Inadequate government facilities make it impossible for low-income families to afford quality healthcare. For this purpose, the Prime Minister of India launched a government-funded healthcare scheme known as Ayushman Bharat Yojana in September 2018.
In fact, the recent developments in the Union Budget 2020 stated that among INR 69,000 crore allocated to the healthcare sector, INR 6,400 crore has been given to Ayushman Bharat Yojana.
Owing to the launch of the Ayushman Bharat Yojana, a majority of eligible families across India are still quite unaware of it. To avail the benefits under Ayushman Bharat Yojana, it is necessary to understand the basics of this scheme. And we are here to help you with that.
Ayushman Bharat Yojana is a healthcare initiative taken by the Indian Government to support the well-being of the poor. It comprises two major health initiatives, Health and Wellness Centre (HWC) and Pradhan Mantri Jan Arogya Yojana (PMJAY).
Under the PMJAY scheme, over 10 crore families are covered with health insurance of Rs. 5 Lakh. The scheme promises cashless treatment at public hospitals as well as empanelled private hospitals. Moreover, expensive surgeries like knee replacements, coronary bypass, and others are also covered.
The prime benefit of the PMJAY scheme is to provide financial protection during unforeseen events. Besides, it offers a plethora of other benefits to ensure financial support throughout their lives.
Medical treatment is available to every vulnerable family in India. However, the states, which opted out of the Ayushman Bharat Yojana cannot avail the treatment facilities.
It prioritizes girls, women, and senior citizens of India.
It covers pre-existing diseases, day-care treatments, follow-ups, and so on.
One can avail medical treatments from all the tertiary and secondary hospitals in India.
It offers the benefits of national portability in India. Each citizen is eligible to receive the services from anywhere in the country.
Ayushman Bharat Yojana holds a strong network of citizens under the plan. However, the eligibility criteria of the scheme must be met before opting for the policy.
This scheme mainly takes care of the medical expenses incurred for secondary and tertiary care procedures. You (the beneficiary) do not have to pay any premiums for the insurance coverage. The health insurance plan includes pre and post-hospitalization costs, as well.
Visit the official PMJAY website and under the ‘Hospital’ section choose ‘Find Hospital’ to know the empanelled hospitals in your region. All these network government and private hospitals have a professional 'Ayushman Mitra' – an individual appointed to coordinate with the beneficiaries of the plan. This expert will be available at the empanelled hospitals and will help you identify eligibility, verify the documents, and guide you through the enrolment process.
The eligibility of an individual is checked through several processes. It includes inspecting letters with QR codes that belong to the beneficiary and then verifying the same. The people enrolled in the scheme are identified by the government through different means, but need to possess specific documents. One of the most basic requirements is a bank account.
The eligibility criteria are divided into two broad categories:
Rag pickers and beggars
Scheduled caste and Scheduled tribes
Construction works, plumbers, security guards, and so on
Go to the PMJAY official website
Click on the ‘Am I Eligible’ option on the website
Enter your name, phone number, ration card number or the Rashtriya Swasthya Bima Yojana URN number. On submitting your mobile number, you’ll receive an OTP
Submit the generated OTP
Select the state you reside in
Click the search button once you’ve filled all the relevant details. When you click search, a list of names will fall under the category
Look for your name in the list
After you have checked your eligibility on the online portal, you should look forward to the Ayushman Bharat registration and application process. In case you are not eligible for the scheme, it is wise to explore other health insurance plans available in the market to safeguard yourself and your family in case of medical emergencies.
Generate a patient verification card for your beneficiaries. For card generation, the patient is directed to the PMJAY kiosk.
Inform yourselves about all the valid charges and payments associated with the PMJAY Scheme.
Confirm any prevailing sickness or diseases from the provided doctors.
Obtain a medical treatment or a prescription of medication from the doctors in the case of any severity. If hospitalization is recommended, avail medical facility from Empanelled Healthcare Providers (EHCP) or Public Hospitals.
After the completion of treatments, receive a discharge certificate/bills/invoices from the hospital.
