- Government health insurance scheme
- Ayushman Bharat Yojana benefits
- Ayushman card utility
What is the Ayushman Bharat Health Insurance Scheme?
The Ayushman Bharat Yojana or PMJAY (Pradhan Mantri Jan Arogya Yojana) is funded by the government of India and comes under its healthcare flagship program, launched in 2018 by the National Health Policy of India. It’s also the world’s largest government-funded healthcare program that envisions a Universal Health Coverage (UHC) goal, one of the SDGs (Sustainable Development Goals) to facilitate the underprivileged and marginalized sections of the country.
It provides comprehensive healthcare services aiming to make India a better place for all. The beneficiaries of the Ayushman Bharat health insurance scheme can undergo hospitalization and medical treatment for secondary and tertiary illnesses over a covered amount of INR 5 Lakhs. The amount of the scheme is allocated for all the members of each family.
This article discusses all the benefits of the Ayushman Bharat Yojana, its eligibility, the benefits of Ayushman card, how to get Ayushman card benefits, and more. Keep on reading so that you can have a clear understanding of the same.
Know the Benefits of Ayushman Bharat Yojana (PMJAY)
| Key features | Specifications |
|---|---|
| Healthcare to EWS | Deprived or underprivileged sections of society like poor rural families who can’t afford healthcare benefits can avail of the specified benefits under the PMJAY scheme. |
| Primary, Secondary and tertiary covers | The Ayushman Bharat card is a lifeline for those who can’t afford expensive and premium healthcare services. It covers the beneficiaries of PMJAY and their family members for primary (basic healthcare), secondary (serious illnesses) and tertiary (critical illnesses) diseases that require treatment and hospitalization over and upto INR 5 Lakhs per year for each family. |
| Cashless hospitalization & treatment | Over 1400 procedures are covered under the scheme. Above this, the beneficiaries get a 3-day pre-hospitalization and 15 days post-hospitalization expenses covered for them. |
| Wide facilitation network | The beneficiaries can avail of the cashless treatment benefits at a government-run hospital, PMJAY empanelled centres, CHCs, PHCs, etc so they don’t have to sit back hopeless in case of any medical emergencies. |
| Medical portability benefits | It allows the beneficiary to avail of a cashless treatment benefit in any government-empanelled hospital around any Indian states and Union territories. For those who migrate for work from one place to the other within the country, this scheme is a life-saver! |
| Social empowerment | This scheme is specially designed to fight against healthcare disparity among marginalized sections of society, helping them receive quality and equalized health benefits while maintaining the socio-economic decorum of our country. |
| Healthcare boost to the masses | The Ayushman Bharat scheme is the ultimate way of developing the medical and healthcare industry, growing infrastructure, intensifying empanelled centre potential, and impacting positively the health of crores of people which is almost half of the Indian population. |
Key Takeaways
- The Ayushman Bharat health insurance scheme offers cashless health benefits upto INR 5 Lakhs to eligible families.
- It covers all sorts of treatment expenses on a family floater basis meaning any member of the family can avail of its benefits.
- There’s no bar on age, family size (general limit of 5 individuals), or gender which allows the beneficiary to cover each member of the family.
- Pre-existing diseases are covered from day 1 with this scheme which ensures the beneficiaries receive treatment against PEDs.
- One can only avail of the health care benefits of this government scheme with their Ayushman Bharat Card.
What is an Ayushman Card and How Does it Work?
The Ayushman Card is just like a health card issued by the government of India that provides cashless healthcare facilitation to economically weaker sections of society. You can avail of the listed benefits at any government-empanelled hospital and health centre.
Ayushman Card Benefits
Ayushman Bharat Yojana provides basic and critical illness coverage with the Ayushman card issued by the government to the beneficiaries, inclusions of this plan are mentioned as follows:
Basic Cover
- Doctor’s consultations, health check-ups, and diagnostics
- Pre and post-hospitalisation follow-up upto 15 days
- Daycare procedures
- Medication costs and consumables
- Room rent and ICU charges
- Food services
- Complication treatment if necessary, and so on
Critical Illness Cover
- Cancer
- Kidney failure
- Burns
- Coronary ABG
- Prostate cancer
- Cardiovascular diseases
- Neonatal diseases
- Parkinson’s disease and more
Key Takeaways
Indemnity health insurance is a type of health insurance that compensates or reimburses for the loss or damage sustained by the insurance holder.
Ideal for business owners and professionals like doctors, lawyers, etc.
Buying professional indemnity insurance for doctors is a shield against claims arising out of injuries and/or death of any patient caused by or alleged to have been caused by error, omission, or negligence in professional services.
Indemnity health insurance covers you for ICU charges, and treatment expenses at affordable premiums and offers additional deductible benefits.
