Top 10 Benefits of the Ayushman Bharat Yojana (PMJAY)

There are several types of insurance available in India, with health insurance being one of the most important, offered by almost every insurance company. However, a majority of Indians, especially the rural population, either have inadequate medical coverage or none at all. The Ayushman Bharat Yojana, now known as the Pradhan Mantri Jan Arogya Yojana (PMJAY), was launched in 2018 by the Government of India to remedy the same. 

The Ayushman Bharat Yojana is the world’s largest health insurance scheme, providing health insurance coverage of Rs 5 lakh to every eligible Indian family, along with access to tertiary and secondary care hospitalisation. Beneficiaries of the scheme receive an Ayushman card, the eligibility of which has been divided among households in rural as well as urban areas. The validity of the Ayushman card is for up to a year, as the scheme must be renewed every year, by the 31st of May.

Who Is Eligible for the Ayushman Card?

The Ayushman Bharat Yojana has defined beneficiaries from rural and urban areas. For rural areas, eligibility is distributed as follows:

• D1: Households with a one-room home with kuccha walls and kuccha roof.
• D2: Households with no adult members (16 to 59 years of age).
• D3: Households with no adult male members (16 to 59 years of age).
• D4: Disabled with no able-bodied adult member in the household.
• D5: SC/ST households.
• D7: Landless households, where a majority of their income is derived from casual manual labour.

For urban areas, there are eleven occupation categories of workers who are eligible for the Ayushman Bharat Yojana.

• Ragpickers
• Beggars
• Domestic Workers
• Street Vendors, Hawkers, Cobblers, and Other Service Providers Working on the Streets
• Construction Workers, Plumbers, Masons, Painters, Welders, Labourers, Security Guards, Coolies, and Other Head-Load Workers
• Gardeners (Mali), Sanitation Workers, and Sweepers
• Artisans, Tailors, Handicrafts Workers, and Home-Based Workers
• Transport Workers, Drivers, Conductors, Helpers (To Drivers and Conductors, Cart Pullers, and Rickshaw Pullers.
• Shop Workers, Peons in Small Establishments, Assistants, Helpers, Delivery Assistants, Attendants, and Waiters
• Electricians, Mechanics, Assemblers, and Repair Workers
• Washermen and Chowkidars

Top Benefits of the Ayushman Card (PMJAY Scheme)

Some of the top benefits of the Ayushman card for eligible beneficiaries are: -

Healthcare Coverage of Rs 5 Lakh

The PMJAY scheme caters to nearly 50 crore beneficiaries, providing healthcare coverage of Rs 5 lakh for each eligible family. This coverage is provided to the families free of charge, as the annual premium for the cover is paid by the central and state governments in a 60:40 ratio. 

Suggested Read: Health Insurance For Rural India

Coverage for All Families Listed in the SECC Database

All 10 crore families, with 8 crore families living in rural areas and 2 crore families in urban areas, listed in the Socio-Economic Caste Census (SECC) 0f 2011 are beneficiaries under the PMJAY scheme.

No Cap on Family Size

The health cover provided under the PMJAY scheme is inclusive for all and there is no cap on the size of the family. Priority is given to women, children, especially girls, and senior citizens over the age of 60.

Pre- and Post-Hospitalisation Coverage

The PMJAY scheme provides coverage for costs incurred during three days of pre-hospitalisation and 15 days of post-hospitalisation. It also covers daycare costs and transportation expenses during the pre- and post-hospitalisation period.

Coverage for Secondary and Tertiary Care

The scheme also provides coverage for secondary healthcare services by specialists, like urologists and cardiologists, and for advanced medical treatment, like cardiac surgery or cancer treatment.

Pre-Existing Disease Coverage

Unlike most types of insurance policies, pre-existing diseases are covered under the PMJAY, and it is mandatory for public hospitals to provide treatment for the same.

Reduced Medical Expenses

The costs for medical treatments have been capped with specified package rates that have been determined by the government. Public and empanelled hospitals cannot charge PMJAY beneficiaries extra money for medical care.

Cashless Treatment

Beneficiaries can avail cashless hospitalisation services across India. The scheme covers all hospitalisation expenses with cashless transactions. People who have an Ayushman card are eligible for cashless treatment at any empanelled hospital and are not required to make any payment to the hospital.

Private Sector Participation

The PMJAY scheme covers a huge population, which means that it will also be purchasing services from healthcare providers in the private sector. It is expected that in the long run, the scheme will encourage the manufacture of more affordable healthcare supplies.

Accessibility

There are no age restrictions for being covered under the PMJAY scheme. Additionally, the Ayushman card is also portable across all states and union territories of India. Even if a beneficiary travels from one place to another within the country, they will be able to continue their free treatment.

The Ayushman Bharat Yojana was launched by the Government of India to make healthcare more accessible to the weaker sections of society, and over the years, the PMJAY scheme has not only proven to be very successful but has also managed to change the healthcare landscape.