Submission of essential documents plays a vital role. Providing all the necessary paperwork quickens the procedure. Here’s a closer look at all the required documents for availing the Ayushman Bharat Yojana.
A valid age proof is required to opt for the Ayushman Bharat Yojana.
Provide your identification proof like PAN card or Aadhar Card.
Submit your current contact details like your mobile number, email ID, residential address. Contact details should be mentioned accurately as it is the sole source of contacting the policyholder.
One must submit two different certificates while opting for the Ayushman Bharat Yojana. The required certificates are as follows:
During the Ayushman Bharat registration and application process, one must specify their family structure. For instance, an individual must mention whether he lives in a nuclear family or a joint family.How to Apply for Ayushman Bharat Yojana?
Follow these steps to apply for Ayushman Bharat Yojana-
Visit the empanelled hospital and look for Ayushman Mitras who will assist you in admission
They will confirm whether you are eligible under the PMJAY scheme
Next, they will authenticate your identity (either through Aadhaar card or ration card)
The hospital that you are seeking treatment in will check the balance
You will be requested to submit necessary evidence for the treatment
The claim will be settled post hospitalization, after you submit discharge summary and post treatment evidence
Once the eligibility is confirmed, the beneficiary is directed to the PMJAY Kiosk where the Pradhan Mantri Arogya Mitra (PMAM) will verify the beneficiary’s identity and eligibility using the Beneficiary Identification System (BIS). Once this is cleared, the beneficiaries are issued an e-card.
PMAM informs the beneficiary about the total expense of treatment. Depending upon the severity of the illness, the beneficiary shall either be prescribed medical drugs or suggested hospitalization.
It is to be noted that if the beneficiaries are not hospitalized and just prescribed general medicines, then they will have to bear the consultations and drug charges.
However, if the condition is critical and demands hospitalization, then the beneficiaries can avail cashless treatment within the empaneled hospital.
On completion of the treatment, the beneficiary will be discharged from the hospital.
If you are a beneficiary under the PMJAY scheme and suffering from the symptoms of Novel Coronavirus, then you can be tested for free of cost. The ayushman bharat corona test is done only at the government-designated labs at the empanelled hospitals.
After you are tested positive for COVID-19, get yourself admitted at the nearest PMJAY empanelled hospital and avail free treatments. However, before you avail treatment for COVID-19 under this scheme, you have to check your Ayushman Bharat Yojana eligibility. You can check the eligibility in either of the following ways: 1) By PMJAY Kiosk through the ‘Am I Eligible’ application 2) By calling the call centre number 14555 of the Ayushman Bharat Yojana 3) By visiting the official website of the PMJAY scheme Once the eligibility is confirmed, proceed to Ayushman Bharat registration process. Upon successful registration, the beneficiaries of the scheme will be given an e-card to avail the benefits.
Yes. All the test charges and treatments for coronavirus are covered under the AB-PMJAY scheme.
The PMJAY scheme is an entitlement based health insurance plan. There are no specific procedures for enrollment. Households that are identified under the PMJAY scheme are based on deprivation and occupational criteria. It utilizes the Socio-Economic and Caste Census data (for rural and urban) to determine the beneficiaries.
Ayushman Bharat Yojana benefits include health insurance coverage of up to INR 5 lakh per family, annually. Here, all the pre-existing illnesses are covered without any waiting period.
You can avail the health services of hospitalization expenses, daycare surgeries, follow-up care, pre and post hospitalization expenses, and newborn childcare services under the PMJAY scheme. A detailed list of the services available under the Ayushman Bharat Yojana is available on the website.
No. For all the individuals who are eligible for the PMJAY Scheme can avail the benefits offered under it. Moreover, you get to avail cashless health services as well.
At the time of hospitalization, you need to carry a ration card, or any other government recognized photo identity document like Aadhaar card.
After you get a discharge from the hospital, the claim submission process is initiated. You have to raise a request on the online portal with your treatment summary and all the necessary documents. The hospital will then submit the requested documents within 24 hours of your discharge.
PMJAY benefits are portable across the country. You can avail services by simply calling the helpline number 14555.