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Ref. No. KLI/22-23/E-BB/492
The Ayushman Bharat Health Insurance Scheme provides annual health coverage of up to ₹5 lakh per family, ensuring financial protection and access to quality healthcare for underprivileged families.
Healthcare has always been a point of concern for most people. With astronomical costs of medical care in the country and worldwide, paying hospital bills is hard, irrespective of the income group the patient falls into. However, things are even more challenging for people who belong to low-income groups. The Ayush Bharat Health Insurance Scheme was launched to ease this and bring monetary relief.
This article discusses the Ayush Bharat Health Insurance Scheme, its eligibility criteria, and how people can benefit from it.
The Ayush Bharat Health Insurance Scheme, now known as the Pradhan Mantri Jan Arogya Yojana or the National Health Protection Scheme, is a healthcare scheme designed for the economically backward citizens of India. The scheme was launched by Prime Minister Narendra Modi on September 23, 2018, to cover approximately 50 crore financially vulnerable people in the country. The scheme has been the country’s most significant government health care scheme.
The Ayush Bharat Health Insurance plans broadly covers up to 40% of people in India. The Rural Development Ministry’s Socio-Economic Caste Census, published in 2011 and 2015, refers to these economically vulnerable classes as’ poor and vulnerable.’ It includes about 10.74 crore families and 50 crore people in total.
Launched in 2018, this scheme seeks to transform the country’s healthcare by ensuring access to quality health services without financial hardship. There are many benefits of the Ayush Bharat Health Insurance Scheme, such as:
The eligibility criteria for the Ayush Bharat Health Insurance Scheme differ for rural and urban populations.
The Socio-Economic Caste Census mentions 6 deprivation categories in rural areas eligible for this scheme. These are:
These categories include the following families:
The eligibility criterion in urban areas has been fixed based on the person’s occupation. These occupations include:
The government has established specific eligibility criteria for hospitals seeking empanelment, which include:
The scheme offers a cover amount of ₹5 lakhs for each family. It includes cashless hospitalization coverage. The scheme is provided to the entire family with no restrictions on the maximum or the minimum number of members. There is also no waiting period for pre-existing illnesses. Critical illnesses covered in the plan include:
In addition to this, the scheme covers the following kinds of expenses:
The scheme does not include the following:
There is no separate application process for enrolling in the scheme. Eligible people are enrolled in the scheme automatically. However, individuals wishing to avail of the scheme must check their eligibility. There are two ways to do this:
In either of the methods, a One-Time Password (OTP) will be sent to the person’s mobile number for verification, after which the person can enter their name, mobile number, ration card number, or the Rashtriya Swasthya Bima Yojna number to confirm their eligibility.
Here are various methods to verify your inclusion in PMJAY health insurance:
Individuals can directly go to an impaneled hospital. There are people known as Arogya Mitras who help with the admission process. Arogya Mitras are stationed at every impaneled hospital. Hospitals use the patient’s Aadhar card to confirm their identification and eligibility. Eligible families have been given a letter that contains a QR code. The patient needs to carry this letter with them. The Arogya Mitras or the hospital will scan the QR code. After the verification, the hospitals admit the person or provide them with the necessary medical aid. The treatment is provided per the coverage of ₹5 lakhs, and any cash payments are not required. The entire process is cashless.
The money for the treatment is paid to the hospital by the state and central government in a 40:60 ratio.
Registering for an ABHA (Ayushman Bharat Health Account) ID is straightforward. Follow these steps to create your ABHA ID card:
Registering for ABHA is exceptionally simple. You only require your Aadhaar number and a verified phone number for registration to ensure ease and efficiency. This straightforward procedure minimizes complexity and facilitates quick enrollment into the program.
Follow these steps to access the Prime Minister’s health insurance scheme, Ayushman Bharat:
The Ayush Bharat Health Insurance Scheme is a noteworthy step by the government to extend the privilege of health insurance to those who cannot afford it. The scheme has helped many families and is expected to aid many others. It is also bound to contribute to the country’s growth and development.
1
You can apply for Ayushman Bharat Health Insurance by visiting the official website or Common Service Centers (CSCs), providing the required documents like an Aadhaar card, and completing the registration process online or offline.
2
Ayushman Bharat Health Insurance covers up to 5 family members, including the head of household and dependent family members, ensuring comprehensive healthcare coverage for eligible beneficiaries.
3
Yes, pre-existing conditions are covered under Ayushman Bharat Health Insurance, ensuring that beneficiaries receive necessary medical treatment and care without exclusions based on existing health conditions.
4
Ayushman Bharat Health Insurance covers many treatments and procedures, including hospitalization, surgeries, diagnostic tests, medications, and post-operative care necessary to treat the listed diseases and medical conditions.
5
Ayushman Bharat Health Insurance is funded through a combination of contributions from the central and state governments and premiums from beneficiaries eligible under the scheme, ensuring sustainable financing for healthcare coverage.
6
Ayushman Bharat Health Insurance provides coverage for one year from the date of enrollment, renewable annually, to ensure continuous access to healthcare services for eligible beneficiaries.
Amit Raje is an experienced marketer who has worked in various Fintechs and leading Financial companies in India. With focused experience in Digital, Amit has pioneered multiple digital commerce in India. Now, close to two decades later, he is the vice president and head of the D2C business department. He masters the skill of strategic management, also being certified in it from IIMA. He has challenged his challenges and contributed his efforts in this journey of digital transformation.
Prasad Pimple has a decade-long experience in the Life insurance sector and as EVP, Kotak Life heads Digital Business. He is responsible for developing user friendly product journeys, creating consumer awareness and helping consumers in identifying need for life insurance solutions. He has 20+ years of experience in creating and building business verticals across Insurance, Telecom and Banking sectors
Ref. No. KLI/22-23/E-BB/2435
The information herein is meant only for general reading purposes and the views being expressed only constitute opinions and therefore cannot be considered as guidelines, recommendations or as a professional guide for the readers. The content has been prepared on the basis of publicly available information, internally developed data and other sources believed to be reliable. Recipients of this information are advised to rely on their own analysis, interpretations & investigations. Readers are also advised to seek independent professional advice in order to arrive at an informed investment decision. Further customer is the advised to go through the sales brochure before conducting any sale. Above illustrations are only for understanding, it is not directly or indirectly related to the performance of any product or plans of Kotak Life.
