Ayushman Bharat Scheme: All You Must Know

The Prime Minister Narendra Modi had introduced many people-friendly schemes during his first term. Ayushman Bharat Scheme or National Health Protection Scheme or Pradhan Mantri Jan Arogya Yojana (PMJAY) is a government-sponsored health insurance plan introduced in 2018.

It is one of the famous initiatives of PM Narendra Modi. The plan comes under the Ayushman Bharat Mission of the Ministry of Health and Family Welfare (MOHFW). Ayushman Bharat Scheme has two elements:

1) Health and Wellness Centres

2) National Health Protection Mission (AB-PMJAY).

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Health and Wellness Centres

The Government had allocated Rs 1,200 Crores to create 1,50,000 health and wellness centres across India, to bring healthcare closer to the common man. There is a proposal to upgrade the existing public healthcare centers, to health and wellness centers.

See Also: Ayushman Bharat To Cover 75% Indians

Healthcare Services Offered at Health and Wellness Centers

• Eye care
• Dental care
• Pregnancy care
• Maternal health services
• Child health
• Mental diseases
• Infant health services
• Non-communicative illnesses
• Geriatric care

Features of National Health Protection Mission (AB-PMJAY):

• The Government offers health insurance cover of up to Rs 5,00,000 per family each year.
• Ayushman Bharat Scheme is expected to cover more than 10.74 crore poor and underprivileged families in India.
• This exclusive health insurance plan has no cap on the size of a family and the age of the members of a family.
• Ayushman Bharat Scheme covers the families that have been listed in the Socio-Economic Caste Census (SECC) database only.
• Pre and post-hospitalization expenses are covered under the plan, which also covers pre-existing conditions from the policy issue date.
• Beneficiaries are entitled to cashless benefits from private (empanelled) and public hospitals anywhere in India. They also get a fixed amount of transport allowance per hospitalization.            
• The scheme benefits are transferrable across the country.
• Both public sector healthcare centers and the health care centers belonging to Employee State Insurance Corporation (ESIC) shall be empanelled for Ayushman Bharat Scheme. Private hospitals shall be empanelled online on the basis of certain criteria.
• The government defines the package rate, which is used to pay medical expenses. It assures a cashless transaction for beneficiaries.

See Also: Ayushman Bharat Yojana - National Health Protection Scheme

Eligibility Criteria for Ayushman Bharat Scheme in Urban and Rural Areas

• Families that have a single room with kuccha walls and kuccha roofs.
• Female-run families with no adult male member between the age group of 16-59 years
• ST or SC families and disabled members
• Families with no land
• Families with no shelter in rural areas
• In case of urban areas, street vendors, domestic workers, beggars, construction workers, painters, security guards, home-based workers, sanitation workers, transport workers, car pullers, rickshaw pullers, cart pullers, shop workers and so on, are covered.

Indian States Planning to Implement Ayushman Bharat Scheme:

As of 15^th June 2018, 20 states were interested in implementing Ayushman Bharat Scheme by signing a Memorandum of Understanding (MOU) with the Union Ministry of Health and Family Welfare. The states that were likely to adopt the insurance model include Jammu and Kashmir, Jharkhand, Haryana, Chhattisgarh, Meghalaya, Uttarakhand and Tripura. The Union Territories of Dadra and Nagar Haveli, Daman and Diu, and Chandigarh also supported the insurance model.

Andhra Pradesh, Bihar, Madhya Pradesh, Assam, Bihar, Manipur, Pondicherry, Goa, Sikkim, Arunachal Pradesh, Telangana and Lakshadweep were interested in adopting the trust model. On the contrary, Tamil Nadu, Maharashtra, Himachal Pradesh, Rajasthan, Kerala and Mizoram were interested in adopting the hybrid model.

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