The Ayushman Bharat Yojana is a part of the National Health Policy, which was launched with the primary target of achieving Universal Health Coverage. It has been crafted with the idea of a more need-based approach to reach the lower and the most vulnerable section of society. This particular scheme caters to around 50 crore beneficiaries, providing them easy access to basic secondary and tertiary care hospitalisation, constituting nearly 40% of the total population of India.
Ayushman Bharat Yojana has been somehow divided among both the urban and rural households and categorized based on deprivation and occupational standards as per the criteria mentioned in Socio-Economic Caste Census, 2011.
During its launch, it was named as National Health Protection Scheme, and eventually subsumed the existing Rashtriya Swastha Bima Yojana, launched in 2008.
What is Ayushman Bharat Yojana?
The Ayushman Bharat Yojana adopts a consistent caring approach based on two major components:
- Ayushman Bharat Pradhan Mantri Jan Arogya Yojana: This is a medical and health insurance scheme initiated by the Government of India, especially aimed at the poor, destitute, marginalised, and vulnerable rung of society. It targets providing basic healthcare accessible along with cashless facilities for secondary and tertiary care for the economically vulnerable section of society.
- Establishment of Several Health Centre with Wellness: It focuses on establishing over 1.5 lakh health centre with wellness across the country, making healthcare easily accessible to the citizens.
Basic Features
- World’s biggest government-sponsored health insurance scheme.
- Covers nearly 1400 procedures including room rent, treatment costs, consultation fees, etc.
- 3 days pre-hospitalisation cover and 15 days post-hospitalisation cover available including diagnostics and medicines.
- The coverage limit is INR 5 lakh.
- Both tertiary and secondary care is available.
- Hospitalisation coverage is available in both private and public panelled hospitals across the country.
- Cashless hospitalisation facility available.
- No restriction on gender, family size, age.
- Since issuance, covers pre-existing ailments.
- Benefits are PAN India.
Critical Diseases Covered
- Prostate cancer
- Double valve replacement
- Coronary ABG
- Anterior spine fixation
- Carotid angioplasty with stent
- Skull base surgery
- Pulmonary valve replacement
- Tissue expander or disfigurement in burn cases
- Laryngopharyngectomy
Exclusions
- OPD costs
- Drug rehabilitation program
- Fertility-related issues
- Transplantation
- Cosmetic processes
Benefits of Ayushman Bharat Yojana
We will focus on the important benefits of the Ayushman Bharat Yojana, enjoyed by the central healthcare system of the country and the beneficiaries:
10 Benefits of the Ayushman Bharat Yojana for the Beneficiaries
- Healthcare Coverage of up to INR 5 lakhs/Family: This family floater health insurance provides coverage up to INR 5 lakhs per family, along with 3 days of pre-hospitalisation and up to 15 days of post-hospitalisation costs and non-intensive and intensive healthcare facilities. The health cover is available for free as the government pays the annual premiums in the 60:40 ratio.
- SECC-listed Families Covered: Offers health protection to nearly 10 crore rural families and 2 crore urban families across the country, consisting primarily of the lower and lower-middle class families, based on the latest data of Socio-Economic Caste Census.
- Prioritising Women, Girl Child, and Senior Citizens: Irrespective of the family size, gender and age of the family members, the over includes all. Moreover, the scheme specialises in prioritizing the needs of women, girls, children and those above 60 years of age.
- Inclusive of Tertiary and Secondary Care: This health scheme provides the needful access to befitting secondary healthcare facilities offered by specialists like urologists, cardiologists, etc. Apart from that, advanced healthcare benefits for ailments like cardiac surgery, cancer, etc. also get covered.
- Covers all Pre-existing Ailments: Unlike many other health insurance options, PM-JAY covers all sorts of pre-existing ailments and offers compulsory treatment for those in all public hospitals.
- Paperless and Cashless Registration: Negating the need for out-of-pocket expenses, this scheme ensures cashless treatment facilities throughout the country.
- Considerable Reduction of Personal Health Expenses: All empanelled private hospitals and public hospitals are thereby directed by the authorities to provide relevant healthcare facilities to all the PM-JAY beneficiaries. Moreover, this scheme even encourages the production of more reasonable drugs and other healthcare equipment.
- Private Sector Cooperation for Achieving Public Health Goals: As the scheme covers a very large section of the population, it is natural that it will buy services from the private sector healthcare industry too. The scheme encourages enhancing the reasonability of healthcare services through more production.
- Improvement in the Basic Quality of Life: This scheme is aimed to make the lives of the weaker sections of society better, ensuring they receive proper medical treatment at the right time and proper management of their finances while managing their health issues.
- Broadening the Scope and Network: PM-JAY is targeted to provide enhanced infrastructural development, especially in the rural and less developed areas throughout the country, leading more fellow citizens to access its benefits. As per records, the government has schemed nearly 1350 health packages covering day-care treatment, hospitalisation, surgery, diagnosis expenses, medicines, drugs, etc.
Conclusion
From the above discussion, it is evident that PM-JAY has nearly revolutionised the health insurance system prevalent in the country. As the health insurance premiums are paid by the government under this government-sponsored scheme, it offers a great respite for the lower and lower-middle-class citizens in the country.
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