Ayushman Bharat health insurance :On this day three years ago, Narendra Modi became Prime Minister and unveiled the Pradhan Mantri Jan Arogya Yojana (PM-JAY), also known as Ayushman Bharat. According to the National Health Authority website, PM-JAY is considered as the world’s largest health insurance scheme, providing 5 lakh coverage annually to over 10.74 crore vulnerable and low income families (approximately 500 million beneficiaries) within India’s bottom 40% population.
In addition to other diseases and ailments, the Ayushman Bharat health insurance scheme includes Covid-19. According to NHA regulations, testing and treatment of Covid-19 can be done free of charge in one of the hospitals enrolled in the scheme. Furthermore, private hospitals that adhere to Quarantine requirements will also be covered under this insurance.
Here we explore the key characteristics of this program, its covered benefits and how to determine eligibility.
Who is eligible to apply for Ayushman Bharat?
Rurals households included are then ranked according to their deprivation status according to seven standards (D1 through D7), while urbans households are classified according to occupation categorys.
Rural beneficiaries:
PM-JAY used seven deprivation criteria for rural areas, Criteria:
- D1- One room that has kucha walls as well as the Kucha roof
- D2- There is no adult member between the ages of 16 and 59
- D3- Households that do not have an adult male in the household between 16 and 59
- D4- Disabled Member and an adult with no ability
- D5-SC/ST household
- D7-Landless families obtaining the majority of their earnings from manual labor
Urban beneficiaries
In urban regions, The following types of occupations are eligible to participate in the scheme:
- Ragpicker
- Beggar
- Domestic worker
- Street vendor/ Cobbler/hawker another service provider who works on the streets
- Construction worker/ plumber/ Mason/ Labor Painter/Welder/ Security guard/coolie and other workers with headloads
- Sweeper/ Sanitation worker/ Mali
- Home-based worker/Artisanor Handicraftsor Tailor
- Transport worker/ driver/ conductorAide to conductors and drivers Cart puller or Rickshaw puller
- Shop worker/ assistant Peon in a small establishment/Helper/Delivery assistant/Attendantor waiter
- Electrician/MechanicAssembler/Repairman
- Washer-man/ Chowkidar
What’s the hospitalization process?
Beneficiaries will not have to foot the bill for hospitalization expenses. Furthermore, this benefit covers both pre-hospitalization and post-hospitalization expenses.
Every hospital that is accredited has an Ayushman Mitra who will assist patients and work together with beneficiaries and the hospital. They operate a help desk and review documents to determine eligibility and enrollment into the scheme.
Furthermore, all beneficiaries will receive letters with QR codes which will be scanned. A demographic verification will then take place to identify each beneficiary and confirm their eligibility to take advantage of the scheme.
Benefits of the scheme can be transferred across India. Participants in the program are eligible to receive cashless benefits from any hospital in India – public or private – regardless of location.
What’s included?
To guarantee hospitals don’t charge too much and rates don’t differ among hospitals, impaneled medical healthcare service providers (EHCP) are compensated based on package rates. Packaged care refers to all costs associated with a procedure, including hospitalization and pre-hospitalization fees. In certain cases, boxes for specific surgeries are paid out as bundled care (explained below), when insurers/SHAs make one lump sum payment directly to EHCP for all inclusive coverage.
The EHCP pays medical packages daily according to the admission unit (general Ward, HDU or ICU), plus any add-ons that have been predetermined and paid separately. Day care packages are paid just like surgical packages. These treatment plans are comprehensive and include treatments for 24 specialties that provide the most cutting-edge care, such as oncology, neurosurgery, cardiothoracic surgery and cardiovascular surgery. The cost of the package (if it includes defined daycare or surgical benefits) includes:
- Registration fees
- Charges for bed (General Ward)
- Fees for nursing and boarding
- Surgeons, Anaesthetists, Medical Practitioners, Consultants’ fees, etc.
- Anesthesia, Blood Transfusion, Oxygen, O.T. Charges, Costs for surgical equipment, etc.
- Medicines and Drugs
- Cost of Prosthetic Implants, devices, etc. (unless paid separately)
- Radiology and pathology tests: radiology may consist of but are not restricted to Xrays, MRI, CT Scan, and more. (as applicable)
- Food for patients
- Pre and post hospitalization costs (Expenses for consultation or diagnostic tests, as well as medicines before the admission of a patient to the hospital, and for up to 15 days after the patient’s release from hospital due to the same condition or surgery.
- Other expenses that are related to the care of the patient as part of the EHCP
Documents are required
To receives benefits under the Ayushman Bharat Yojana, an eligible person must prove their eligibility by presenting evidence like the Aadhaar card, Voter ID card, or ration cards.
What can you do to determine if you are qualified to be eligible for PMJAY?
- Visit the official website of the government.
- Click on the tab ‘Am I Eligible?’
- Enter your phone number and CAPTCHA code, and click “Generate OTP.”
- Input the information, which includes the state of your residence, your name, the number of your ration card, and household number
- If your family is covered by PMJAY, your name will be highlighted on the screen.
You can also verify this by dialing 14555 and the 1800111565 assistance number.
What’s the process of enrolment? Do you have a deadline for enrollment?
PM-JAY is an entitlement-based mission, and there isn’t an enrolment procedure. Families recognized by the government based on deprivation and other measures through the SECC database in urban and rural areas are eligible for PM-JAY.
Does the recipient give a gift card?
Families eligibles for PM-JAY ID number will be assign a unique PM-JAY ID number and an ecard will be distributed durings hospitalization.
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