Ayushman Bharat National Health Protection Scheme

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB – PMJAY) is a public health insurance scheme. It was launched by the Government of India in September 2018 [1]. It aims at providing free and easy access to health insurance coverage for citizens with low income. The program provides access to free secondary healthcare for those who need specialist treatment or require hospitalization. Ayushman Bharat Yojana is a part of the National Health Policy with a national health mission of achieving Universal Health Coverage (UHC).

Ayushman Bharat health insurance is jointly financed by union and state governments that cover above 50 crore Indians, making it the largest government-funded health scheme. With the announcement of Ayushman Bharat Health Accounts (ABHA), the government hopes to increase participation in Ayushman Bharat Digital Mission. Read to know more about ABHA and the Ayushman Bharat health insurance scheme

What are the eligibility criteria for Ayushman Bharat Yojana?

  1. ·        The following qualify for the Ayushman Bharat Yojana among rural families
  2. ·        Destitute families relying on alms
  3. ·        Households with no proper shelter
  4. ·        Families of bonded labour
  5. ·        Primitive and vulnerable tribal groups
  6. ·        Families of manual scavengers
  7. ·        Families with no earning adult between 16 and 59 years of age
  8. ·        Households with one room made of makeshift walls and a roof
  9. ·        Households from the categories of Scheduled Tribes and Scheduled Castes
  10. ·        Households with differently-abled members and no support
  11. ·        Manual labourers with landless households
  12. ·        Households headed by female members with no adult male members aged between 16 and 59 years
  13. ·        The following qualify for the Ayushman Bharat Yojana among urban families
  14. ·        Street vendors or domestic workers
  15. ·        Hawkers and cobblers
  16. ·        Rag pickers and beggars
  17. ·        Plumbers, painters, and welders
  18. ·        Construction site workers
  19. ·        Security guards, sweepers, and sanitation workers
  20. ·        Gardeners, coolies, washermen, and watchmen
  21. ·        Conductors, drivers, and cart pullers
  22. ·        Home-based workers, artisans, and handicraft workers
  23. ·        Tailors, peons, shop workers, and helpers
  24. ·        Delivery assistants and attendants
  25. ·        Electricians and mechanics
  26. ·        Assemblers and repair workers

What is the medical package and hospitalization process under Ayushman Bharat Yojana?

Individuals and families get an insurance cover of Rs.5 lakh under PMJAY. It covers medical and surgical treatments across 25 specialties. Once you are identified as a beneficiary and get a health card under PMJAY, you can get hospitalized at network hospitals and access the benefits of the scheme

Ayushman Bharat Yojana covers the following:

  • ·        Medical treatment and consultation
  • ·        Cost of medicines
  • ·        Diagnostics and lab tests
  • ·        Non-intensive and intensive care services
  • ·        Implantation
  • ·        Food services
  • ·        Pre-hospitalization
  • ·        Post-hospitalization
  • ·        Complications during treatments

What are the features and benefits of Ayushman Bharat Yojana?

Here are some features and benefits of Ayushman Bharat Yojana:

  • ·        It provides maximum coverage of Rs.5 lakh per family per year
  • ·        It covers over 10.74 crore poor families
  • ·        It is the largest health insurance scheme by the government
  • ·        It gives access to cashless healthcare services
  • ·        It covers all pre-existing conditions from day one
  • ·        Its benefits are portable across the country
  • ·        The reimbursement at public hospitals is at par with private hospitals
  • ·        Its services include approximately 1,393 procedures
  • ·        It does not have any restriction on the family size, age, or gender
  • ·        It covers up to 3 days of pre-hospitalization and 15 days of post-hospitalization expenses

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