Ayushman Bharat Scheme Details – Key Features and Eligibility

Ayushman Bharat Yojana or Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY), is a nationwide program which is run by the Government of India to provide health care services to the common citizens so as to create a healthy, capable and content India.

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The program is run with 2 primary missions. Firstly, it aims to deliver primary health care services by creating a network of healthcare and wellness centres throughout the length and breadth of India. The second aim is to provide medical insurance cover to a vast majority of the population which remained beyond the coverage of secondary and tertiary healthcare till now.

Based on the Socio-Economic and Caste Census database and estimated 10 crore families (i.e. nearly 50 crores individuals) which amount to 40% of the populations will be covered under the Ayushman Bharat Yojana and will be provided with an annual health cover of Rs.500,000 per year.

This scheme was launched by the Prime Minister of India Shri Narendra Mosi on 23rd of September 2018.

Let us now the salient points of the Ayushman Bharat Scheme, who are eligible and who will get the benefits of the scheme:-

  1. The coverage is up to Rs.500,000 per family, per year
  2. As per the Socio-Economic and Caste Census database, a total of around 10 crore families (which is approx 50 crore individuals assuming 5 persons per family) will be covered by this scheme
  3. No restrictions on the age as well as the number of family members being covered. However, priority will be given to ladies, old age citizens and children
  4. This scheme will be covering a wide range of diseases including coronary bypass surgery, stenting, knee replacements etc.
  5. Pre-existing illness covered from Day 1 of the scheme commencement
  6. Fixed travel allowance is payable from one’s place of residence to the hospital where treatment is being undertaken
  7. The applicants will be required to contribute only Rs1000 to Rs1200 per year to enrol to the program and be eligible for the benefits
  8. This scheme will be covering those who are identified as poor or marginal in the Socio-Economic and Caste Census database, they will be given the benefit. There are a number of criteria for this category which are mentioned in the website of the Ayushmann Bharat Scheme, they are –
    • If a family has a kutcha roof or kutcha wall
    • there is no male of 16 to 59 years in a female-centric family
    • there is a disabled person in the family and there is no adult member,
    • Families of scheduled castes and scheduled tribes and
    • Families which have lost their land 
  9. Shelterless families, beggars, people engaged in the profession of sweeping and adivasi families (e.g. Santhali, Khasis, Naga, Apatani etc. ethnic groups) are automatically covered by this scheme
  10. The beneficiaries of Rashtriya Swasthya Bima Yojna (RSBY) in states wherever it is active are also eligible for the scheme
  11. All the services will be delivered free of cost to anybody admitted to the designated hospitals or health care centres under the scheme. In other words, this is a cashless scheme.
  12. This facility can also be availed for post-hospitalization care
  13. Adhaar card is desirable but not mandatory for availing the benefits of the scheme. What is important is that one should be able to establish one’s identity using any of the applicable identity cards like, voter id card (Election ID card), ration card etc.
  14. To know whether one is eligible, one can visit the website (mera.pmjay.gov.in) made by the National Health Agency (NHA), which is the apex body entrusted with implementing the AB-NHPM. One can also call at the helpline number 14555
  15. All the empanelled hospitals are required to have an ‘Ayushman Mitra Helpdesk’ to help a prospective beneficiary by checking his documents, verification and enrolment into the scheme
  16. To identify and verify a prospective beneficiary’s eligibility, a demographic authentication check will be conducted and after satisfactory results a letter with QR codes will be issued
  17. As of 24th September 2018, a total of 15,686 applications from various hospitals received for empanelment to the scheme and a total of 8,735 public and private hospitals have already been empanelled across India.
  18. Ayushman Bharat Scheme will cover more than 1350 packages under 23 medical specialities

Latest Update as of 7.10.2018:

The National Health Agency CEO has said on Sunday 7th of October 2018 that the Aadhaar card will NOT BE mandatory for those seeking treatment under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana for the first time. However, Aadhar will be mandatory for the second treatment onwards.

In case you need any further details please feel free to comment below.

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