Introduction to Ayushman Bharat Yojana

The Ayushman Bharat Yojana or the Pradhan Mantri Jan Arogya Yojana is an exclusive healthcare scheme launched in India. It caters to the economically weaker sections of society with the aim of providing cashless healthcare facilities. This scheme has already benefited millions of people in India.

The e-card provided to beneficiaries allows them to avail themselves of medical services at empanelled hospitals, whether public or private, across the country. With coverage for pre and post-hospitalisation expenses, and several medical procedures, this scheme provides coverage up to ₹5 lakh per family per year, giving much-needed financial assistance to those who need it the most.

Ayushman Bharat Yojana (PMJAY) Health Cover Categories

The PMJAY scheme is designed to offer healthcare benefits to a vast population of 10 crore families with lower-middle-class income through a health insurance plans covering ₹5 lakh per family. This translates to 50 crore individual beneficiaries, with eight crore families residing in rural areas and 2.33 crore families in urban areas.

However, to qualify for this scheme, certain pre-conditions must be met. For rural areas, the beneficiaries are selected based on their lack of housing, low income, and other deprivations. In contrast, the urban list of PMJAY beneficiaries is determined based on their occupation.

Ayushman Bharat Yojana - Rural

According to the 71st round of the National Sample Survey Organisation, almost 86% of rural households lack access to any healthcare insurance or assurance. In rural areas, 24% of families borrow money to pay for healthcare facilities. 

PMJAY has been launched to provide yearly assistance of up to ₹5 lakh per family to economically disadvantaged families, which includes those mentioned in the Socio-Economic Caste Census 2011.

This scheme exclusively includes households registered under the Rashtriya Swasthya Bima Yojana. It also has various groups that include scheduled caste and scheduled tribe households. The scheme also caters to families with no male members aged 16 to 59 years, beggars, landless households, etc. The scheme aims to help these families avoid debt traps and avail services, thus providing much-needed assistance to the rural population.

Ayushman Bharat Yojana - Urban

The National Sample Survey Organisation (71st round) report states that a staggering 82% of urban households do not possess any health insurance. The report also found that 18% of urban Indians resort to borrowing money to meet their healthcare expenses.

To address this issue, Pradhan Mantri Jan Arogya Yojana was introduced to provide financial assistance of up to ₹5 lakh per family per year for those who qualify. The PMJAY scheme is aimed at benefiting the families of urban workers falling under the occupational category present in the Socio-Economic Caste Census 2011 and any family enrolled under the Rashtriya Swasthya Bima Yojana.

The categories of urban workers who can avail themselves of this scheme are:

• Washerman/ chowkidars
• Ragpickers
• Mechanics, electricians, repair workers
• Domestic help
• Sanitation workers, gardeners, sweepers
• Home-based artisans or handicraft workers, tailors

However, there are certain categories of people who are not entitled to this health cover, such as those who own a two, three or four-wheeler or a motorised fishing boat. It also excludes people with mechanised farming machines and those who have Kisan cards. It does not cover those who are working in either government or government-managed non-agricultural enterprises. The scheme also excludes people with a monthly income of ₹10000 or those who have refrigerators and landlines. 

How Does it Work?

The Pradhan Mantri Jan Arogya Yojana (PMJAY) offers individuals and families health insurance coverage of up to ₹5 lakh, which covers medical and surgical treatments in 25 specialities, including cardiology, neurosurgery, oncology, and orthopaedics, among others. 

In cases where multiple surgeries are necessary, the highest package cost is paid for the first surgery, followed by a 50% waiver for the second and a 25% discount for the third. Pre-existing diseases are covered without any waiting period under the PMJAY scheme, which is part of the larger yojana.

If a beneficiary or anyone in their family requires hospitalisation, they will not have to pay anything if they are admitted to any empanelled government or private hospital. The cost of treatment and hospitalisation is shared between the Centre and states in a 60:40 ratio.

By understanding these features of the Pradhan Mantri Jan Arogya Yojana, you can either benefit from it yourself or help someone else avail of the healthcare coverage benefit.

To Sum Up

Ayushman Bharat Yojana, or the Pradhan Mantri Jan Arogya Yojana, is an ambitious scheme launched by the Indian government to provide financial protection to millions of economically disadvantaged families across the country.

By offering comprehensive health insurance coverage of up to ₹5 lakh per family per year, the scheme aims to ensure that no one is left behind when it comes to accessing quality healthcare services.

This yojana is not just a healthcare scheme but a symbol of the government's commitment to the welfare of its citizens and a step towards building a healthier, more equitable society. Consult Niva Bupa insurers to know more about it.