Ayushman Bharat Insurance is a type of health insurance scheme offered by the Central Government of India. It is a flagship scheme by the Government of India and was launched as well as recommended by the National Health Policy 2017.
It is available in almost all the states of India. Ayushman Bharat PM-JAY is the largest health assurance scheme and a great initiative by the central government of India in the entire world. It provides health cover to Rs. 5 Lakhs per year per family for secondary and tertiary care hospitalization to over 10.74 crores of poor and vulnerable families.
At present, it has approximately 50 crores beneficiaries in India that form the bottom 40% population in India. It aims to achieve the vision of Universal Health Coverage (UHC). This is really a great initiative to fulfill the Sustainable Development Goals (SDG).
The main aim of this health insurance scheme is to “leave no one behind.” For the Ayushman Bharat health insurance scheme Ayushman Bharat Card is needed. We will discuss what this card this and how it is prepared.
Ayushman Bharat Health Insurance Scheme is a great attempt to move from a segmented approach or sectoral approach of the health service industry to a comprehensive need-based health care service.
This means lots of health-related issues are covered in it rather than only a particular disease. This health insurance scheme adopts and works in such a manner that it case provide a continuum of care approach. It mainly comprised of 2 inter-related components, are –
- Pardhan Mantri Jan Arogya Yojana (PM-JAY)
- Health and Wellness Centres (HWC’s)
In this article, we will try to cover all important aspects of this great health insurance scheme by the Great Government of India.
How much Amount of Insurance is Covered in Ayushman Bharat Health Insurance Scheme (PM-JAY)?
The maximum amount is Rs. 5,00,000 per family per year subject to other terms and conditions. This is a huge benefit and is absolutely free of cost. This means you don’t need to pay any kind of policy premium and you are eligible. Please note that Rs. 5,00,000 is not just for 1 time. It is given every year.
The Major Benefit of this Health Insurance Scheme is that it is absolutely Totally Free. Which means there is no Cost of Premium.
This health insurance scheme is also applicable for accidents. which means accidental insurances are also covered in this scheme in addition to other health diseases.
For Example, Mr. X’s family is beneficiary under Ayushman Bharat (PM-JAY) Health Insurance Scheme. Mr. X met with a road accident. He was admitted to the hospital which was registered under Ayushman Bharat Health Insurance Scheme.
The cost of his treatment comes at Rs. 1,00,000. Now his remaining balance in card is Rs (5,00,000-1,00,000)= Rs. 4,00,000. Now suppose In Mr. X’s family there was also some member who has the severe disease and there comes Rs. 2,00,000 on his/her treatment in the same year.
Then the balance that remains on the card is Rs. 2,00,000. There was not any further medical need in that year.
In the next year, Mr. X can recharge his Ayushman Bharat card up to Rs. 5,00,000. But Rs. 5 lakhs is the maximum limit.
What is an Ayushman Bharat Card?
This is simply a card that is absolutely free of cost and generally prepared at all the eligible Sewa-Kendra across India. One can also prepare this card online by himself/herself.
The people who are eligible and want to take the benefits of PMJAY can apply for The Ayushman Bharat card. With the help of this card, one can avail of the benefits of the Ayushman Bharat Health Insurance Scheme in the future. Just your details and identity is checked by the system.
Once you are eligible it is available free of cost. The most important eligibility is that you should be a Resident of India and that’s all. Normally your Aadhaar Card, Family Identification proof, Ration Card details are checked and this card is issued to you.
After your verification is completed, The Ayushman Bharat Card or e-card is issued to you on which the unique AB-PMJAY ID number is mentioned which is often used at the time when you use this card for any kind of health operation up to Rs. 5,00,000 per year.
What are the Main Features of the Ayushman Bharat (PM-JAY) Health Insurance Scheme?
- This Scheme covers nearly 1393 procedures dealing in all the costs related to treatment, which includes but is not limited to medicines, drugs, diagnostic services, supplies, room charges, physician’s fees, surgeon charges, ICU and OT charges, supplies, etc.
- It is the World’s Largest health insurance scheme entirely finances by the government. which means all the expenses are paid by the government.
- World-class Government Hospitals, as well as Private Hospitals, are covered for service. This means the patient can take the treatment from top-class hospitals if that is covered under this scheme.
- As discussed above the amount of cover is Rs. 5 lakhs per family per year in secondary as well as tertiary care top-class impaneled hospitals in India.
- All the Pre-existing Conditions from 1st day onwards
- It provides cashless access to health care services for the beneficiary in the hospital.
- Nearly 50 Crore People In India or over 10.74 crore poor and vulnerable entitled families are eligible for this insurance scheme which simply means there is a high probability of eligibility for this health insurance scheme for almost 1 person in 3.
- 3 days of Pre-Hospitalisation expenses which cover medicines expenses, patients care expenses as well as full diagnostic service expenses are covered in Ayushman Bharat Health Insurance Scheme.
- In Addition, 15 days of post-hospitalization expenses are also covered. This means a patient can remain in the hospital free of cost for 15 days. For more information, one can contact and talk with his/her doctor.
- There is absolutely no bar on the family size, age, gender, disease (if that disease is covered under the PM-JAY list).
- This scheme is available across all the states and cities in India.
What are the benefits covered under The Ayushman Bharat Health Insurance Scheme?
The following benefits are covered in this health insurance scheme.
