Ayushman Bharat Health Insurance: An Introduction

The Ayushman Bharat Insurance Scheme is a government health insurance scheme designed to cover medical expenses for individuals and families belonging to the vulnerable economic sections of society. It is the flagship health insurance scheme launched by the Government of India on September 25, 2018.

'My government has been working for the last four years to empower the poor. We will launch the Pradhan Mantri Jan Arogya Abhiyan on the birth anniversary of Pandit Deendayal Upadhyay on 25 September this year. The government decided to start the scheme to provide good healthcare facilities to the poor and common people so that for serious ailments, they also receive free health facilities in big hospitals.'

Narendra Modi, Hon’ble Prime Minister of India

Describing it as one of the biggest schemes for the common man, the Prime Minister launched the world's largest health insurance scheme. Pradhan Mantri Jan Arogya Yojana (PM-JAY) was launched under the Ayushman Bharat umbrella to offer health coverage of ₹5 lakh to over 50 crore beneficiaries in India.

Ayushman Bharat Health Insurance: Key Milestones

• February 2018: 1,50,000 Health and Wellness Centres (HWCs) announced.
• September 2018: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) launched.
• December 2018: 5 lakh treatments availed by beneficiaries.
• January 2019: 100 days of PM-JAY completed.
• April 2019: 20 lakh treatments availed by beneficiaries.
• June 2019: 30 lakh treatments availed by beneficiaries.
• September 2019: 10.39 crore e-cards issued.
• November 2019: 20,908 hospitals empanelled, 11.4 crore e-cards issued.
• May 2020: 1 crore hospital admissions under PM-JAY.
• August 2020: 12.55 crore e-cards issued.
• July 2024: AB-PMJAY budget increased to ₹7,300 crore from ₹6,800 crore.

Table of Contents

• Ayushman Bharat Health Insurance: An Introduction
• Ayushman Bharat Health Insurance: Key Milestones
• What Is Ayushman Bharat Health Insurance?
• What Is The Eligibility Criteria For Ayushman Bharat Yojana?
• Ayushman Bharat Insurance Scheme: Key Features
• Inclusions Of Ayushman Bharat Health Insurance Scheme
• Exclusions Of Ayushman Bharat Health Insurance Scheme
• What Is ABHA - Ayushman Bharat Health Account?
• What Are The Documents Required For Ayushman Bharat Yojana?
• Ayushman Bharat Insurance and Union Budget 2024
• Ayushman Bharat Yojana: Towards an Inclusive Health Scheme
• How To Check Your Name In The Ayushman Bharat Health Insurance Scheme

Key Takeaways

• The Ayushman Bharat Health Insurance Scheme, the world’s largest health insurance scheme, covers around 50 crore individuals in India.
• It was launched on September 25, 2018.
• The scheme fulfills the motto: "Leave no one behind."
• A unique Ayushman Bharat Health Account (ABHA) number is assigned to each beneficiary.
• Check the eligibility criteria by visiting the official website of PM-JAY.

What Is Ayushman Bharat Health Insurance?

The Ayushman Bharat Health Insurance Scheme was designed to achieve Universal Health Coverage. This flagship government scheme aims to meet Sustainable Development Goals and fulfill the motto: "Leave no one behind." The scheme adopts a holistic approach to need-based healthcare services, including coverage at:

• Primary
• Secondary, and
• Tertiary levels.

Ayushman Bharat focuses on two key elements:

• Launching 1,50,000 Health and Wellness Centres to bring quality healthcare closer to people.
• The other element of Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojana or PM-JAY.

It is important to note that Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the largest health insurance scheme in the world. Over 50 crore beneficiaries are provided ₹5 lakh coverage per family annually for secondary and tertiary care hospitalization.

What Is The Eligibility Criteria For Ayushman Bharat Yojana?

