Ayushman Bharat health insurance: Today, exactly three years ago, the Prime Minister was elected. Narendra Modi It was launched in it. It’s called the Pradhan Mantri Jan Arogya Yojana (PM-JAY), also referred to informally as Ayushman Bharat. As per the official National Health Authority (NHA) website, the Ayushman Bharat PM-JAY is the most significant health insurance scheme in the world that will provide health insurance coverage of 5 lakh for each family every entire year, for both secondary and third hospitals to more than 10.74 crores of vulnerable and low-income families (approximately 50 million beneficiaries) who comprise the bottom 40 percent part of the Indian population.
Along with other diseases and ailments, the Ayushman Bharat health insurance scheme includes Covid-19. According to NHA, the testing and treatment of Covid-19 can be performed at no cost in one of the hospitals that are enrolled in the scheme. This insurance will also cover the Quarantine procedure at private hospitals.
Here’s a look at the main characteristics of the program, its benefits that are covered, and how to determine the eligibility.
Who is eligible to apply for Ayushman Bharat?
Rural households included (not excluded) are then ranked according to their deprivation status according to seven standards (D1 through D7). Urban households are classified by occupation category.
In the total of seven deprivation criteria used for rural areas, PM-JAY included all families that are in the most one of the six deprivation categories (D1 up to D5, D7) and automatically inclusion(Destituteor dependent on food aid, manually scavenger homes, or primitive tribal groups legally released and bonded labor) 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
In urban regions, The following types of occupations are eligible to participate in the scheme:
- 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
- Washer-man/ Chowkidar
What’s the hospitalization process?
The beneficiaries won’t be forced to pay costs or premiums for hospitalization expenses. The benefit also covers the expenses of pre-hospitalization and post-hospitalization.
Every hospital that is impaneled has an ‘Ayushman Mitra who will assist patients and work with the beneficiaries and the hospital. They will operate the help desk and review documents to determine eligibility and enrollment to the scheme.
Furthermore, all beneficiaries will receive letters with Q.R. codes that will be scanned. A demographic verification will be carried out to identify the beneficiary and verify their eligibility to benefit from the scheme.
The scheme’s benefits can be transferred across the nation. A participant in the program will be permitted to receive cashless benefits from any hospital impaneled by public or private throughout the country.
To ensure hospitals are not charging too much and that rates are not different among hospitals, impaneled medical healthcare service providers (EHCP) are compensated following the package rates. A package comprises all costs related to the procedure, including hospitalization and pre-hospitalization fees. The boxes for specific surgeries are paid out as bundled care (explained below) when a single, all-inclusive payment is made directly to EHCP by the insurer/SHA. The medical packages are paid to the EHCP daily based on the admission unit (general Ward, HDU, ICU) with specific add-ons that are pre-determined and payable separately. Day-care packages are paid precisely like surgical packages. These treatment plans are extensive and cover treatments for 24 specialties that comprise the most advanced care, such as oncology, neurosurgery, cardiothoracic surgery, and cardiovascular surgery, and so on. The cost of the package (in the case of defined day-care or surgical benefits) comprises:
- 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 receive 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 card.
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?
A unique PM-JAY ID number for families will be allocated to eligible families. An e-card will be issued to the recipients during hospitalization.