Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana: What you need to know | Tomorrowmakers

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana is claimed to be the world’s biggest government-sponsored healthcare scheme. Here’s a look at its benefits and eligibility criteria.

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana What you need to know

In his Independence Day address in August this year, PM Modi announced the launch of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PMJAY), India’s largest health insurance scheme. Hailed as the biggest government-sponsored healthcare scheme in the world, this will offer an insurance cover of Rs 5 lakh per family and cover almost 50 crore citizens.

In this article we shall discuss in detail the benefits and the eligibility criteria for this health program. But first let’s understand why the need was felt for such a health insurance scheme.

India does not have a comprehensive government health insurance scheme. In the event of sickness or hospitalisation, most citizens end up paying more than three-fourths of their healthcare cost out of their own pockets. Getting proper medical care can be really tough for those living below the poverty line. Ayushman Bharat has been designed to help such families. 

Related: Health Insurance 101 

Who is covered under this insurance scheme?

The mission aims to cover 10 crore families. The Rs 5 lakh cashless family floater insurance scheme covers all members of the household for one year. Members can be added to the insurance with the government’s approval.

There is no cap on family size, age, or gender. All members of eligible families as present in the latest Socio Economic Caste Census (SECC) database are automatically covered by this scheme. Existing Rashtriya Swasthya Bima Yojana (RSBY) beneficiaries and even those who are a part of similar schemes in other states will be included.

What is covered under the scheme?

Families insured under Ayushman Bharat will be covered for up to 1354 medical and surgical packages that have been categorised under 25 separate specialties – which include cardiology, neurosurgery, oncology (chemotherapy for 50 types of cancers), burns, etc. Patients can avail of any one package – either surgical or medical – at one time.

Related: Budget 2018 Proposes major advances in the healthcare sector  

What are the key benefits of Pradhan Mantri Jan Arogya Yojana?

While the biggest benefit is the Rs 5 lakh cashless cover that families enjoy, there are other benefits that make the program appealing to the common man.

  • The scheme covers all pre-existing conditions from the day the policy comes into effect.
  • Insured families can visit a public or empanelled private hospital anywhere in the country and get free treatment.
  • Hospitalisation expenses – including registration, nursing, and boarding charges in a general ward – are all covered by the insurance policy.
  • The scheme also takes care of surgical equipment, consultation fees, and procedure charges, as well as cost of implants, medicines, diagnostic tests, and food for patients during their hospital stay.
  • All follow-up care, including pre- and post-hospitalisation expenses, will be taken care of.
  • The insured family pays no money towards treatment in case of hospitalisation.
  • In the event the insured individual requires multiple surgeries, the highest package rate will be waived for the first treatment; and 50% and 25% of the expense will be provided for the second and third treatment respectively.
  • To receive treatment at any registered hospital, the injured family member must carry the prescribed ID.

Related: Healthcare rates could be 20% lower than CGHS under modicare 

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana: What you need to know

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How to check your eligibility online

1) On the landing page of the ‘Am I Eligible’ portal, you must enter an active mobile number (to get an OTP) and then the captcha letters displayed on the screen. Then click on the ‘Generate OTP’ button. You will receive an OTP as a text message at the mobile number entered. Enter this and click on ‘Verify OTP,’ which takes you to a page where you can enter search details.

2) An individual can search whether he/she is an eligible beneficiary for Pradhan Mantri Jan Arogya Yojana using the following:

Mobile number/Ration card Number: An Additional Data Collection Drive (ADCD) was conducted on 30th April 2018 at all Gram Sabhas across India to capture active mobile numbers and ration card numbers of families in the SECC database. Only if the individual got their mobile number or ration card number captured during this drive will it show up on the portal. If despite doing this no results are displayed, search using the ‘SECC Name’ option.

SECC Name: Individuals can search if they are eligible for Pradhan Mantri Jan Arogya Yojana using the details as per the SECC database – name, father’s name, gender, state, etc. If no results are displayed even now, contact a nearby Ayushman Mitra.

RSBY URN: Additionally, all active families that are enrolled under RSBY (till 31st March 2018) that do not feature in the targeted groups as per SECC data will be included; they can identify if they are eligible for Pradhan Mantri Jan Arogya Yojana using their RSBY URN.

3) If the search is successful, the individual has an option to receive a text message with the HHID number/ RSBY URN in future on their phone by clicking the ‘Get SMS’ button and entering the mobile number. Note: This mobile number can be different from the one used in the first step for OTP generation.

Related: Here's how getting healthy today can save you additional costs later 

How to check your eligibility offline

You can also check your eligibility for Ayushman Bharat by calling the helpline number 14555.

Ayushman Bharat is an ambitious project by the Government of India that aims to offer a comprehensive health insurance plan to the economically weaker sections of the society, thereby making healthcare affordable and accessible to the country's economically weaker section.  

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