A Complete Guide to Ayushman Bharat Yojana

The Ayushman Bharat Yojana is a health assurance scheme for poor and vulnerable families in the bottom 40% of the Indian population. The health insurance scheme aims to offer an annual coverage of Rs 5 lakhs for each family to meet secondary and tertiary care hospitalization charges.

Anyone who can afford a health insurance policy enjoys multiple benefits. The introduction of the Ayushman Bharat policy by Prime Minister Narendra Modi will benefit people from the lower strata of society in need of treatment. Let’s get into the details of the national health scheme now.

Eligibility Criteria

Rural beneficiaries who are eligible for the national health insurance policy can be categorized into seven different deprivation categories:

• D1: One room with kucha roof and kucha walls
• D2: No adult between 16-59 years
• D3: No adult member between 16-59 years
• D4: Lack of able-bodied adult members
• D5: SC/ST households
• D6: Living on alms/ destitute, a primitive tribal group, manual scavenger households, legally released bonded laborers
• D7: Landless households with manual casual labor as a major income source

In the urban area, people in the 11 occupational categories are eligible:

• Beggar
• Ragpicker
• Domestic worker
• Mali/ Sweeper/ Sanitary worker
• Street vendor/ hawker/ cobbler/ any other service provider working on the streets
• Plumber/ construction worker/ mason/ painter/ security guard/ labour/ painter/ welder/ coolie and other head-load workers
• Driver/ conductor/ helper to driver or conductor/ rickshaw puller/ cart puller/ other transportation worker
• Assistant/ peon/ helper/ shop worker/ waiter/ attendant/ delivery assistant
• Tailor/ handicrafts worker/ artisan/ home-based worker
• Electrician/ assembler/ repair worker/ mechanic
• Chowkidar/ washerman

Hospitalization Process

Like most health insurance plans, beneficiaries of the Ayushman Bharat scheme are not required to bear any hospitalization expenses. The benefits also cover pre- and post-hospitalization expenses. Every hospital treating beneficiaries under the scheme has an Ayushman Mitra.

The person is responsible for assisting patients and coordinating with beneficiaries and the hospital. They run a help desk to check documents and verify eligibility. Beneficiaries can turn to the Ayushman Mitra for any concerns regarding the scheme.

The beneficiaries are given letters with QR codes. The letters are scanned to conduct a demographic authentication for identification. The beneficiary’s eligibility to avail of the benefits is also verified through the code.

The benefits of the PMJAY scheme are portable throughout the country. Any beneficiary under the scheme can take cashless benefits from any impaneled hospital in the country. You will find both public and private hospitals in the list of impaneled hospitals.

What’s Included?

Impaneled health care providers under the Ayushman Bharat scheme are based on particular package rates to avoid discrepancies and differences across hospitals. Surgical packages are paid as bundled care, and the EHCPs get an all-inclusive payment.

Medical packages are payable to the EHCP at a per-day rate based on the admission unit. Some pre-decided add-ons separately payable are included within medical packages. The day-care packages are payable similar to the surgical packages.

The treatment packages are pretty comprehensive, like the best health insurance in India. The packages cover treatment for around 24 specialties like neurosurgery, cardiothoracic, cardiovascular surgery, and oncology. The package for surgical or defined day-care benefits includes the following:

• Registration charges
• Nursing and boarding charges
• Bed charges for the general ward
• Fees of consultants, surgeons, anesthetists, and other medical practitioners
• Oxygen, blood transfusion, anesthesia, cost of surgical appliances, OT charges, and more
• Cost of implants and prosthetic devices unless payable separately.
• Pathology and radiology tests like MRI, CT scan, X-ray, and more
• Food for patients
• Pre-hospitalization expenses: Any expense required for consultation, medicines, and diagnostic tests before admitting the patient to the hospital.
• Post-hospitalization expenses: Any expense required for consultation, medicines, and diagnostic tests for up to 15 days of discharge from the hospital for the same disease or injury.

Ending Note

If you understand what health insurance is, you will find it easy to grasp the concept of the Ayushman Bharat Yojana. The scheme is meant for people in the low-income group who cannot afford a health insurance policy.