The Finance minister announced a massive health protection scheme in the budget 2018-19. After that Prime Minister announced about this flagship project Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) on Independence Day, 2018. The project will be launched on 25th September, on the birth anniversary of Deen Dayal Upadhay. This is going to be the World’s largest government-funded health protection scheme.
The 62.58% of Indian population is paying for their hospitalization expenses from their own as they are not covered under any health insurance scheme. People use to borrow money and also sell the assets to meet the healthcare needs which push 4.6% of the population to below poverty line. The government of India is solving the above problem through this National Health protection Scheme, Ayushman Bharat.
There is much confusion around us about the scheme and its benefits. In this article we will focus on Ayushman Bharat Scheme details eligibility benefits registration, how to apply etc.
What is Ayushman Bharat Scheme?
Ayushman Bharat is a national Health Protection Scheme which covers 10 crores of vulnerable families with more than 50 Cr of members providing health coverage up to 5 lakhs per year per family. The scheme is meant for poor and economically deprived people.
The persons who are listed in Socio-Economic Caste Census (SECC) database will be automatically be included in this scheme. In this scheme, the beneficiaries can take cashless benefits from any public or private hospitals which are under this scheme.
The scheme is to be implemented jointly by Central government and state governments. Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) will be set up to give policy directions and better co -ordinations between center and states. States would need to have state health agencies (SHA) to implement the scheme.
Escrow account would be set up for transfer of funds from central government to SHA. An IT platform will be provided for paperless and cashless transaction for Aushman Bharat scheme with the help of NITI Aayog.
Ayushman Bharat Scheme Details, Benefits:
The Ayushman Bharat – National Health Protection Mission (AB-NHPM) has the following features and benefits.
- Ayushman Bharat will provide a cover of Rs 5 lakhs per family per year for almost all secondary and most of tertiary medical care facilities.
- It covers 1350 medical packages which cover surgery, medical and day care treatments including medicines, diagnostic charges and transport charges.
- If you are eligible under the health insurance scheme, you get automatic coverage. Eligibility is based on Socio-Economic Caste Census (SECC) database.
- There will be no restrictions on the family size and age to ensure that nobody is left out from this scheme especially girl child, women and elderly persons.
- The scheme will be cashless and paperless at the hospitals designated for this scheme.In case of hospitalization, you or your family members do not need to pay anything under the scheme provided you go to any government or empanelled private hospital.
- Ayushman Bharat is unlike other medical insurance schemes where there is a waiting period for pre-existing diseases. All kinds of diseases are covered from day one of the Ayushman Bharat policy. The benefit cover also includes both pre and post hospitalization expenses.
- Aadhaar card is not mandatory to avail of Ayushman Bharat benefit but beneficiaries need to carry a prescribed ID to receive free treatment at the hospital.
- Eligible beneficiaries can avail services across India, offering benefit of national portability. The beneficiaries can also reach out for information, assistance, complaints and grievances via a 24×7 helpline number – 14555
- The scheme directly helps India to achieve universal health coverage and sustainable development goals.
- It will strengthen the public health care systems through infusion of insurance in public health.
Ayushman Bharat Yojana Eligibility:
The Ayushman Bharat scheme eligibility is based on SECC database. If you belong to any of the below categories and SECC database you will get automatic coverage.
In rural areas:
- Families living in only one room with “kuchcha walls and kuchcha roof”
- Families with no adult members aged between 16 and 59
- Female-headed family with no adult male member in the 16-59 age group
- Families having at least one disabled member and no able-bodied adult member
- SC/ST households
- Landless households deriving major part of their income from manual casual labour
- Destitutes and those surviving on alms
- Manual scavenger families
- Primitive tribal groups
- Legally-released bonded labourer
In urban areas:
The government has made a list of these 11 occupational categories of workers who are automatically included in the list:
4.Street vendor/cobbler/ hawker/ other service provider working on streets
5.Construction worker/ plumber/ mason/ labour/ painter/ welder/ security guard/ coolie and other head-load workers
6.Sweeper/ sanitation worker/gardener
7.Home-based worker/ artisan/ handicrafts worker / tailor
8.Transport worker/ driver/ conductor/ helper to drivers and conductors/ cart puller/ rickshaw puller
9.Shop worker/ assistant/ peon in small establishment/ helper/ delivery assistant / attendant/ waiter
10.Electrician/ mechanic/ assembler/ repair worker
Ayushman Bharat Yojana How to Apply:
There are various misleading information across the web about the application procedure for Ayushman Bharat scheme. But there is no such application or registration you need to do to be in the scheme. Those who are in the SECC database are automatically being covered under this scheme.
