Ayushman Bharat is the National Health Protection Scheme aimed at covering more than 10 crore citizens of India who are below the poverty line according to census 2011. The government has decided to provide the coverage of maximum 5 lakh rupees per family, every year for secondary and tertiary care hospitalization. Both Rastriya Swasthya Bima Yojana and the Senior Citizen Health Insurance Scheme would be subsumed by the Ayushman Bharat Yojana.
All pre-existing conditions are covered from day one of the policy. The benefit cover will include pre-& post hospitalization. An Individual would be required to carry a prescribed ID to receive treatment at the hospital.
Features of the Scheme
- Benefits can be availed across the country and an individual covered under the Ayushman Bharat Yojana would be able to take cashless benefits in public and private hospitals.
- It is an entitlement-based scheme which would be decided on the basis of deprivation criteria as provided by the SECC database.
- The reimbursement of the expenses would be done of the package base as defined by the Government of India. The authority has decided to offer the benefits of Ayushman Yojana under 1354 treatment packages.
- An Ayushman Bharat National Health Protection Mission Council would be set up and chaired by Union Health and Family welfare minister.
- State should establish the State Health Agency for the implementation of the scheme.
- The Central government would transfer the funds to the State Health Agencies through and escrow account.
- The plan of a scalable and robust IT platform for the ease of implementation has been laid out.
Process of registration
The benefits of the Ayushman Yojana would be on the entitlement basis. It means that the government would decide who is eligible for availing the benefit. The beneficiary list would be made according to the latest Socio-economic caste census.
- To check if your name falls in the Beneficiary list, go to the official website https://www.abnhpm.gov.in/
- Click Download Eligible Beneficiary List
An individual whose name is mentioned in the list can avail the benefits of the Ayushman Bharat Yojana.
Who is eligible
For Urban areas – The entitlement would be decided based on 11 occupational criteria. Also, individuals who are covered under the Rashtriya Swasthya Bima Yojana are also eligible. Main source of income is either of these:
- Beggars
- Domestic-workers
- Service providers working on the streets
- Rag-pickers
- Street vendors/cobblers/hawkers
- Security guards/welders/painters/construction workers/labors/mason/coolies and other head-load workers.
- Sweepers/ malis / sanitation workers
- Tailors /Home-based workers/ artisans/handicrafts workers
- Helpers to drivers and conductors /Transport workers/ rickshaw pullers / conductors/ /cart pullers/ /drivers;
- shop workers/ assistants/ peons in small establishments/ helpers/ delivery assistants / attendants/ waiters;
- electricians/ mechanics/ assemblers/repair workers
- washer-men/ chowkidars; Other work/Non-work;
- Other work/Non-work; Non-work (Pension/ Rent/ Interest, etc.)
For Rural areas – These are the following criteria:
- Family living in one room with kutcha roof
- No adult member between the age of 16 and 59
- Disabled members and no able-bodied adult
- SC/ST households
- Landless households who are earning their maximum income from manual casual labor.
Process of Hospitalization
The benefit would consist of both pre and post- hospitalization expenses. Every hospital that is empaneled under the scheme would have a ‘Aysuhman Mitra’ to assist the patients and coordinate with the hospital. At the help desk, the Ayushman Mitra would check all the documentations, Proofs and verify the eligibility.
Beneficiaries would be provided the letter with QR codes which would be scanned, and demographic authentication would be required for the identification and verification.
