Ayushman Bharat Health Insurance: An Introduction

A government health insurance scheme designed to cover medical expenses for individuals and families belonging to the vulnerable economic sections of society. Ayushman Bharat Insurance is the flagship health insurance scheme launched by the government of India on 25 September 2018.

’My government has been working for the last four years to empower the poor. We will launch the Pradhan Mantri Jan Aroyga Abhiyan on the birth anniversary of Pandit Deendayal Upadhyay on 25 September this year. The government decided to start the scheme to provide good healthcare facilities to the poor and common people so that for serious ailments, they also receive free health facilities in big hospitals.’

Narendra Modi, Hon’ble Prime Minister of India

Describing it as one of the biggest schemes for the common man; the Prime Minister launched the World’s Largest Health Insurance Scheme. Pradhan Mantri Jan Arogya Yojana (PM-JAY) was launched under the Ayushman Bharat umbrella to offer health coverage of INR 5 Lakhs to over 50 crore insurance holders in India.

Ayushman Bharat Health Insurance: Key Milestones

• Feb 2018: Announced 1,50,000 Health and Wellness Centres (HWCs)
• September 2018: Launched Ayushman Bharat Pradhan Mantri Bima Yojana
• December 2018: Treatments availed by 5 Lakh beneficiaries
• January 2019: 100 days of PM-JAY completed
• April 2019: Treatments availed by 20 Lakh beneficiaries
• June 2019: Treatments availed by 30 Lakh beneficiaries
• Sep 2019: 10.39 Crore e-cards issued
• Nov 2019: 20,908 hospitals empanelled, 11.4 Crore e-cards issued
• May 2020: 1 Crore hospital admissions under PM-JAY
• August 2020: 12.55 Crore e-cards issued
• July 2024: AB-PMJAY budget increased to INR 7,300 Crores from 6,800 Crores

Table Of Content

• Ayushman Bharat Health Insurance: An Introduction
• Ayushman Bharat Health Insurance: Key Milestones
• What Is Ayushman Bharat Health Insurance?
• What Is The Eligibility Criteria For Ayushman Bharat Yojana?
• Ayushman Bharat Insurance Scheme Top 10 Features
• Inclusions Of Ayushman Bharat Health Insurance Scheme
• Exclusions Of Ayushman Bharat Health Insurance Scheme
• What Is ABHA - Ayushman Bharat Health Account?
• What Are The Documents Required For Ayushman Bharat Yojana?
• Ayushman Bharat Insurance and Union Budget 2024
• Ayushman Bharat Yojana: An Inclusive Health Scheme
• How To Check Your Name In The Ayushman Bharat Health Insurance Scheme

Key Takeaways

• Ayushman Bharat Health Insurance Scheme, the world’s largest health insurance scheme covers around 50 Crore individuals in India.
• It was launched on 28th September 2018.
• The scheme fulfills the motto: "Leave no one behind."
• A unique Ayushman Bharat Health Account Number is assigned to each beneficiary.
• Check the eligibility criteria by visiting the official website of PM-JAY.

What Is Ayushman Bharat Health Insurance?

The Ayushman Bharat Health Insurance Scheme was designed to achieve Universal Health Coverage. Launching this flagship government scheme aims to meet Sustainable Development Goals and fulfil the motto: "Leave no one behind." The scheme is an attempt to move towards need-based healthcare services and has a holistic approach that includes coverage at

• Primary
• Secondary, and
• Tertiary levels.

The Ayushman Bharat focuses on 2 elements:

• Launching 1,50,000 Health and Wellness Centres bringing premium healthcare closer to people.
• The other element of Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojana or PM-JAY.

It is important to note that Ayushman Bharat Pradhan Mantri Bima Yojana is the largest health insurance scheme in the world. Over 50 crore beneficiaries are provided INR 5 lakhs coverage per family annually for secondary and tertiary care hospitalization.

What Is The Eligibility Criteria For Ayushman Bharat Yojana?

