What is the Ayushman Bharat Health Insurance Scheme?
The Ayushman Bharat Yojana or PMJAY (Pradhan Mantri Jan Arogya Yojana) is a healthcare flagship program funded by the Government of India, launched in 2018 under the National Health Policy. It is also the world's largest government-funded healthcare program, envisioning Universal Health Coverage (UHC) as one of its Sustainable Development Goals (SDGs) to facilitate underprivileged and marginalized sections of the country.
It provides comprehensive healthcare services, aiming to make India a better place for all. Beneficiaries of the Ayushman Bharat health insurance scheme can undergo hospitalization and medical treatment for secondary and tertiary illnesses, with coverage up to ₹5 Lakhs. The scheme provides coverage for all members of each eligible family.
This article discusses the benefits of the Ayushman Bharat Yojana, its eligibility, Ayushman card benefits, how to avail them, and more. Read on for a clear understanding.
Know the Benefits of Ayushman Bharat Yojana (PMJAY)
| Key features | Specifications |
|---|---|
| Healthcare to EWS | Deprived or underprivileged sections of society, such as poor rural families who cannot afford healthcare, can avail of specified benefits under the PMJAY scheme. |
| Primary, Secondary and tertiary covers | The Ayushman Bharat card is a lifeline for those who cannot afford expensive and premium healthcare services. It covers PMJAY beneficiaries and their family members for primary (basic healthcare), secondary (serious illnesses), and tertiary (critical illnesses) diseases requiring treatment and hospitalization up to ₹5 Lakhs per year per family. |
| Cashless hospitalization & treatment | Over 1400 procedures are covered under the scheme. Additionally, beneficiaries receive coverage for 3 days of pre-hospitalization and 15 days of post-hospitalization expenses. |
| Wide facilitation network | Beneficiaries can avail of cashless treatment at government-run hospitals, PMJAY empanelled centers, CHCs, PHCs, etc., ensuring they are not left helpless during medical emergencies. |
| Medical portability benefits | It allows beneficiaries to avail of cashless treatment in any government-empanelled hospital across Indian states and Union Territories. This scheme is a life-saver for those who migrate for work within the country! |
| Social empowerment | This scheme is designed to combat healthcare disparity among marginalized sections of society, helping them receive quality and equitable health benefits and promoting socio-economic well-being. |
| Healthcare boost to the masses | The Ayushman Bharat scheme significantly contributes to developing the medical and healthcare industry, growing infrastructure, enhancing the potential of empanelled centers, and positively impacting the health of crores of people, almost half of the Indian population. |
Key Takeaways
- The Ayushman Bharat health insurance scheme offers cashless health benefits up to ₹5 Lakhs to eligible families.
- It covers all sorts of treatment expenses on a family floater basis, meaning any family member can avail of its benefits.
- There is no bar on age or gender, allowing beneficiaries to cover each family member.
- Pre-existing diseases are covered from day one, ensuring beneficiaries receive immediate treatment.
- One can only avail of the healthcare benefits of this government scheme with their Ayushman Bharat Card.
What is an Ayushman Card and How Does it Work?
The Ayushman Card is a health card issued by the Government of India that provides cashless healthcare to economically weaker sections of society. You can avail of the listed benefits at any government-empanelled hospital or health center.
Ayushman Card Benefits
The Ayushman Bharat Yojana provides basic and critical illness coverage through the Ayushman card issued to beneficiaries. Inclusions of this plan are as follows:
Basic Cover
- Doctor’s consultations, health check-ups, and diagnostics
- Pre and post-hospitalization follow-up up to 15 days
- Daycare procedures
- Medication costs and consumables
- Room rent and ICU charges
- Food services
- Complication treatment if necessary, and so on
Critical Illness Cover
- Cancer
- Kidney failure
- Burns
- Coronary Artery Bypass Graft (CABG)
- Prostate cancer
- Cardiovascular diseases
- Neonatal diseases
- Parkinson’s disease, and more
Quick Facts About the Ayushman Bharat Card
- Over 50 crore Indian families from rural and underprivileged sections of society are registered under the PMJAY beneficiary list.
- More than 13.4 crore Indians have received benefits from the Ayushman Bharat Swasthya Yojana.
- Approximately 33 crore individuals have been issued an Ayushman card based on their beneficiary entitlement.
Exclusions: Ayushman Bharat Health Insurance Scheme
- Alcoholism/drug abuse and related treatments
- Breach of law or unlawful activities
- Infertility or sterility treatment
- Outpatient Department (OPD) cover
- Beauty treatment and cosmetic surgery
- Rest, cure, and rehabilitation treatments
- Weight management or obesity treatment
- Organ donor expenses
- Dental surgery, etc.
How Can I Get an Ayushman Card and Where Should I Apply for it?
To get an Ayushman card, eligibility criteria include: being from an SC/ST community with no earning person above 16 years in the family, a collective income not exceeding ₹2.5 Lakhs, and being listed in the SECC-2011 database of PMJAY beneficiaries.
To avail benefits under the PMJAY healthcare scheme, the following documents are required for identification and proof of enlisted beneficiaries:
- PM/CM Entitlement Letter
- Ration card
- Aadhaar Card (for identification only)
Steps to Follow while Applying for an Ayushman Card
The following are the steps to follow while applying for an Ayushman Card:
Step 1
Check your eligibility for an Ayushman card.
Step 2
Visit the official PMJAY website (pmjay.gov.in) and initiate the online application.
Step 3
Click on the 'ABHA' option to proceed with filling your Aadhaar Card details.
Step 4
Enter the OTP received on your phone to verify Aadhaar.
Step 5
Fill out further details such as your name, income, PAN Card, etc.
Step 6
Application approval may take some time; wait until it is updated.
Step 7
Once you receive confirmation of eligibility for an Ayushman card, revisit the PMJAY website and generate an OTP to download your Ayushman Bharat card.
Step 8
Download and print your Ayushman card to avail of cashless treatment benefits.
P.S.: Beneficiaries can visit an Ayushman Kiosk at any PMJAY empanelled hospital or Common Service Centre (CSC) to receive their Ayushman Bharat card. For more details or queries related to the PMJAY health card, contact official executives on toll-free numbers 14555, 1800-111-565, or 1800-180-2415.
Summarising: All About Ayushman Bharat Health Insurance Scheme
For those who cannot afford expensive health insurance with high premiums, the PMJAY Ayushman Bharat card offers crucial support. The Ayushman Bharat health card benefits not only serve marginalized sections of society but also provide free and cashless treatment during medical emergencies for any family member. The Government of India provides coverage up to ₹5,00,000 for the benefits mentioned above for beneficiaries.
Need further help or want to know more about the PMJAY Scheme? Contact us at 1800-4200-269.
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