In his Independence Day speech of 2018, Prime Minister Shri Narendra Modi made an announcement that caught the attention of the nation—the introduction of the Ayushman Bharat Yojana, also known as PMJAY. This ambitious initiative, funded by the Government of India, aims to provide comprehensive health protection to citizens and stands as a prominent program under the leadership of the Prime Minister. The Pradhan Mantri Jan Arogya Yojana (PMJAY) holds the distinction of being a flagship National Health Protection Scheme, reflecting the government’s commitment to the well-being of its people.
The Ayushman Bharat Yojana, commonly referred to as AB-PMJAY, is a comprehensive scheme that encompasses and integrates the best health insurance for senior citizens Scheme (SCHIS) and the Rashtriya Swasthya Bima Yojna (RSBY). This unified program is designed to extend its benefits not only to economically disadvantaged individuals but also to rural families. By catering to the needs of both poor and destitute households in rural and urban areas, the Ayushman Bharat scheme serves as an economically advantageous initiative, aiming to improve the healthcare accessibility and affordability for a wide range of communities.
Ayushman Bharat Yojana Sum Insured and Other Benefits
Let’s explore the key features of the Ayushman Bharat Yojana:
- Comprehensive Family Floater Coverage: Each enrolled household is entitled to a family floater health insurance plan that provides a sum assured of ₹ 5 Lakh per annum. This coverage ensures that medical expenses are taken care of in case of hospitalisation or treatment.
- Targeted for Individuals Below the Poverty Line: The Ayushman Bharat Yojana is specifically designed to cater to individuals who fall below the poverty line. It aims to provide financial protection to those who are most in need of healthcare assistance.
- Cashless Healthcare Services: Beneficiaries of this scheme have access to cashless healthcare services across a wide network of both private and public sector hospitals. This enables them to receive necessary medical treatments without any financial burden at the point of service.
- Coverage for Pre-existing Diseases: The insurance scheme also offers coverage for certain pre-existing diseases. This ensures that individuals with pre-existing health conditions are not denied the necessary medical attention and treatment they require.
- Transportation Expense Support: This also provides transportation expenses during pre and post-hospitalisation periods. This feature helps alleviate the financial burden of travel costs related to medical care.
- Establishment of Healthcare and Wellness Centers: The government-backed health scheme aims to establish various healthcare and wellness centres based on data from the socio-economic caste census. This initiative ensures that healthcare facilities are set up in areas where they are most needed, providing accessible medical services to the eligible population.
Eligibility Criteria
People who need to access benefits of Ayushman Bharat Yojana health insurance scheme, need their names verified in the Socio-Economic Caste Census-2011 data. This step ensures that their families are eligible for coverage under the Ayushman Yojna. Only households listed in the SECC database and possessing active RSBY cards are entitled to avail the benefits provided by the PMJAY.
Eligibility Criteria for Rural under the PMJAY Scheme:
- Households without any adult/male/earning member between the ages of 16 and 59 years
- Families living in one-room dwellings with kuccha walls and roofs
- Families without any members aged between 16 and 59 years
- Households lacking a healthy adult member but having one disabled member
- Families engaged in manual scavenging
- Landless households are primarily dependent on manual labour for their family income
Eligibility Criteria for Urban under the PMJAY Scheme:
- Domestic workers
- Beggars
- Ragpickers
- Home-based artisans/tailors, sweepers, handicraft workers, sanitation workers, and gardeners
- Construction workers, labourers, painters, welders, security guards, and coolies
- Washer-men, plumbers, and masons
- Electricians, mechanics, assemblers, and repair workers
- Transport workers, rickshaw pullers, conductors, and cart pullers
- Waiters, shop workers, assistants, peons, and delivery assistants
- Street vendors, hawkers, and cobblers
Wrapping Up
The PM Ayushman Bharat Yojana scheme has introduced a seamless and efficient approach by going paperless, while providing cashless hospitalisation coverage at both public hospitals and a network of private hospitals. This comprehensive best health insurance plan encompasses various aspects of medical care, including the expenses associated with hospitalisation, pre-hospitalisation, medication, and post-hospitalisation costs incurred during the treatment process. These benefits are applicable to a wide range of tertiary and secondary care procedures, ensuring that individuals receive the necessary financial support.
Under the Ayushman Bharat Yojana scheme, an extensive list of approximately 1,400 advanced treatments, such as skull surgery and knee replacements, is included. This inclusive approach aims to cater to the diverse medical needs of patients. Also, the scheme recognises the importance of follow-up treatments for ensuring complete recovery, allowing patients to receive ongoing care and support. Make sure to consult the right insurance company to guide you well throughout!