Ayushmaan Bharat Yojana | Know About Scheme Eligibility & Benefits

In September 2018, Prime Minister Narendra Modi launched a health insurance scheme Ayushmaan Bharat Yojana/Scheme, also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY). It includes the coverage of about 50 crore citizens in India and has already had several success stories to the credit. It was duly reported that 18,059 hospitals have been impaneled as of September 2019. Over 1 crore e-cards have been issued and over 4.406,461 lakh beneficiaries have been admitted.

This scheme plans at making secondary and tertiary healthcare completely cashless since it is the National Health Protection Scheme. To avail of services at impaneled hospitals, anywhere in the country, public or private, the PM Jan Arogya Yojana beneficiaries get an E-card. You can easily walk into a hospital and get cashless treatment with this.

3 days of pre-hospitalization and 15 days of post-hospitalization expenses are all included within the coverage here. It also takes care of around 1400 procedures with all the related costs including the OT expenses. Coverage of INR 5 lakh for each family, per year, helps the economically disadvantaged obtain easy access to the healthcare services with PMJAY.

Eligibility Application Procedure

Ayushmaan Bharat Yojana / Scheme involves two categories – Rural & Urban People

10 crore families including the poorest and have lower middle income are provided healthcare coverage with this scheme’s help where each family will be getting INR 5 lakhs through the health insurance scheme. In rural areas, the 10 crore families comprise 8 crore families, and in the urban areas, there are 2.33 crore families. This will mean that the scheme is aiming to cater to 50 crore individual beneficiaries when they are broken into smaller units.

It chooses who can avail of the health cover benefit with the help of a scheme that has certain pre-conditions. The list is highly categorized on lack of housing, meager income, and other deprivations, while in the rural areas, and based on the occupation, the urban list of PMJAY beneficiaries are drawn up.

PMJAY Rural:

A shocking 85.9% of rural homes do not have access to any healthcare insurance or assurance with the 71st round of the National Sample Survey Organization. 24% of rural families have an access to healthcare facilities by borrowing money additionally. Helping this sector avoids the debt traps and availing the services by providing yearly assistance of up to INR 5 lakh per family is what PMJAY aims at. According to the data in the Socio-Economic Caste Census 2011, the scheme will aid economically disadvantaged families. Under the ambit of PM Jan Arogya Yojana, the households are enrolled under the Rashtriya Swasthya Bima Yojana.

Within the rural areas, the following are covered by the PMJAY:

Individuals living under the scheduled tribe and scheduled caste households.
Families without any make members aged 16 to 59 years.
People surviving on alms and beggars.
Families with none between the age of 16 and 59 years.
Families with no able-bodied adult members and one physically challenged member.
Landless households making a living working as the casual manual laborers.
The primitive tribal communities.
The legally released bonded laborers
Families living under the single room makeshift homes with no proper walls or roof
Manual scavenger families.

PMJAY Urban:

According to the reports of the National Sample Survey Organization, 82% of the urban households do not have an access to healthcare insurance or assurance. Simply by borrowing money in one form or the other, 18% of Indians in urban areas have addressed healthcare expenses. With funding of up to INR 5 lakhs for each family every year, the Pradhan Mantri Jan Arogya Yojana helps the households avail of these healthcare services. As per the Socio-Economic Caste Census 2011, PMJAY will benefit the urban worker’s families in the occupational category present. Along with these, the families can also enjoy the benefit from the PM Jan Arogya Yojana who is enrolled under Rashtriya Swasthaya Bima Yojana.

The following are criteria to avail of government-sponsored scheme in the urban areas:

Washerman/chowkidars
Ragpickers
Mechanics, electricians, repair workers
Domestic help
Sanitation workers, gardeners, sweepers
Home-based artisans or handicraft workers, tailors
Cobblers, hawkers, and others providing services by working on streets or pavements
Plumbers, masons, construction workers, porters, welders, painters and security guards
Transport workers like drivers, conductors, helpers, cart or rickshaw pullers
Assistants, peons in small establishments, delivery boys, shopkeepers, and waiters

The following are individuals who are not entitled to the health coverage under the PMJAY:

Having two, three, or four-wheeler or even a motorized fishing boat.
Individuals owning mechanized farming tools and equipment.
Individuals having Kisan cards with a credit limit of Rs.50000.
Government employees.
Earning a monthly income of above INR 10,000.
Individuals owning refrigerators and landlines.
Working in government-managed non-agricultural enterprises.
Individuals owning 5 acres and more agricultural land.

Medical packages and hospitalization process

Both the individuals and families, in general, can use the INR 5 lakh insurance coverage provided by the Pradhan Mantri Jan Arogya scheme. The medical and surgical treatments covered within 25 specialties among which includes cardiology, oncology, neurosurgery, orthopedics, and others is the lump sum that is offered. But, the specification that you need to know is that the medical and the surgical expenses cannot be reimbursed.

The highest package price is paid for in the first instance followed by a 50% waiver for the second and a 25% discount for the third if multiple surgeries are required. There is no waiting period for the pre-existing diseases under the PMJAY scheme that will come under the larger umbrella scheme of the Ayushmaan Bharat Yojana, unlike the other health insurance schemes. Provided that they are admitted to any impaneled government or private hospital if any beneficiary or anyone in their family requires hospitalizations, then they need not pay anything.

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