New Health Insurance Scheme by Centre: Who’s Eligible, What’s Covered, and How to Apply

On Wednesday, the Center approved the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) program, which provides health coverage to all elderly people aged 70 and above. About 4.5 crore households would profit from this move, with 6 crore elderly persons getting a family health insurance cover worth ₹ 5 lakh.

Regardless of their financial situation, older residents will have access to full healthcare coverage under the program, which is said to be the largest publicly financed health assurance program in the world. Seniors who meet the requirements will receive a new, unique card under AB PM.

What is the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)?

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a flagship health insurance scheme launched by the Government of India in 2018, aimed at providing affordable healthcare to the most vulnerable sections of society. It is the world’s largest health assurance scheme, targeting over 12 crore poor and vulnerable families, covering approximately 55 crore beneficiaries, which is about 40 per cent of the Indian population.

Objectives

1. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana was designed to fulfil the National Health Policy 2017’s vision of Universal Health Coverage (UHC), ensuring that no one is left behind.
2. The scheme addresses healthcare from primary to tertiary levels, providing preventative, promotive and curative services.

Components

1. Health and Wellness Centres: These centres provide primary healthcare services, including maternal and child health and management of non-communicable diseases. Essential medicines and diagnostic services are also available free of charge.
2. Pradhan Mantri Jan Arogya Yojana (PM-JAY): This component provides health insurance coverage of up to ₹ 5 lakh per family annually for secondary and tertiary care hospitalisation.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana: Eligibility criteria

1. To be eligible, applicants must belong to specified categories:
2. SC/ST
3. Lower Income Group
4. Economically Weaker Sections (EWS)

Rural:

1. Scheduled caste and scheduled tribe households
2. Beggars and those surviving on alms
3. Families with no individuals aged between 16 and 59 years
4. Families having at least one physically challenged member and no able-bodied adult member
5. Landless households who make a living by working as casual manual labourers
6. Primitive tribal communities
7. Legally released bonded labourers
8. Families living in one-room makeshift houses with no proper walls or roof
9. Manual scavenger families

Urban:

1. Urban workers’ families in occupational categories present in the Socio-Economic Caste Census 2011
2. Families enrolled under the Rashtriya Swasthya Bima Yojana (RSBY)

How to check eligibility online:

1. Visit the official website
2. Access the “Am I Eligible” section
3. Input mobile number and captcha code, then click “Generate OTP”
4. Enter OTP and click “Verify OTP”
5. Furnish essential information and click “Submit”

How to Apply for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

1. Visit the official website
2. Get your Aadhaar card or ration card verified at a PMJAY kiosk
3. Provide family identification proofs
4. Get your e-card printed with a unique AB-PMJAY ID

Benefits of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana 

1. Beneficiaries are entitled to a health cover of ₹ 5 lakh annually, covering costs like hospitalisation, treatment, diagnostics, medicines, surgery and post-treatment care.
2. Pradhan Mantri Jan Arogya Yojana provides cashless services across public and private hospitals, reducing out-of-pocket expenses for beneficiaries.
3. Unlike previous health schemes, there is no cap on the family size, age, or gender of the beneficiaries.
4. The scheme covers up to 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses, including diagnostics and medicines.
5. Beneficiaries can avail of services across India in any empanelled hospital.
6. From the first day of enrollment, all pre-existing diseases are covered under the scheme.
7. The scheme helps mitigate the financial burden caused by serious illnesses and hospitalisation, preventing families from being pushed into poverty.
8. The scheme covers almost 1,929 procedures, including costs for physician fees, room charges, diagnostics, ICU care and medical implants.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana coverage details

1. The scheme covers all expenses related to:
2. Medical examinations, treatment and consultations.
3. Pre-hospitalisation care, up to three days before admission.
4. Medicines and medical consumables.
5. Non-intensive and intensive care services (ICU care).
6. Diagnostic and laboratory investigations.
7. Medical implants, if necessary.
8. Accommodation and food services during hospitalisation.
9. Complications arising during treatment.
10. Post-hospitalization follow-up care, up to 15 days after discharge.

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Source: NDTV