- Medical Checking, Any Type of consultation and treatment
- All Pre-hospitalization related expenses
- All Medicines related expenses and incidental & ancillary expenses related to medicines.
- All Food-Related Services
- Accommodation related benefits
- Intensive and non-intensive care services related expenditure
- Lab. Investigation and Diagnostics Related Expenditure
- If there any Complications arises during treatment
- Post-hospitalization-related expenditure, as well as the follow-up, care up to 15 days.
- Either whole family or 1 person/2 person can take the benefits of Rs. 500000 in 1 year so it is on a family floater basis not person to person basis.
Critical Diseases Covered and not Covered under Ayushman Bharat Health Insurance Scheme?
List of Critical Diseases Covered Under Ayushman Bharat Health Insurance Scheme?
Almost every small disease is covered under the Ayushman Bharat Health Insurance Scheme but not the extremely small diseases like cough, cold, headache, etc. But there are critical diseases are also covered in this scheme which is written as follow
- Prostate Cancer
- Anterior Spine Fixation
- Pulmonary Valve Replacement
- Double Valve Replacement
- Tissue Expander for disfigurement in case of burns
- Skull Base Surgery
- Carotid angioplasty with stent
- Coronary ABG
For more information, one can consult with their doctors as to what diseases are cover and what are not. you can also visit their official website.
List of Disease not Covered Under Ayushman Bharat Health Insurance Scheme?
- Any Kind of Organ Transplant
- Drug Rehabilitation Related Diseases
- Any kind of Cosmetic Procedures
- Fertility Related Diseases
- OPD Related Expenses
This is one of the best health insurance schemes in the entire world. you can see that all maximum major and severe diseases are covered in it. This is a great scheme for poor people who can not afford costly treatments.
Eligibility Criteria For Ayushman Bharat Health Insurance Scheme
- For Eligibility Criteria, one has to login to the official website link under am I eligible?
- Here you should enter your mobile number and CAPTCHA Code (CAPTCHA code is generally be asked to check as you are not a bot but a real human)
- After that, you must Generate OTP.
- After that, you must select your state as well as search by NAME/RATION CARD NUMBER/HHD NUMBER/MOBILE NUMBER
- You can easily find out whether your family is eligible for Ayushman Bharat Health Insurance Scheme.
In case you need any more help or directly wanted to know your eligibility without checking online eligibility you can call Ayushman Bharat Helpline 1800-111-565 or 14555 or you can contact any Empanelled Health Care Provider (EHCP).
This Insurance Scheme is a great help to Poor people and underprivileged people of the nation.
Eligibility in case of Urban Areas
As per National Sample Survey Organisation (71st Round), 82% of the urban area population do not have health care insurance. PM-JAY or Ayushman Bharat will help in the occupational category present following the socio-economic caste census 2011.
furthermore, any family enrolled under Rashtriya Swasthya Bima Yojna will also become the Beneficiary under PM-JAY Scheme.
The following list is not exhaustive. which means at least these people are easily eligible for Ayushman Bharat Health Insurance Scheme subject to other conditions.
- All Mechanics, Electricians, Washerman/Chowkidars,
- Cobblers, Domestic Helpers and Rag Pickers,
- Sanitation Workers, sweepers,
- Gardners, Painters, welders, porters,
- construction workers, plumbers, masons, Peons, Assistants,
- Shopkeepers, waiters, Domestic Helpers,
- Transport workers like conductors, drivers, helpers, cart pullers,
- rickshaw pullers, Repair Workers, Hawkers,
- and similar people who provide services on the street or pavements, Gardners, Home-based artisans, security guards, delivery boys.
Eligibility in case of Rural Areas
The following list is not exhaustive. which means at least these people are easily eligible for Ayushman Bharat Health Insurance Scheme subject to other conditions
- Manual Scavenger Groups.
- Those Families who do not have any male members between 16 years to 59 years.
- People or Beggars Who have not optioned but surviving on Alms.
- People of SC, ST Caste, or Household.
- Those Families who do not have any individual between 16 years to 59 years.
- Lawfully Discharged bounded workers
- People who are living in single room poor quality homes with no proper roof and walls
- Primal Tribal Communities or Groups
- Families in which there is at least 1 Physically harmed member and there is no such adult member which can be called able-bodied
- Landless families whose livelihood is not stable and they had only the casual work, not the permanent work.
People who may not be eligible under Ayushman Bharat Health Insurance Cover
- Normally All-Big Corporates and Extraordinary Rich People.
- People having Mechanised Farming Equipments.
- People having Two-Wheelers, Three Wheelers, or 4 Wheelers.
- People Who are Government Employees
- People With Kothis, Bungalows, etc.
- People Have assets like Air-conditioners, Refrigerators, Landlines.
- People With 5 acres or more than 5 acres of agricultural land
- People Have their own motorized fishing boat
- People Working in Non-Agricultural Organisations managed by Government.
As this Scheme is available to nearly 50 crores people in India as per Government of India. One must ask and contact Ayushman Bharat Helpline 1800-111- 565 or 14555 or you can contact any Empanelled Health Care Provider (EHCP).
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- We had taken the help of Ayushman Bharat Website for writing this post. The Credit of this post goes to the honourable Central Government of India and its official website related to Ayushman Bharat Scheme.
- We had added the organisation logo for Review and Discussion Purposes and in good faith. If the organisation object to it. They can contact us. We will remove it within 48 hours. The Credit of Logo is goes to The Ayushman Bharat and Honourable Central Government.