Everything You Need to Know About the Ayushman Bharat Health Insurance Scheme

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.

10,729 Views | Updated on: Aug 06, 2024

Protect Your Family with Comprehensive Coverage

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.

What is the Ayush Bharat Health Insurance Scheme?

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.

What are the benefits of the Ayush Bharat Health Insurance Scheme?

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:

It offers cashless treatment: The patient can be treated at an empaneled hospital without paying cash, eliminating the hassle of applying for a claim later.
It has empaneled hospitals all over India: Patients can use the scheme anywhere in the country at their nearest empaneled hospital.
It offers a health cover of up to five lakhs: The cover of ₹5 lakhs can help low-income groups cover health care expenses without worrying about the costs. No premiums are charged, so these families stay protected without incurring fees.
It covers various treatments: Medical issues such as cardiac problems, kidney problems, COVID-19 treatment, and cancer can all be treated under the scheme.
It covers any pre-existing diseases: The scheme also covers pre-existing illnesses without a waiting period.
It covers many people: The scheme covers up to 50 crore people and ten crore families, which comprise 40% of the country’s population.
It covers the entire family: The whole family can be covered under the same scheme. There is no restriction on the number of members.
It covers senior citizens, children, and women: There is no need for a separate cover for women, senior citizens, or children. The Ayush Bharat Health Insurance Scheme covers all family members.
It offers monetary relief to economically vulnerable groups. Lower-income groups can get the proper medical attention at no cost, improving their health and standard of living.

What are the eligibility criteria for the Ayush Bharat Health Insurance Scheme?

The eligibility criteria for the Ayush Bharat Health Insurance Scheme differ for rural and urban populations.

Eligibility Criteria for Rurals

The Socio-Economic Caste Census mentions 6 deprivation categories in rural areas eligible for this scheme. These are:

These categories include the following families:

Families living in scheduled caste and scheduled tribe households.
Families living in houses with only one room and Kucha (makeshift) walls and roof.
Families with no earning adult or male members between 16 and 59.
Families with only females with no adult members between 16 and 59.
Families with disabled or physically challenged people and no able-bodied adults.
Families without land ownership derive their income from casual manual labor.
Families earn their income from manual scavenging.
Families with released bonded laborers.
Families surviving on begging.

Eligibility Criteria For Urbans

The eligibility criterion in urban areas has been fixed based on the person’s occupation. These occupations include:

Domestic helps
Sanitation workers
Washer men
Chowkidars (security guards)
Ragpickers
Waiters
Electricians
Repair workers
Mechanics
Tailors
Cobblers
Gardeners
Sweepers
Painters
Home-based artisans
Handicraft workers
Hawkers and others working on streets or pavements
Plumbers
Masons
Construction workers
Porters and welders
Transport workers: drivers, conductors, helpers, rickshaw pullers
Peons
Delivery executives
Shopkeepers

Eligibility Criteria For Hospitals

The government has established specific eligibility criteria for hospitals seeking empanelment, which include:

Registration with state health agencies.
Availability of qualified medical and nursing staff round the clock.
Minimum of 10 in-patient beds.
Accessible washroom facilities.
Implementation of an interoperable IT system for data management.
Maintenance and sharing of complete records of Ayushman Bharat patients as required.
Availability of ambulance and emergency services.
Appointment of a dedicated medical officer for AB-NHPS operations.
Proximity to a blood bank and testing laboratory.
Availability of necessary medical equipment and technical infrastructure.
Adequate facilities for regulated water, electricity, and biomedical waste disposal.

What Does the Ayush Bharat Health Insurance Scheme Cover?

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:

Prostate cancer
Double valve replacement
Coronary artery bypass grafting
Pulmonary valve replacement
Anterior spine fixation
Carotid angioplasty with stent
Laryngopharyngectomy with gastric pull-up
Skull base surgery
Tissue expander for disfigurement following burns

In addition to this, the scheme covers the following kinds of expenses:

Up to 3 days of pre-hospitalization expenses
Up to 15 days of post-hospitalization expenses
Medical examination, doctor’s consultation, and treatment of disease
Medicines
COVID-19 treatment
Food
Accommodation
Medical implant services
Non-intensive and intensive care procedures
Diagnostic and laboratory expenses,

The scheme does not include the following:

OPD expenses
Cosmetic treatments
Fertility procedures
Organ transplants
Drug rehabilitation programs
Individual diagnostics for evaluation

Who All are not Entitled to Receive Coverage under the PMJAY Scheme?

People who own a two-wheeler, three-wheeler, four-wheeler, or a motorized fishing boat. People with a Kisan card with a credit limit of ₹50,000.
People in government jobs or those employed by the government. People with a monthly income of over ₹10,000.
People who own mechanized farming equipment. People who own refrigerators. People living in properly built houses (Pukka houses).
People who work in government-managed non-agricultural enterprises. People who own at least 5 acres of agricultural land or more.

How to Enroll in the Ayush Bharat Health Insurance Scheme?

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:

They can visit the official government website: https://www.pmjay.gov.in/
They can call the helpline number: 14555 or 1800-111-565

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.

How to check your name on the PMJAY Ayushman Bharat scheme?

Here are various methods to verify your inclusion in PMJAY health insurance:

Access the National Health Authority’s official website for Ayushman Bharat Yojana and verify your enrollment status.
Visit your nearest Common Service Centre or any empaneled hospital to obtain information.
Alternatively, contact the toll-free number to inquire about your status on the Ayushman Bharat card.

How can people use the Ayush Bharat Health Insurance Scheme in their hour of need?

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.

How to apply for ABHA health ID card registration online?

Registering for an ABHA (Ayushman Bharat Health Account) ID is straightforward. Follow these steps to create your ABHA ID card:

Visit the official ABHA website and select ‘Create ABHA number.’
Use your Aadhaar card or driver’s license, then proceed by clicking ‘Next.’
Enter your chosen Aadhaar or license number and carefully review the declaration.
Agree to the declaration and input the one-time passcode sent to your registered mobile number.
Click ‘Submit’ to successfully generate your ABHA identity card.

Documents required for ABHA card registration

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.

How to Download the Ayushman Bharat Card (PMJAY Card)?

Follow these steps to access the Prime Minister’s health insurance scheme, Ayushman Bharat:

Visit the official website of the Ayushman Bharat Yojana.
Provide your email address and password to log in.
Enter your Aadhaar card number.
Select the “Approved Beneficiary” option to proceed to the help center.
Enter your password and PIN for verification.
You will then be redirected to the homepage to download your Ayushman Bharat card.

Key Takeaways

Ayushman Bharat provides up to ₹5 lakh health coverage per family annually.
The scheme covers over 1,500 medical procedures and treatments.
Beneficiaries can avail of cashless treatment at empaneled hospitals.
The scheme includes both public and private healthcare providers.
It emphasizes preventive healthcare through regular screenings and check-ups.

To Sum it Up

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.

FAQs on Ayushman Bharat Health Insurance

How can I apply for Ayushman Bharat Health Insurance?

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.

Is there a family limit on the Ayushman Bharat Health Insurance coverage?

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.

Are pre-existing conditions covered under Ayushman Bharat Health Insurance?

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.

What treatments and procedures are covered under Ayushman Bharat Health Insurance?

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.

How is Ayushman Bharat Health Insurance funded?

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.

What is the validity period of Ayushman Bharat Health Insurance coverage?

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.