – CAPF”. A dedicated nodal officer will address your grievance.
27. In which case can I raise a grievance ?
You may raise a grievance in the following cases:
- If there is no PMAM at the hospital
- If you are not getting any support from PMAM at the empaneled private hospital
- If PMAM is asking for money
- If the empaneled private hospital is refusing to treat a beneficiary
- If the empaneled private hospital is asking for payment
- Any other issue