The Ayushman Bharat Health Scheme is provided to weaker economic sections of the society. To check your eligibility follow the steps given below:

Step 1 - Visit the official website of the Ayushman Bharat Health Insurance Scheme

Step 2 - Click on ’Am I Eligible’ section

Step 3 - Enter your mobile number and click on ’Verify’

Step 4 - Enter the OTP sent on your registered mobile number

Step 5 - Enter the name of the scheme, State, City, District, and Aadhar Number

Step 6 - Once all your details are entered click on the ’Submit’ button

Ayushman Bharat Insurance Scheme: Top 10 Features

Read below to explore the key features of the Ayushman Health Insurance Scheme

• A fully funded government health scheme that is implemented with the cooperation of central and state governments in India.
• Beneficiaries are entitled to avail the best cashless medical care in government and private empanelled hospitals.
• Extensive network hospitals across India are available to members covered under the scheme.
• Health and wellness centres are made accessible to families and individuals covered under the scheme for efficient medical care.
• There are no restrictions on the number of family members covered under Ayushman Bharat insurance cover.
• All pre-existing conditions are covered from day 1, unlike private health insurance plans where you have to serve a waiting period.
• Safeguards nearly 6 crore Indian individuals and families from being pushed to poverty due to medical-related expenditure.
• Covers the cost of treatment for approximately 1,929 procedures.
• The reimbursement offered to public hospitals is at par with private hospitals in the country.
• Covers pre and post-hospitalization expenses for 3 and 15 days respectively.

Inclusions Of Ayushman Bharat Health Insurance Scheme

The inclusions of the Ayushman Bharat Health Insurance Scheme are given below:

• Pre and Post-hospitalization expenses
• Cost of consultation, diagnostic tests, and treatment
• Medicine cost is covered
• Intensive care (ICU) cost is covered
• The cost of food and accommodation are covered
• Complications arising during treatment

Exclusions Of Ayushman Bharat Health Insurance Scheme

The exclusions of the Ayushman Bharat Health Insurance Scheme are given below:

• Cosmetic surgeries
• Injuries or hospitalization due to involvement in illegal activities
• Hospitalization due to adventure sports
• Drug abuse or alcohol abuse
• Fertility treatments, and more

What Is ABHA - Ayushman Bharat Health Account?

ABHA number is a 14-digit number assigned to the insured individual as a participant in India’s public digital healthcare ecosystem. ABHA number will help you across the country when you seek treatments in any cashless network hospital or medical centre.

The various benefits of the Ayushman Bharat Health Account (ABHA) are:

• It creates a unique and trustable identity across healthcare providers.
• It will link all your healthcare benefits and insurance benefits to your unique ABHA number.
• Avoid long lines at healthcare providers across India.
• Easy health data sharing among medical practitioners and insurance providers.

What Are The Documents Required For Ayushman Bharat Yojana?

Provide the following documents for the enrolment for the Ayushman Bharat Health Insurance Scheme:

• Aadhar card, Voter ID card, Passport or Driving Licence
• Electricity bill, or lease agreement for address proof
• A document that shows your economic status like an SECC identification certificate
• Family photograph
• Mobile number
• Bank account details

Ayushman Bharat Insurance and Union Budget 2024

The latest union budget of 2024 saw some development in the world’s largest public welfare health insurance scheme. Finance Minister Nirmala Sitharaman announced a budget increase from INR 6,800 crores to INR 7,300 crores.

Additionally, the sum insured cover was suggested to be increased from INR 5 lakhs to INR 10 lakhs.

Ayushman Bharat Yojana: An Inclusive Health Scheme

The Ayushman Bharat Health Insurance scheme may even cover you soon, here is how:

• Women may get special benefits as the coverage amount will be increased to INR 15 lakhs available to women in ’specific diseases and specific circumstances’.
• Ayushman Bharat Health Insurance Scheme plans to bring senior citizens above 70 years of age under the scheme.
• The ruling government has also pledged to bring all individuals from the transgender community under the scheme.
• A target has been set to increase the number of beneficiaries under the Ayushman Bharat Health Insurance scheme to 100 crores in the third term of the NDA government.

How To Check Your Name In The Ayushman Bharat Health Insurance Scheme?

Here are the steps to follow:

Contact the PMJAY toll-free number 14555 or 1800-111-565 to learn about your eligibility for the scheme.

OR

You can visit the official website of the Ayushman Bharat Health Insurance Scheme.

Conclusion

The launch of the Ayushman Bharat Health Insurance Scheme by the Government of India has inspired nations and world leaders massively. It is designed to be fully dedicated to serving the vulnerable sections of Indians for whom quality healthcare is a very distant dream. Being the largest public welfare health insurance scheme in the world, it is credited with being efficient and bringing easy access to health care to every individual’s fingertips.

With increasing healthcare costs year on year, a government flagship scheme like Ayushman Bharat Health Insurance is a saviour to those who are pushed to poverty each year due to the inability to pay their medical bills. To know more about Ayushman Bharat Health Insurance Scheme connect with PolicyX insurance experts.

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