India is a land where people of various economic statuses reside; some have got all the necessities while some don’t. Above all, access to healthcare services is the most important necessity. Unfortunately, some people in India do not have enough resources to afford them.
Hence, to cater to this need, the Indian government especially rolled out a Health Insurance scheme – Ayushman Bharat Yojana.
What is Ayushman Bharat Yojana?
It is a national health protection scheme that aims to help those in need of healthcare services. Launched by Prime Minister Narendra Modi on 23 September 2018, the scheme intends to ensure a health cover for the economically weaker sections of the society. Later renamed as Pradhan Mantri Jan Arogya Yojana (PMJAY), the scheme targets around 50 crore people.
Under Ayushman Bharat Yojana, the government plans to make healthcare services cashless (secondary and tertiary). Also, the beneficiaries receive an e-card that acts as a free pass to avail cashless healthcare services from empanelled hospitals.
Now, after a year almost 18,000 hospitals are empanelled, with more than 4,000,000 lakh beneficiaries. Moreover, the scheme provides a cover of Rs. 5 lakhs every year to each family.
Furthermore, the beneficiary can obtain cashless treatment in any empanelled hospital across the country whether public or private. Along with the necessary course of treatment, the scheme also covers 3 days of pre-hospitalization and 15 days of post-hospitalization expenses.
In addition to this, Ayushman Bharat Yojana covers the costs of around 1400 medical procedures such as OT expenses.
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Who is eligible to apply for Ayushman Bharat yojana?
The healthcare insurance scheme has certain criteria that make a family accordingly eligible to apply for it. The 10 crore families include 8 crores from the rural and the remaining 2 crores from the urban.
The criteria are based on the economic and financial conditions of an individual, for example, the occupation, and income. However, there are different sets of criteria for rural and urban.
Eligibility criteria for Rural
People living in rural areas are usually economically weak and are unable to afford healthcare services. As a result, they borrow money from others for treatment in case of any medical calamity and fall into a debt trap.
Thus, to save them from such a situation, the government issues Rs. 5 lakhs as assistance to each family. Furthermore, a family in the Rashtriya Swasthaya Bima Yojana database is eligible for this scheme too.
The following people according to low income, lack of housing and other deprivations are eligible for this –
- Scheduled caste and scheduled tribe households
- Manual scavenger families
- Families with no male member aged 16 to 59 years
- Families living in one-room makeshift houses with no proper walls or roof
- Beggars and those surviving on alms
- Legally released bonded laborers
- Families with no individuals aged between 16 and 59 years
- Landless households who make a living by working as casual manual laborers
- Families having at least one physically challenged member and no able-bodied adult member
- Primitive tribal communities
Eligibility criteria for Urban
Besides the rural areas, people living in urban who can’t afford medical expenses. Ayushman Bharat Yojana provides a cover of Rs. 5 lakhs for such families on the basis of their occupation. Furthermore, a family in the Rashtriya Swasthaya Bima Yojana database is eligible for this scheme too.
Following is a list of people that are eligible based on occupation –
- Washerman or chowkidars
- Assistants or peons in small establishments
- Delivery boys, shopkeepers, and waiters
- Mechanics, electricians, repair workers
- Sanitation workers, gardeners, sweepers
- Plumbers, masons, construction workers, porters, welders, painters and security guards
- Domestic help
- Transport workers like drivers, conductors, helpers, and cart or rickshaw pullers
- Home-based artisans or handicraft workers, tailors
- Cobblers, hawkers and others providing services by working on streets or pavements
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Individuals not eligible
- People who own a two, three or four-wheeler or a motorized fishing boat
- Those owning 5 acres or more of agricultural land
- An individual who owns mechanized farming equipment
- Those with decent, solidly built houses
- People who have Kisaan cards with a credit limit of Rs.50000
- Government employees
- Those earning a monthly income above Rs.10000
- Individuals working in government-managed non-agricultural enterprises
- People who own refrigerators and landlines
How to apply for Ayushman Bharat Yojana?
The scheme applies to all those who are in the data of Socio-Economic Caste Census 2011 and Rashtriya Swasthaya Bima Yojana. So, there is no special registration needed to apply. However, one must check his/her eligibility for the same
Here’s the procedure on how to check your eligibility to avail benefits under Ayushman Bharat Yojana –
- First, visit the official website of the scheme – https://www.pmjay.gov.in/
- Next, to login to the website, click on ‘I am eligible’.
- Soon you’ll get to the homepage where you need to enter your mobile number.
- After this enter the captcha code in the box below and click on ‘Generate OTP’
- Finally, you’ll receive an OTP number to your mobile, enter the same on the website and verify.
- Subsequently, to check if your family is covered under PMJAY, select your state and search by name/ ration card number / HHD number / mobile number.
Also, to check your eligibility offline, you can contact any Empanelled Health Care Provider (EHCP) or you can also dial the scheme’s call center number: 14555 or 1800-111-565.
How to get a PMJAY e-card?
After that you have checked your eligibility, now you’ll need a PMJAY e-card so that you can identify yourself to avail benefits in the future. For this, you can go to the nearest PMJAY kiosk and verify your identity there through your Aadhaar card or ration card. After verification, you’ll receive the printed e-card along with a unique AB-PMJAY ID.
Inclusions and exclusions under PMJAY
The scheme includes daycare procedures and pre-existing conditions also along with providing coverage for over 1350 medical packages.
Here’s a list of procedures and treatments that are included and excluded from the scheme.
- Prostate cancer
- Anterior spine fixation
- Carotid angioplasty with stent
- Coronary artery bypass grafting
- Skull base surgery
- Double valve replacement
- Pulmonary valve replacement
- Laryngopharyngectomy with gastric pull-up
- Tissue expander for disfigurement following burns
- Organ transplants
- Cosmetic related procedures
- Fertility related procedures
- Drug rehabilitation program
- Individual diagnostics (for evaluation)
What are the benefits of Ayushman Bharat yojana?
Besides, the health insurance cover of Rs. 5 lakhs, the scheme has the following benefits –
- Every person enlisted under the Socio-Economic Caste Census 2011 and Rashtriya Swasthaya Bima Yojana database is eligible to be a beneficiary.
- Women, a girl child, and senior citizens are given priority.
- It provides benefits for secondary and tertiary healthcare facilities such as a cardiologist or that of any surgeon.
- The scheme covers treatment for pre-existing illness and there is no waiting period for the same.
- With a cashless and paperless registration procedure, the scheme operates nationally.
Ayushman Bharat Yojana offers assistance for medical and surgical treatments in 25 specialties which include cardiology, pediatrics, neurosurgery, orthopedics, oncology, etc. in case of multiple treatments; the first one is covered completely, followed by a 50% discount on the second one and then a 25% discount on the third. The scheme is the biggest healthcare insurance initiative launched by the Modi government.
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