All You Need to Know About Ayushman Bharat Yojana

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Ayushman Bharat Yojana is theNational Health Protection Schemeaiming to provide quality healthcare to impoverished classesacross the country. This scheme is also known as PradhanMantri Jan ArogyaYojana (PMJAY).

Ayushman Bharat Yojana was launched on 23rd September 2018by Prime Minister Narendra Modi. Until September 2019, about 180,599 hospitals across India were empanelled as part of this scheme. Since the launch of the initiative, about 4,406,461 beneficiaries have been treated, and approximately 1 crore e-cards have been issued.

People from underprivileged sections of society can take advantage of cashless treatment for secondary and tertiary healthcare under this scheme. The beneficiaries get an e-card to receive medical care at empanelled public or private hospitals across the country. Armed with the card, you can walk into any empanelled hospital and availof the cashless treatment facility.

The PMJAY scheme offers pre-hospitalisation coverage for three days and post-hospitalisation coverage for 15 days. Furthermore, the scheme covers about 1400 procedures and other related costs such as OT fees.

In all, by providing Rs 5 lakh annual coverage to each family in India, the PMJAY scheme aims to help people belonging to economically backward classesaccessquality medical care facilities.

PMJAY Scheme: Eligibility criteria for the rural and urban populace

The PMJAY scheme aims to provide healthcare access to 10 crore families hailing from lower and middle-income groups. It offers Rs 5 lakh per family.The targeted 10 crore families include 2.33 crore families in urban areas and 8 crore families in rural districts. In other words, the scheme will provide healthcare coverage to 50 crore individuals.

However, the scheme comes with certain conditionsfor beneficiary selection. Among people belonging to rural areas, beneficiaries are selected based on their income, lack of housing, and other deprivations. On the other hand, the PMJAY beneficiaries are identified as per their occupation.

PMJAY Rural

In rural areas, the PMJAY health coverage is offered to:

  • People belonging to the scheduled tribes and castes
  • Families having no male member or individuals that are within the age group of 16 to 59 years
  • Beggars
  • Families with at least one physically-challenged member and no adult members
  • Families having no land and family members who work as casual manual labourers
  • Primitive tribal groups
  • Bonded labourers who were legally released and manual scavengers
  • Families residing in one-room makeshift houses, without durable roofs or walls

PMJAY Urban

The following sections of society are eligible for PMJAY benefitsin urban areas:

  • Ragpickers and domestic helpers
  • Mechanics/chowkidars/gardeners
  • Washermen/sanitation workers/sweepers
  • Electricians/handicraft workers/cobblers/hawkers/artisans
  • Plumbers/masons/construction workers/painters/security guards
  • Rickshaw pullers/porters/welders/drivers/conductors
  • Delivery boys/peons/shopworkers/waiters/helpers

People ineligible for health coverage under the PMJAY scheme include:

  • Government employees
  • Individuals who own a two-wheeler, three-wheeler, motorised boat, farming machinery, landlines, refrigerators, durable houses, and/or 5 acres or more of agricultural land
  • People having Kisan cards with Rs 50,000 credit limit
  • Employees working in government-run non-agricultural enterprises
  • Individuals earning a monthly income of more than Rs 10,000

PMJAY: Inclusions and exclusions

The PMJAY covers the following illnesses:

  • Prostate cancer
  • Anterior spine fixtures
  • Carotid angioplasty including stent
  • Skull base surgery
  • Double valve alternate
  • Pulmonary valve attachments

The PMJAY does not cover the below-mentioned conditions and procedures:

  • Outpatient procedures
  • Fertility-linked procedures
  • Drug-rehabilitation programs
  • Cosmetic surgeries
  • Organ transplants

PMJAY: Medical packages and the hospitalisation process

Certain individuals and specific families can avail of Rs 5lakh insurance cover benefits under the PMJAY scheme. This assured sum can be used for availing medical and surgical treatments in 25 specialities including orthopaedics, neurosurgery, cardiology, and oncology. However, you cannot claim for both medical treatments and surgeries simultaneously.

In case an individual has to undergo multiple surgeries, the charges for the highest package are paid for the first time. Then, they can receive a 50% and 25% waiver for the second time and third time, respectively.

Contrary to other health insurance plans, the PMJAY scheme has no waiting period for pre-existing illnesses. Also, in case aPMJAY beneficiary requires hospitalisation, they do not have to pay anything when admitted to an empanelled public or private hospital.

Benefits of health insurance in India

Medical bills can drain your savings and put you in a debt trap. The PMJAY scheme ensures that even weaker sections of society gain access to good healthcare facilities without causing any burden on their pockets.

For coverage during medical emergencies, you can also purchase health insurance plans from reputed insurance companies such as ICICI Lombard. One of the best insurance providers in the Indian market, ICICI Lombard offers robust health insurance plans for individuals as well as families.However, if you are buying insurance for your parents, it is advisable to purchase separate parents’ insurance plans to cover their medical expenses. ICICI Lombard offers very good senior citizen health insurance plans that are specifically designed to meet the needs of elderly policyholders.

PMJAY Scheme: The registration and application process

The PMJAY scheme has no particular registration process. The scheme appliesto all beneficiaries identified by the Socio-Economic and Caste Census (SECC) 2011 and those who are eligible for the RashtriyaSwasthyaBima Yojana (RSBY) scheme.

To know if you are eligible for the PMJAY scheme or not, just follow these steps:

  • Visit the PMJAY portal and click on the “Am I Eligible” tab
  • Enter your registered mobile number, input the CAPTCHA code, and proceed by clicking the “Generate OTP” link
  • Continue by selecting your state and searching via ration card number/HHD number/name/mobile number
  • As per the search results, you can know whether you and your family are entitled to the PMJAY benefits

Another way of knowing whether you are eligible for PMJAY or not includes approaching an Empanelled Health Care Provider (EHCP) or calling the PMJAY scheme’s call centre number 1800-111-565 or 14555.

PMJAY: E-card generation

If you are eligible for the PMJAY benefits, you can receive an e-card. You have to take your ration card or Aadhaar card to a PMJAY kiosk for verification purposes. Among family identification proofs, you can produce an RSBY card, a letter from the Prime Minister or a government-certified list of members. After the verification process is completed, your e-card, along with your unique PMJAY ID, is generated.

Conclusion

The PMJAY scheme is a welcome initiative that promises quality medical care to the economically-weaker sections. The Rs 5lakh cover per family comes as a relief to people who do not have access to healthcare.

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