Quick Facts About the Ayushman Bharat Card
- Over 50 crore Indian families from rural and underprivileged sections of society have been registered under the beneficiary list of PMJAY.
- More than 13.4 crore of India’s population has received the benefit of the Ayushman Bharat Swasthya Yojana.
- The Ayushman card has been issued to approximately 33 crore individuals based on their beneficiary entitlement.
Exclusions: Ayushman Bharat Health Insurance Scheme
- Alcoholism/drug abuse and treatment arising thereof
- Breach of law or an unlawful activity
- Infertility or sterility treatment
- OPD cover
- Beauty treatment and cosmetic surgery
- Rest, cure and rehabilitation treatments
- Weight management or obesity treatment
- Organ donor expenses
- Dental surgery, etc
How Can I Get an Ayushman Card and Where Should I Apply for it?
To get an Ayushman card, the eligibility criteria are: for an individual from an SC/ST community with no earning person above 16 years in the family, their collective income is not more than 2.5 Lakhs and is listed in the SECC-2011 database of the PMJAY beneficiary list.
To get the benefits under the PMJAY healthcare scheme, these are the documents required for identification and proof of enlisted members of the beneficiaries:
- PM/CM entitlement letter
- Ration card
- Aadhaar card for identification only
Steps to Follow while Applying for an Ayushman Card
The following are the steps to follow while applying for Ayushman Card:
-
Step 1
Check your eligibility to get an Ayushman card
-
Step 2
Visit the official website of PMJAY (pmjay.gov.in) and initiate the online application
-
Step 3
Click on the ‘ABHA’ option to further proceeding with filling your Aadhaar card details
-
Step 4
Enter OTP from your phone to verify the process of Aadhaar verification
-
Step 5
Fill out the further details such as your name, income details, PAN card, etc
-
Step 6
Approving your application will take some time, wait till it’s updated
-
Step 7
Once you get the confirmation of receiving eligibility for an Ayushman card, visit again the PMJAY website and generate an OTP to download the issued Ayushman Bharat card
-
Step 8
Download and get printed the Ayushman card to avail of the cashless treatment benefit with it
P.S.: A beneficiary can visit the Ayushman Kiosk in any PMJAY empanelled hospitals, or the CSCs (Common Services Centres) to receive their Ayushman Bharat card. For more details of the scheme and any queries related to health card PMJAY, contact the official executives on toll-free numbers 14555/ 1800-111-565/ 1800-180-2415.
Summarising: All About Ayushman Bharat Health Insurance Scheme
For those who can’t afford to buy expensive health insurance with high premiums, the PMJAY Ayushman Bharat card saves their world from collapsing. The Ayushman Bharat health card benefits are not only attached to the marginalised sections of society, but it also helps them get free and cashless treatment when a medical emergency hits any of their family members. The government of India pays upto INR 5,00,000 for the benefits mentioned above for the beneficiaries.
Need further help? Or if you want to know more about the PMJAY Scheme, contact us at 1800-4200-269.
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Ayushman Bharat Yojana Benefits (PMJAY) : FAQs
1. What is an Ayushman card and how is it beneficial for me?
An Ayushman card is like a general health insurance card, without which one can not receive any cashless hospitalization benefit under Ayushman Bharat Yojana.
2. Can I get a cashless treatment with my Ayushman card?
Yes. Beneficiaries can avail of the cashless hospitalization and listed healthcare treatment at a private and public health centre or government facilitations.
3. Is a family floater cover available with the Ayushman Bharat Yojana?
Yes, beneficiaries can get their Ayushman Bharat Yojana including all family members. It’s available on a one-policy per family basis.
4. What is the maximum sum insured option available under the Ayushman Bharat health insurance scheme?
The maximum sum insured under this policy is INR 5 Lakhs, which covers basic and advanced treatment like critical illnesses.
5. Does the Ayushman Bharat Scheme cover critical illnesses?
Yes, it covers the critical illnesses. For more details on the diseases, refer to the inclusion section of this page.
6. Can I get an Ayushman card for free?
Yes, anybody can claim their Ayushman card for free once they have registered for the Ayushman Bharat Yojana and received their policy documents.
7. Who is eligible to buy the Ayushman Bharat health insurance scheme?
There is no restriction on age, gender, number of family members, etc to get covered with this policy. For more details of the scheme, give us a call at 1800 4200 269.
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Written By: Simran Nirala
Simran has an experience of 3 years in insurance content writing. She transitioned from hospitality to the insurance industry after her emerging interest in how vast insurance is. With her ability to write complex insurance concepts in a simple, relatable manner she keeps her audience hooked and solves their doubts smoothly.
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