Government of India has already cleared that there is no need of filling up application forms or go through any registration process. Beneficiaries will receive letters once they are covered under this scheme.
We request you to visit the official website of Ayushman Bharat regularly for updates and queries.
Ayushman Bharat Registration:
As said earlier, there is no need of registration from the beneficiaries. The beneficiaries will be identified by the state governments under a policy framework set under the Ayushman Bharat scheme. The beneficiaries will be identified in the following process.
- Pradhan Mantri Rashtriya Swasthya Suraksha Mission (PMRSSM) constructs a broad policy framework for inclusion of beneficiaries. It targets about 10.74 crore poor, deprived families and identified occupational category of urban workers’ families as per SECC database.
- States or union territories will be carrying out information, education and communication (IEC) activities amongst targeted families such that they are aware about the entitlement, benefits, process to avail the services under PMRSSM.
Beneficiaries will be identified in the following broad steps.
- The operator searches through the PMRSSM list to determine if the person is covered.
- Search can be through Name, Location, Ration Card or Mobile number.
- If the beneficiary’s name is found in the PMRSSM list, Aadhaar (or an alternative government ID) and Ration Card (or an alternative family ID) is collected against the Name / Family.
- The system determines a confidence score for the link based on how close the name / location / family members between the PMRSSM record and documents is provided.
- The operator sends the linked record for approval to the Insurance company / Trust
- If the confidence score is high, the operator can immediately issue the e-Card and admit the patient for treatment. Otherwise, the patient shall have to wait for approval from the insurance company/ trust
- The insurance company / Trust will setup a Beneficiary approval team that works on fixed service level agreements. The insurance company / Trust can either approve or reject with reason based on the PMRSSM details and the information received.
- All cases recommended for rejection will be scrutinised by a State team and either accept rejection or approve with reason.
- The e-card will be printed with the unique ID under PMRSSM and handed over to the beneficiary to serve as a proof for verification for future reference.
- The beneficiary will also be provided with a booklet/ pamphlet with details about PMRSSM and process for availing services. Presentation of this e-card will not be mandatory for availing services. However, the e-card may serve as a tool for reinforcement of entitlement to the beneficiary and faster registration process at the hospital when needed.
- Addition of new family members will be allowed. This requires at least one other family member has been approved by the Insurance Company/Trust. Proof of being part of the same family is required in the form of
- Name of the new member is in the family ration card or State defined family card
- A marriage certificate to a family member is available
- A birth certificate to a family member is available.
How will the finances of Ayushman Bharat be covered?
A good amount of money is required to fund this massive amount of expenditure. The health benefit is to be given to the families with the help of health insurance. To get the insurance from the insurance company the premium is to be paid. In this case, the expenditure incurred in premium payment will be shared between Central and State Governments in a specified ratio.
The funding for the scheme will be shared – 60:40 for all states and UTs with their own legislature, 90:10 in Northeast states and the three Himalayan states of Jammu and Kashmir, Himachal and Uttarakhand and 100% Central funding for UTs without legislature.
The states are also free to continue with their own health programmes. So far, 14 states have finalised their memoranda of understanding with the Centre. Of these Andhra Pradesh, Telangana, Madhya Pradesh, Assam, Sikkim and Chandigarh are the states that will use a trust model for the mission. In a trust model, bills are reimbursed directly by the government.
Gujarat and Tamil Nadu have opted for mixed mode implementation. In an insurance model, the government pays a fixed premium to an insurance company, which pays the hospitals.
I hope you have got a fair idea about the details and benefits of Ayushman Bharat scheme, the largest health care scheme by any Government. You have also come to know that you don’t have to do anything to get the benefit. So, if any people or website misleads you to give you advantages please don’t fall into the trap. Always enquire from the government officials to know the true fact. Also visit the official website regularly to know the updates.
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