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.

Ayushman Bharat Yojana logo. The associated article talks about features of the scheme and eligibility details

Published: January 23, 2020 at 1:57 pm

Last Updated on

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.

Before we begin, you can now watch for free the first lecture of the goal-based portfolio management lecture series. The contents of the course and FAQ can also be found there.

What is Ayushman Bharat Yojana? 

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.

 

Join our 1200+ Facebook Group on Portfolio Management! Want to know how to reduce fear, doubt and uncertainty while investing for financial goals? Sign up for our lectures on goal-based portfolio management and join our exclusive Facebook Community

 

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.

Do share if you found this useful
Join our 1200+ Facebook Group on Portfolio Management! Want to know how to reduce fear, doubt and uncertainty while investing for financial goals? Sign up for our lectures on goal-based portfolio management and join our exclusive Facebook Community

Hate ads but would like to support the site? Subscribe to our ad-free newsletter and get beautifully formatted full articles delivered to your inbox!

About the Author

Pattabiraman editor freefincalM. Pattabiraman(PhD) is the founder, managing editor and primary author of freefincal. He is an associate professor at the Indian Institute of Technology, Madras. since Aug 2006. Connect with him via Twitter or Linkedin Pattabiraman has co-authored two print-books, You can be rich too with goal-based investing (CNBC TV18) and Gamechanger and seven other free e-books on various topics of money management. He is a patron and co-founder of “Fee-only India” an organisation to promote unbiased, commission-free investment advice.
He conducts free money management sessions for corporates and associations on the basis of money management. Previous engagements include World Bank, RBI, BHEL, Asian Paints, Cognizant, Madras Atomic Power Station, Honeywell, Tamil Nadu Investors Association. For speaking engagements write to pattu [at] freefincal [dot] com

About freefincal & its content policy

Freefincal is a News Media Organization dedicated to providing original analysis, reports, reviews and insights on developments in mutual funds, stocks, investing, retirement and personal finance. We do so without conflict of interest and bias. We operate in a non-profit manner. All revenue is used only for expenses and for the future growth of the site. Follow us on Google News
Freefincal serves more than one million readers a year (2.5 million page views) with articles based only on factual information and detailed analysis by its authors. All statements made will be verified from credible and knowledgeable sources before publication. Freefincal does not publish any kind of paid articles, promotions or PR, satire or opinions without data. All opinions presented will only be inferences backed by verifiable, reproducible evidence/data. Contact information: letters {at} freefincal {dot} com (sponsored posts or paid collaborations will not be entertained)

Connect with us on social media

Our Publications


You Can Be Rich Too with Goal-Based Investing

You can be rich too with goal based investingThis book is meant to help you ask the right questions, seek the right answers and since it comes with nine online calculators, you can also create custom solutions for your lifestyle! Get it now. It is also available in Kindle format.
   

Gamechanger: Forget Startups, Join Corporate & Still Live the Rich Life You Want

Gamechanger: Forget Start-ups, Join Corporate and Still Live the Rich Life you wantThis book is meant for young earners to get their basics right from day one! It will also help you travel to exotic places at low cost! Get it or gift it to a young earner

Your Ultimate Guide to Travel

Travel-Training-Kit-Cover-new

This is a deep dive analysis into vacation planning, finding cheap flights, budget accommodation, what to do when traveling, how traveling slowly is better financially and psychologically with links to the web pages and hand-holding at every step. Get the pdf for Rs 199 (instant download)  

Free Apps for your Android Phone

Comment Policy

Your thoughts are the driving force behind our work. We welcome criticism and differing opinions.Please do not include hyperlinks or email ids in the comment body. Such comments will be moderated and I reserve the right to delete the entire comment or remove the links before approving them.

5 Comments

  1. I really like how clear and concise this article is written. To portray the merits and salient features in an apolitical way is also commendable.

  2. Dear Sir,
    Nice article giving the details in a crisp manner. I would like to add some salient points though.
    In general, only procedures are included for free. Many times the disease of the patient does not come under any possible heading and thus the patient does not get benefit of the scheme
    Secondly, although the limit per family is Rs 5 Lacs, this whole amount is not available for a single procedure. Every procedure has a capping on the amount that can be sanctioned (this too varies from state to state). These capped amounts are not viable for private hospitals since they have many over heads unlike govt hospitals.
    Thanks
    Dr M Kishan

Leave a Reply

Your email address will not be published. Required fields are marked *