The government believes that only a healthy India can succeed in global competition. In order to ensure affordable healthcare services to all classes of people, a number of government-sponsored health schemes have been introduced in recent years. Alongside, the government has also come up with the Pradhan Mantri Ayushman Bharat health insurance scheme.
yushman Bharat Yojana is a ‘National Health Protection Scheme’ introduced by the Central Government of India in budget 2018. The Ayushman Bharat Yojana scheme will provide Rs. 5 lakh of health insurance coverage to poor families for the protection of their health.
Through the Ayushman Bharat Yojana scheme, nearly 10 crore families will be benefited, which means that more than 50 crore people will be benefited from this scheme. In this article, we look at the features, eligibility criteria and enrollment procedures pertaining to the scheme.
What is Ayushman Bharat health insurance?
Ayushman Bharat is a health protection scheme to provide health insurance to citizens. It provides insurance coverage of up to Rs.5 lakh on a family floater basis to beneficiaries every year in order to receive primary, secondary, and tertiary healthcare services. The scheme was earlier referred to as AB-NHPS as it is an initiative under the existing National Health Protection Scheme (NHPS). Currently, it is known as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY). The government plans to distribute this scheme through national insurance companies. The scheme subsumes the existing senior citizen health insurance scheme as well as the Rashtriya Swasthya Bima Yojana.
Features of Ayushman Bharat Yojana
- This Yojana focuses on creating a health and wellness infrastructure, and extending insurance coverage to at least 40 percent of the Indian population.
- This NHPS scheme will overcome the flaw of the currently existing Rashtriya Swasthya Bima Yojana scheme, which covers the unorganized sectors.
- This scheme offers Rs. 5 lakh to each eligible Indian families for their medical care.
- Enables the beneficiaries to avail cashless treatment facilities within the country from both private and government hospitals.
- Under this scheme, National health protection scheme will provide the cashless treatment to the patients.
- This scheme provides wellness centers to care for the patients. In future, the government will upgrade the public health centers into wellness centers.
- The scheme can be utilised to get primary, secondary, and tertiary healthcare services.
- The benefits of the scheme can be availed at any government hospital or empanelled private hospital.
- The eligibility of beneficiaries targeted towards the poor, deprived rural families and identified occupational category of urban workers’ families based on the Socio-Economic Caste Census (SECC) 2011 data.
- Package model will be followed to make payments. The package will be defined by the government-in-charge in terms of payment of total costs, specific services, and procedures.
- An Ayushman Bharat National Health Protection Mission will be established for effective coordination between the Central and the state governments.
- The scheme covers about 40% of the country’s population who are poor and vulnerable.
- All expenses incurred by the beneficiary from his pocket during the hospitalisation will also be covered.
- The cost incurred during the pre and post-hospitalisation period will be covered.
- The insurance provides cashless hospitalisation facility.
- Daycare treatment expenses are covered by the scheme.
- The insurance scheme covers all pre-existing health conditions. Follow-up of medical examinations upto 15 days are also covered to ensure that the patients have recovered completely.
Ayushman Bharat Yojana Eligibility criteria for rural families
- Families that do not have an earning adult member aged between 16 and 59 years.
- Households headed by female members having no adult male members aged between 16 and 59 years.
- Households with a single room having makeshift walls and roof.
- Households belonging to the Scheduled Castes and Scheduled Tribes categories.
- Households that have disabled members with no able members offering support.
- Landless households with manual labour as their basic source of income.
In addition, the following households are automatically eligible:
- Destitute families who rely on alms.
- Families of manual scavengers.
- Households without proper shelter.
- Families of bonded labour.
- Primitive and particularly vulnerable tribal groups.
Eligibility criteria for urban families
An urban family must belong to one of the listed occupational categories to be eligible for the scheme:
- Street vendors, cobblers, and hawkers.
- Domestic workers.
- Rag pickers and beggars.
- Construction site workers, plumbers, masons, painters, welders, and security guards.
- Coolies.
- Sweepers, sanitation workers, and gardeners.
- Transport workers such as conductors, drivers, cart pullers, and others.
- Artisans, home-based workers, handicraft workers, and tailors.
- Washermen and watchmen.
- Electricians, mechanics, repair workers, and assemblers.
- Peons, helpers, shop workers, delivery assistants, attendants, and waiters.
Eligibility criteria for hospitals
Similar to setting eligibility criteria for beneficiaries, the government has framed eligibility criteria for a hospital to be empanelled. The criteria are:
- The hospital must be registered with state health agencies.
- Qualified medical and nursing staff must be available 24/7.
- The hospital must have a minimum of 10 in-patient beds.
- The medical facility must have an accessible washroom.
- An interoperable IT system should be in place to manage data.
- A complete record of Ayushman Bharat patients must be maintained and shared with the government as per the requirement.
- Ambulance and other emergency services must be available.
- A dedicated medical officer should be appointed to take care of AB-NHPS operations.
- There should be a blood bank and testing laboratory in the vicinity.
- The medical facility must have all the equipment and technical necessities.
- The hospital must have facilities such as regulated water, electricity, and bio-medical waste disposal.
How can you start registering for Pradhan Mantri Ayushman Bharat Yojana online?
To commence the registration process, you will have to visit the Pradhan Mantri Ayushman Bharat Yojana website. It is followed by entering your mobile number and the Captcha Code. You must then click on the ‘Generate OTP’ option.
An OTP number is sent to your mobile number through which you can access the website and complete the verification process. You are taken to the PMJAY login screen.
Moreover, you must select the state from which you are applying for the Pradhan Mantri Ayushman Bharat Yojana. You then choose how you want to select your eligibility criteria.
- Mobile Number
- Name
- Ration Card Number
- RSBY URN number
If you are eligible for the Pradhan Mantri Ayushman Bharat Yojana, your name will reflect on the right-hand side of the page. Moreover, you can check beneficiary details by clicking on the ‘Family Members’ tab.
How to Claim the Cashless Bills under the Pradhan Mantri Ayushman Bharat Yojana?
you and your family members are enrolled under the Pradhan Mantri Ayushman Bharat Yojana, an enrollment letter containing a unique QR code and identification number is sent. It helps to identify your family members in case of a hospitalisation claim.
All hospitals empanelled under the Pradhan Mantri Ayushman Bharat Yojana have an ‘Ayushman Mitra’ to help insured families get cashless medical treatment.
The Ayushman Mitra checks your eligibility by scanning the QR code contained in the enrollment letter against your data in the scheme’s database. You enjoy cashless medical treatment if you are eligible for the scheme.
After submitting valid identification proof, you are issued a Golden Card to avail of cashless hospitalisation treatment. Moreover, you can enjoy a cashless treatment at government hospitals as all of them are empanelled under the scheme.
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