What Is Ayushman Bharat Health Insurance, How Does It Work?
Updated On May 31, 2022
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The world’s biggest healthcare scheme was launched on 23rd September 2018 by PM Modi in Ranchi, the capital of Jharkhand. It became operational on 25th September, which also marks the birth anniversary of Pandit Deendayal Upadhyaya.
Since its launch, the scheme has been renamed as PM Jan Arogya Yojana (PMJAY). It offers insurance cover of Rs 5 lakh per family. About 50 crore citizens stand to benefit, and it covers only the poor and economically backward segment.
Who Does The Scheme Cover?
The scheme is aimed at providing insurance cover to economically backward people in rural and urban areas who will be identified on the basis of data from the Socio-Economic Caste Census (SECC) 2011. The cover will be Rs 5 lakh per family per year.
The entire process is paperless and cashless in public hospitals and empanelled private hospitals. Also, to include more women and children in the scheme, there’s no limit on the age and size of the families. The more specific eligibility criteria for this scheme are given below:
For rural areas:
- Families living in only one room with kachcha walls and kachcha roof
- Families with no adult members aged between 16 and 59
- Female-headed family with no adult male member in the 16-59 age group
- Families having at least one disabled member and no able-bodied adult member
- SC/ST households
- Landless households deriving a major part of their income from manual casual labour
- Destitutes and those surviving on alms
- Manual scavenger families
- Tribal groups
- Legally-released bonded labourers
For urban areas:
The following 11 occupational categories of workers are included in the list by the government:
- Ragpicker
- Beggar
- Domestic worker
- Street vendor/cobbler/hawker/ other service providers working on the streets
- Construction worker/ plumber/ mason/ labour/ painter/ welder/ security guard/ coolie and other head-load workers
- Sweeper/ sanitation worker/ gardener
- 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
- Washerman/ chowkidar
The scheme aims at addressing the shortcomings of Rashtriya Swasthya Bima Yojana (RSBY). Hence, it also includes the beneficiaries of the RSBY scheme in all the states where it is active.
How Does The Scheme Work?
The scheme covers medical expenses for secondary care and most tertiary care procedures. No premium needs to be paid by the beneficiaries for the insurance cover. The insurance includes pre- and post-hospitalisation expenses.
All the empanelled hospitals will have ‘Ayushman Mitra’, a person recruited to coordinate with the beneficiaries of the scheme and provide assistance to patients. A helpdesk will also be provided at all the empanelled hospitals to identify eligibility, authenticate documents, and assist in the enrolment process.
Eligibility shall be checked by various processes, which include inspecting letters with QR codes that belong to be beneficiaries and authenticating the same. Those who wish to enrol for the scheme will be identified by the government through various means, but there are certain documents they will need to possess. A bank account is the most basic of these requirements.
Conclusion
This provides farmers with an exclusive option to open a basic savings bank deposit account with facilities such as zero account maintenance and zero initial pay-in. These would go a long way in helping people in rural areas and set India on track towards a better standard of living.
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