The Ayushman Bharat Health Scheme is designed for the economically vulnerable sections of society. To check your eligibility, follow the steps given below:

Step 1 - Visit the official website of the Ayushman Bharat Health Insurance Scheme

Step 2 - Click on 'Am I Eligible' section

Step 3 - Enter your mobile number and click on 'Verify'

Step 4 - Enter the OTP sent on your registered mobile number

Step 5 - Enter the name of the scheme, State, City, District, and Aadhar Number

Step 6 - Once all your details are entered, click on the 'Submit' button

Ayushman Bharat Insurance Scheme: Key Features

Explore the key features of the Ayushman Bharat Health Insurance Scheme:

• A fully funded government health scheme implemented with the cooperation of central and state governments in India.
• Beneficiaries are entitled to avail cashless medical care in government and private empanelled hospitals.
• An extensive network of hospitals across India is available to members covered under the scheme.
• Health and wellness centres are made accessible to families and individuals covered under the scheme for efficient medical care.
• There are no restrictions on the number of family members covered under the Ayushman Bharat insurance cover.
• All pre-existing conditions are covered from day one, unlike private health insurance plans which typically have a waiting period.
• Safeguards nearly 6 crore Indian individuals and families from being pushed into poverty due to medical expenses.
• Covers the cost of treatment for approximately 1,929 medical procedures.
• Reimbursement offered to public hospitals is at par with private hospitals in the country.
• Covers pre-hospitalization expenses for 3 days and post-hospitalization expenses for 15 days.

Inclusions Of Ayushman Bharat Health Insurance Scheme

The inclusions of the Ayushman Bharat Health Insurance Scheme are given below:

• Pre and post-hospitalization expenses
• Cost of consultation, diagnostic tests, and treatment
• Medicine costs are covered
• Intensive care unit (ICU) costs are covered
• The cost of food and accommodation is covered
• Complications arising during treatment are covered.

Exclusions Of Ayushman Bharat Health Insurance Scheme

The exclusions of the Ayushman Bharat Health Insurance Scheme are given below:

• Cosmetic surgeries
• Injuries or hospitalization due to involvement in illegal activities
• Hospitalization due to adventure sports
• Drug or alcohol abuse
• Fertility treatments.

What Is ABHA - Ayushman Bharat Health Account?

The ABHA number is a 14-digit number assigned to insured individuals participating in India’s public digital healthcare ecosystem. The ABHA number helps you access treatments across the country at any cashless network hospital or medical centre.

The various benefits of the Ayushman Bharat Health Account (ABHA) are:

• It creates a unique and verifiable identity across healthcare providers.
• It links all your healthcare and insurance benefits to your unique ABHA number.
• Helps avoid long queues at healthcare providers across India.
• Facilitates easy health data sharing among medical practitioners and insurance providers.

What Are The Documents Required For Ayushman Bharat Yojana?

To enroll in the Ayushman Bharat Health Insurance Scheme, provide the following documents:

• Aadhar card, Voter ID card, Passport, or Driving License
• Electricity bill or lease agreement for address proof
• A document showing your economic status, such as an SECC identification certificate
• Family photograph
• Mobile number
• Bank account details

Ayushman Bharat Insurance and Union Budget 2024

The Union Budget 2024 announced developments for the world’s largest public welfare health insurance scheme. Finance Minister Nirmala Sitharaman announced a budget increase from ₹6,800 crore to ₹7,300 crore.

Additionally, the sum insured was suggested to be increased from ₹5 lakh to ₹10 lakh.

Ayushman Bharat Yojana: Towards an Inclusive Health Scheme

The Ayushman Bharat Health Insurance scheme may soon expand its coverage as follows:

• Women may receive special benefits, with coverage potentially increasing to ₹15 lakh for 'specific diseases and circumstances'.
• The Ayushman Bharat Health Insurance Scheme plans to include senior citizens above 70 years of age.
• The government has also pledged to include all individuals from the transgender community under the scheme.
• A target has been set to increase the number of beneficiaries under the Ayushman Bharat Health Insurance scheme to 100 crore during the third term of the NDA government.

How To Check Your Name In The Ayushman Bharat Health Insurance Scheme?

Here are the steps to follow:

Contact the PMJAY toll-free number 14555 or 1800-111-565 to learn about your eligibility for the scheme.

OR

You can visit the official website of the Ayushman Bharat Health Insurance Scheme.

Conclusion

The launch of the Ayushman Bharat Health Insurance Scheme by the Government of India has significantly inspired nations and world leaders. It is dedicated to serving vulnerable sections of Indians for whom quality healthcare was once a distant dream. As the world's largest public welfare health insurance scheme, it is credited with efficiently bringing easy access to healthcare to every individual.

With healthcare costs increasing year on year, a government flagship scheme like Ayushman Bharat Health Insurance is a savior for those who are pushed into poverty annually due to the inability to pay medical bills. To know more about the Ayushman Bharat Health Insurance Scheme, connect with PolicyX insurance experts.