The government believes that only a healthy India can succeed in global competition. In order to ensure affordable healthcare services to all classes of people, a number of government-sponsored health schemes have been introduced in recent years. Alongside, the government has also come up with the Pradhan Mantri Ayushman Bharat health insurance scheme.
Ayushman Bharat is a health protection scheme to provide health insurance to citizens. It provides insurance coverage of up to Rs.5 lakh on a family floater basis to beneficiaries every year in order to receive primary, secondary, and tertiary healthcare services. The scheme was earlier referred to as AB-NHPS as it is an initiative under the existing National Health Protection Scheme (NHPS). Currently, it is known as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY). The government plans to distribute this scheme through national insurance companies. The scheme subsumes the existing senior citizen health insurance scheme as well as the Rashtriya Swasthya Bima Yojana.
There are six deprivation criteria to identify the rural families that are eligible for the benefits of the scheme. They are:
In addition, the following households are automatically eligible:
An urban family must belong to one of the listed occupational categories to be eligible for the scheme:
Similar to setting eligibility criteria for beneficiaries, the government has framed eligibility criteria for a hospital to be empanelled. The criteria are:
To commence the registration process, you will have to visit the Pradhan Mantri Ayushman Bharat Yojana website. It is followed by entering your mobile number and the Captcha Code. You must then click on the ‘Generate OTP’ option.
An OTP number is sent to your mobile number through which you can access the website and complete the verification process. You are taken to the PMJAY login screen.
Moreover, you must select the state from which you are applying for the Pradhan Mantri Ayushman Bharat Yojana. You then choose how you want to select your eligibility criteria.
If you are eligible for the Pradhan Mantri Ayushman Bharat Yojana, your name will reflect on the right-hand side of the page. Moreover, you can check beneficiary details by clicking on the ‘Family Members’ tab.
If you and your family members are enrolled under the Pradhan Mantri Ayushman Bharat Yojana, an enrollment letter containing a unique QR code and identification number is sent. It helps to identify your family members in case of a hospitalisation claim.
All hospitals empanelled under the Pradhan Mantri Ayushman Bharat Yojana have an ‘Ayushman Mitra’ to help insured families get cashless medical treatment.
The Ayushman Mitra checks your eligibility by scanning the QR code contained in the enrollment letter against your data in the scheme’s database. You enjoy cashless medical treatment if you are eligible for the scheme.
After submitting valid identification proof, you are issued a Golden Card to avail of cashless hospitalisation treatment. Moreover, you can enjoy a cashless treatment at government hospitals as all of them are empanelled under the scheme.
Yes, there is no limit of family size under the PMJAY. The newborn baby will be provided care under the PMJAY provided the benefit limit is not exhausted. The newborn baby should be added to the PMJAY scheme with at least one PMJAY verified beneficiary.
Yes. When a beneficiary wants an upgrade in the room, then all expenses for treatment will not be covered under the PMJAY scheme. However, admission to ICU for specified packages is allowed.
No, a beneficiary does not have to pay for the medicines he/she receives for the treatment. Under the PMJAY, medicines will be included in the package for the duration of treatment, including up to 15 days after discharge from the hospital.
Post-hospitalisation expenses are the expenses incurred by the patient from the date of discharge up to 15 days for medicines, consultation, diagnostics and post-operative care. Also in the case of surgery, any post-operative complication and re-admission linked to the treatment are to be covered under the earlier package cost.
Pre-hospitalisation expenses mean the expenditure incurred by the beneficiary of the scheme up to 3 days before getting admitted to the hospital. However, it is applicable only to the expenses made in the same hospital where treatment under the PMJAY is initiated. The expenditure may be related to consultation, diagnostics, medications, etc., and inclusive in the package.
Any outpatient care, cosmetic treatments, drug rehabilitation, fertility treatment and organ transplants are not covered under the PMJAY.
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