Two schemes covered it. Two different forms. One 72-day deadline.
🧑⚕️ Anmol, 42, was a supervisor at a Delhi municipal water depot. His father, a retired railway employee on ₹19,500 monthly pension, needed quintuple-vessel bypass at AIIMS Delhi for ₹2,18,000. The catch: he was eligible for both Ayushman Bharat PMJAY (central, national coverage) AND Delhi Arogya Kosh (territorial, Delhi-only coverage). Both covered the surgery. Neither official could explain how to access both simultaneously. One said pick one. Another said the choice didn't exist.
🚨 The problem
Delhi has dual coverage for poor families. PMJAY (central, 8–12 weeks) and DAK (territorial, 12 weeks, but 72-day deadline post-discharge). No AIIMS material explained overlap. The social-welfare desk said file PMJAY first, then DAK if needed. But two separate processing tracks, two separate forms, two separate visits to AIIMS, and a hard 72-day deadline for DAK meant filing both simultaneously was necessary—not optional.
🚀 How GabFORGE helped
Anmol photographed the CABG cost estimate, his father's pension certificate, the AIIMS discharge summary, and the vague social-welfare desk note. He asked the app: what happens if we need both schemes?
- 🔍 Found the overlap rule. Read both scheme guidelines and discovered: overlap is permitted. PMJAY reimbursement first; DAK covers any remaining balance. But filing must be simultaneous to meet the 72-day deadline.
- 💬 Named the exact sequence. Day 1 post-discharge: PMJAY file at AIIMS social-welfare desk (standard), AND DAK online submission at health.delhi.gov.in (separate portal, separate login). Do not wait for PMJAY processing—DAK deadline is 72 days.
- 📞 Provided the DAK portal URL and filing requirements. health.delhi.gov.in/arogya-kosh. Upload discharge summary, hospital bill, AIIMS approval letter, Aadhaar. Processing 12 weeks; deadline 72 days from discharge.
Anmol filed PMJAY at the social-welfare desk and DAK online the same afternoon. PMJAY processed and paid ₹2,18,000 in ten weeks. DAK's 12-week processing continued but deadline was not missed. Both schemes treated, coordinated, final bill: zero.
🇮🇳 Why this matters
Overlapping schemes are designed to catch safety gaps. But the gap between them—which to file first, how to coordinate, when deadlines apply—is invisible. Families file one, miss the other, or skip the second entirely and lose coverage they were entitled to.
The long version has the social-welfare desk confusion, the 72-day deadline buried in DAK fine print, the moment Anmol understood he had to file both schemes simultaneously to keep both alive.