Ayushman Bharat Yojana – 5 lakh health Insurance: Who is eligible?

Ayushman Bharat Yojana is a government health insurance scheme for five lakh. We consider the features of the scheme and who is eligible.

Published on / By M. Pattabiraman Twitter: @pattufreefincal / 5 Comments

Published: January 23, 2020 at 1:57 pm

Last Updated on August 30, 2021 at 9:07 am

Ayushman Bharat Yojana is a government health insurance scheme for five lakh. In this article, we discuss who is eligible for the scheme and what the features and facilities available. This is a guest post by Pratik Jain.

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What is Ayushman Bharat Yojana? 

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Ayushman Bharat Yojana(ABY) also known as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana(PM-JAY) also known as National Health Protection Scheme, is a scheme rolled by the government on 23 September 2018. It aims to provide healthcare facilities to 10.74 Crore economically weak families (approximately 50 crore Beneficiaries). PM-JAY is a Health Insurance Scheme fully funded by the government without any contribution from the beneficiary.

What are the benefits of Ayushman Bharat Yojana? 

The key benefits are, 5 Lakh Cover per family per year, All Pre-existing Diseases are Covered, cashless benefit, no restriction on Family Size, no waiting period for pre-existing diseases. These are explained below.

 

  • 5 Lakh Cover per family per year – Family will get free 5 lakh healthcare cover per year for hospitalization across all public hospitals and private empanelled Hospitals in India. As of now, 19,871 Hospitals have been empanelled in this scheme.

 

  • All Pre-existing Diseases are Covered – Unlike most Health-Insurance covers this scheme covers all pre-existing illnesses.
  • Cashless – Ayushman Bharat Yojana aims to provide a cashless process to avoid the burden of paying for healthcare facility upfront. Insured family can get the treatment from all over India.
  • Fewer restrictions – There is no restriction on Family Size, Age of person or Gender. It covers all types of people. It covers up to 1393 Procedures and both Medical and Surgical expenses. However If Multiple Surgeries are required then the highest amount is paid in full and 50% waiver on second followed by 25% on third surgical operation cost. Multiple Surgeries cannot be claimed in full simultaneously.
  • No waiting period – As said above all the pre-existing diseases are covered under this scheme. There is no waiting period for pre-existing diseases which means they are covered from the very first day.
  • Cover – This covers up to 3 days of pre-hospitalization and 15 days of post-hospitalization expenses including but not limited to diagnostics, medicine Food Services, Complications arising during treatment, Accommodation benefits, medical examination and consultation.

 

 

Ayushman Bharat Yojana Eligibility

Who is Eligible under this scheme?

The inclusion of households is based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas, respectively. This number also includes families that were covered in the RSBY but were not present in the SECC 2011 database.

For Rural Parts of India, Out of 7 Deprivation categories It covers 6 (D1 to D5and D7):

  • D1- Only one room with kucha walls and kucha roof
  • D2- No adult member between ages 16 to 59
  • D3- Households with no adult male member between ages 16 to 59
  • D4- Disabled member and no able-bodied adult member
  • D5- SC/ST households
  • D7- Landless households deriving a major part of their income from manual casual labour

For Urban Parts of India following 11 occupational category workers are Eligible:

  • Ragpicker
  • Beggar
  • Domestic worker
  • Street vendor/ Cobbler/hawker / other service provider working on streets
  • Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and other head-load worker
  • Sweeper/ Sanitation worker/ Mali
  • Home-based worker/ Artisan/ Handicrafts worker/ Tailor
  • Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ cart puller/ Rickshaw puller
  • Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter
  • Electrician/ Mechanic/ Assembler/ Repair worker
  • Washer-man/ Chowkidar

How to Check Eligibility?

You need to follow the following steps to check your eligibility for this scheme:

  1. Visit https://pmjay.gov.in and click on “Am I Eligible”.
  2. You will be asked to log in. To log in enter your Mobile Number and captcha shown in the image.
  3. Click on “Generate OTP” button.
  4. An OTP will be sent to your mobile number, which you need to enter in order to get your mobile number verified.
  5. On Next Page Enter Your State and wait for the page to reload.
  6. You will have four ways to search,  By Name, By RationCard Number, By Mobile number or HHD Number.
  7. Alternatively, to check your Eligibility you can call there call centre at 14555 or 1800-111-565.

These are the steps to know your eligibility, if you are eligible you need to visit nearest empanelled hospital or Community Service Center(CSC) to get E-Card.

Summary

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana aims at bottom 40% of the vulnerable population. This is indeed a good step towards increasing the quality of life and health of the Economically weak population.