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Ayushman Bharat Yojana

 

Introduction:

 

Ayushman Bharat Yojana is a health care program undertaken by the Indian Government to support the welfare of the poor. It contains 2 major health programs, the Health and Wellness Centre (HWC) and the Pradhan Mantri Jan Arogya Yojana (PMJAY).

 

Under the PMJAY program, more than 10 crore families are covered by health insurance of INR 5 Lakh. The plan promises free medical treatment in public hospitals and the provision of private hospitals. In addition, expensive surgeries such as knee replacement, heart transplants, etc. are covered.

 

The main benefit of the PMJAY program is to provide financial protection during unforeseen events. In addition, it offers a number of other benefits to ensure financial aid throughout their lives.

 

 

Recent Updates:

 

Inadequate government institutions make it difficult for low-income families to afford quality health care. To this end, the Indian Prime Minister unveiled a government-sponsored health care program known as Ayushman Bharat Yojana in September 2018.

 

In fact, recent developments in the Union Budget 2020 have revealed that among the INR 69,000 crore allocated to the healthcare sector, INR 6,400 crore was awarded to Ayushman Bharat Yojana.

 

As a result of the launch of Ayushman Bharat Yojana, many qualified families throughout India are unaware of this. To get the benefits under Ayushman Bharat Yojana, it is necessary to understand the basics of this scheme. And we are here to help you with that.

 

 

Key Benefits - PMJAY Scheme:

 

Treatment is available for all vulnerable families in India. However, the states, which have opted out of Ayushman Bharat Yojana, are unable to access medical services.

  • Prioritizes Indian girls, women, and adults.

  • Includes existing diseases, preschool treatments, follow-up, and so on.

  • One can get treatment at all the tertiary and secondary hospitals in India.

  • Provides benefits of national portability in India. Every citizen has the right to receive services from anywhere in the country.

Ayushman Bharat Yojana runs a strong citizen network under the program. However, the eligibility process for the scheme must be met before selecting a policy.

 

PMJAY Scheme – Working:

 

The scheme pays close attention to the medical expenses incurred by the secondary and tertiary care systems. You (the beneficiary) do not have to pay any insurance coverage premiums. The health insurance plan includes pre and post-hospital expenses.

 

Visit the official PMJAY site and under the 'Hospital' section select 'Find a Hospital' to get to know the accredited hospitals in your region. All these connections of state and private hospitals have a specialist 'Ayushman Mitra' - a person appointed to communicate and coordinate with the beneficiaries of the program. 

 

The specialist will be available at the equipped hospital and will assist you in determining eligibility, verifying the documents, and guiding you through the registration process.

 

Human suitability is assessed by a number of procedures. It involves checking documents with QR codes that belong to the beneficiary and verifying them accordingly. People registered for the program are identified by the government in various ways, but they need to have certain documents. One of the most basic requirements is a bank account.

 

 

Eligibility Criteria - Ayushman Bharat Yojana:

The eligibility process is divided into 2 broad categories:

  • Urban sector

  • Rural sector

URBAN SECTOR

RURAL SECTOR

Rag pickers and beggars

Bonded laborers


Domestic workers

Scheduled caste and Scheduled tribes

Street vendors

Landless households

Construction works, plumbers, security guards, and so on

Manual scavengers

 

How to Apply for Ayushman Bharat Yojana?

 

Follow these steps to apply for Ayushman Bharat Yojana-

  • Visit an empanelled hospital and look for Ayushman Mitras who will assist you with admission

  • They will confirm your eligibility under the PMJAY program

  • Next, they will prove your authenticity (either with an Aadhaar card or ration card)

  • The hospital you want to treat will look at the balance

  • You will be asked to submit the required medical evidence

  • The claim will be paid after hospitalization, after submitting a summary of the discharge and proof of treatment after treatment.

Once your eligibility is confirmed, the beneficiary is referred to the PMJAY Kiosk where Pradhan Mantri Arogya Mitra (PMAM) will verify the identity of the beneficiary and eligibility through the Beneficiary Identification Program (BIS). Once this is cleared, beneficiaries are issued an e-card.

Steps verification for online eligibility - Ayushman Bharat Yojana: 

  • Go to the official PMJAY site

  • Click on the 'I am eligible' option on the website

  • Enter your name, phone number, share card number, or Rashtriya Swasthya Bima Yojana URN number. Upon submitting your mobile number, you will receive an OTP

  • Submit a received OTP

  • Choose your state of residence

  • Click on the search button once you have completed all the relevant details. When you click a search, a list of names will fall under the category

  • Look at your name on the list

After checking your eligibility online, you should look forward to the Ayushman Bharat registration process and the application process. In the unlikely event that you do not qualify for this program, it is advisable to check other health insurance programs available in the market to protect yourself and your family in the event of a medical emergency.

 

Registration Process:

  • Create a patient verification card for your beneficiaries. In the making of the cards, the patient is directed to the PMJAY store.

  • Inform yourself of all applicable payments and fees associated with the PMJAY Scheme.

  • Confirm any illnesses or illnesses that may arise from your attending doctors.

  • Get medical treatment or prescriptions in case they lead to severe disease. If hospitalization is recommended, seek medical help from the Empanelled Healthcare Provider (EHCP) or Government hospitals.

  • After completion of treatment, get a certificate/debt/discharge invoice.

 

Necessary Documents:

  • Proof of age

  • Valid proof of age is required to select Ayushman Bharat Yojana.

  • Identification

  • Provide proof of identity as a PAN card or Aadhar Card.

  • Contact Details

Send your current information such as your mobile number, email ID, residential address. Contact details must be stated accurately as it is the only source of contact with the policyholder.

 

Certificates:


One has to submit 2 different certificates while choosing Ayushman Bharat Yojana. The required certificates are as follows:

  • Income certificate

  • Caste Certificate

  • Family Building

During the registration of Ayushman Bharat and the application process, one must specify their family structure. For example, one should state whether one lives in a nuclear family or a joint family.

 

Treatment at the hospital:

  • PMAM informs the beneficiary of the total cost of treatment. Depending on the severity of the illness, the recipient may be prescribed medication or hospitalized.

  • It should be noted that if the beneficiaries are not hospitalized and are given standard treatment, they will have to bear the cost of treatment.

  • However, if the condition is serious and requires hospitalization, beneficiaries can receive free treatment within a skilled hospital.

  • Upon completion of treatment, the beneficiary will be discharged from the hospital.

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