Healthcare is a major concern for any government. The Indian government and India’s Health Minister understood the importance of healthcare and hence launched the Ayushman Bharat scheme which is a branch of the Pradhan Mantri Jan Arogya Yojana.
What is the Ayushman Yojana?
In simpler terms, the Ayushman Yojana is basically the biggest health insurance scheme set out by the Indian government. It basically covers the family with healthcare insurance of ₹5 lakhs per family. The scheme covers up to 10 crore families in the country.
What are the benefits available?
- The medical scheme is now known as Pradhan Mantri Jan Arogya Yojana (PMJAY) and aims at making secondary and tertiary healthcare and facilities entirely cashless.
- Under this scheme, 3 and 5 days of pre- and post-hospitalization expenses are taken care of by the government of India.
- Moreover, the scheme covers over 1400 medical protocols and procedures, including operation theater expenses. Each family is allocated Rs. 5 lac per year to obtain healthcare facilities and services easily. It is a cashless health insurance scheme.
- The government also allocates transport allowance per hospitalization.
- To ensure that a large number of beneficiaries are covered, there is no limitation on the number of family members and their age.
- Payment for medical treatments is based on various packages and their subsequent rates.
Who all are eligible?
As per the socio-economic census of 2011, all families and individuals registered under Rashtriya Swasthaya Bima Yojana are eligible for Pradhan Mantri Ayushman Bharat Yojana. The National Sample Survey Organization revealed in the 71st round that over 85.9% of rural families have no access to any medical insurance. Moreover, 24% of these families obtain medical facilities by borrowing money from others. In rural parts of India, Pradhan Mantri Ayushman Bharat Yojana includes the following:
- People living in the households that belong to scheduled caste and scheduled tribes
- Families wherein male member(s) is 16–59 years old
- Families wherein no member is 16–59 years old
- People surviving on alms and begging for money
- Families with minimum one member with special needs
- People belonging to landless households and who work as casual manual laborers to obtain money
- Primitive tribal communities
- Laborers who are legally released and bonded
- Families living under one-room makeshift houses without proper walls and roof to support
- Manual scavenger families
The National Sample Survey Organization revealed in the 71st round that over 82% of urban families have no access to any medical insurance. Moreover, 18% of these families obtain medical facilities by borrowing money from others. In urban parts of India, Pradhan Mantri Ayushman Bharat Yojana includes the following:
- Those who pick rag
- Mechanics, electricians, and repair workers
- Those into domestic helping services
- Sanitation workers, gardeners, and sweepers
- Home-based or handicraft artisans and tailors
- Cobblers, hawkers and others providing labor services by working on street-side
- Those associated with plumbing, construction work, porting, welding, and painting
- Transport workers, such as drivers, conductors, helpers, and cart/rickshaw pullers
- Assistants and servants in small establishments
- Delivery agents, shopkeepers, and waiters
Along with inclusion criteria, Pradhan Mantri Ayushman Bharat Yojana has defined its exclusion criteria as well. The exclusion includes the following:
- People owing 2–4 wheeler vehicle or a motorized fishing boat
- People owing merchandized farming equipment and instrument
- People holding Kisan cards, which allows a credit limit of Rs. 50,000
- People who are already employed by the government of India
- People working at government-operated nonagricultural enterprises
- People earning Rs. 10,000 or more per month
- People owing refrigerators and/or landlines
- People living in solid houses
- People owing 5 acres or more of agricultural land
What critical diseases are covered under the scheme?
The scheme covers a plethora of critical illnesses, some of which are prostate cancer, coronary artery bypass grafting, double valve and pulmonary valve replacement, carotid angioplasty with stent, skull base surgery, Laryngopharyngectomy along with gastric pull-up, spine fixation, and tissue expander for disfigurement after skin burns. The Central government has decided to provide free testing and treatment of Coronavirus under the Ayushman Bharat Yojana. However, medical conditions, such as outpatient department facilities, drug rehabilitation programs, procedures associated with fertility and cosmetics, organ transplantation, and individual diagnostic services, are excluded from the scheme.
How to check details with regards to the scheme?
If you are willing to enroll for the scheme and know if you are eligible for it, here is how you can go about it. To check the beneficiary list, these are the methods you can follow:
- Common Service centers: You can check out with the nearest Common Service Centres and you can also find out about your HHID from such centers, or even impaneled hospitals.
- Helpline number: You can also get in touch with the helpline numbers provided by the government. The numbers are 14555 and 1800111565
- Online: To check details online, you can visit https://mera.pmjay.gov.in and click on the “Am I eligible” tab. Once you fill in the details, you will receive an OTP. Post this OTP in the given slot, and you can select your region and pull out the information you need. You can get your HHID number here.
The government has a system in place to elevate healthcare insurance and make sure that people – including those below the poverty line and even rural population get to avail of the benefits of better healthcare facilities.