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Ayushman Bharat Yojana (ABY) | National Health Protection Mission

“Swasth Bharat, Samriddha Bharat”

What Is Ayushman Bharat Yojana (ABY)?

This scheme aims to cover over 10 crore poor and deprived rural families as well as families of identified occupational categories of urban workers (as per the latest Socio-Economic Caste Census, or SECC, data) for secondary and tertiary care hospitalization. This can have a real transformative effect if implemented effectively and, equally importantly, if the target population is made aware of the scheme. We all are aware of the economic consequences of poor health and a scheme such as this one can go a long way in achieving the goal of a nation of healthy, happy, productive and prosperous people.

What does Ayushman Bharat under National Health Protection Scheme offer?

Under Ayushman Bharat – National Health Protection Scheme, the government is setting up or converting some 150,000 sub-centres in the country into so-called ‘health and wellness’ centres that will provide comprehensive primary healthcare to the
target beneficiaries who otherwise cannot afford medical treatment due to the costly medicines and investigations. At these centres they will have access to free diagnostic services and essential drugs. The services will cover maternal and child health, mental health, vaccinations against selected communicable diseases, and screening for hypertension, diabetes and some cancers, among others.

These are the main features of the scheme: 

  • All eligible beneficiaries can avail free services for secondary and tertiary hospitalisation care for identified packages (1,350 medical packages) covering surgery, medical and day-care treatments, cost of medicines and diagnostics.
  • All pre-existing health conditions are covered from Day 1 of the implementation of the scheme in respective states/union territories.
  • Benefits of the scheme are portable across the country. A beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospital across the country.
  • Insurance cover of up to Rs 500,000 will be given per year per family.
  • The yearly premium for the insurance will be shared between the central and state/UT government on a specified ratio.
Who are eligible for Ayushman Bharat Scheme?

As on date, the government claims to have identified 80 per cent of the beneficiaries in rural areas and 60 per cent in urban regions who will receive these benefits. So, exactly who all are eligible?

Those whose names are on the list of deprived rural families and families of occupational categories of urban workers as per SECC data are eligible to receive the benefits of the schemeAB-NHPM. Their details have been shared with the respective state governments as well as auxiliary nurses and midwives (ANMs)/block medical officers (BMOs)/block development officers
(BDOs).

 

Does this scheme cover all family members?

Yes. As per the SECC data, the families & urban workers who are already identified are eligible under the AM-NHPM. However, under this Phase, no additional/new families can be added. But names of additional family members (male/female marrying/newborns) can be added for those families whose names are already on the SECC data.

Is Ayushman Bharat Yojana (ABY) free (no payment of premium)?

Yes. All eligible beneficiaries can avail free services for secondary & tertiary hospitalization care for identified packages (1350 medical packages) covering surgery, medical & day care treatments, cost of medicines & diagnostics.

What is the insurance cover & premium of Ayushman Scheme?

The insurance cover is of Rs. 5,00,000 per family will be given. Premium is not expected to be more than Rs.2,000 per year which will be borne by Central Government (60%) & State Government (40%).

How to apply for Ayushman Bharat Yojna or does one need to apply/register?

This is an entitlement-based mission. There is no enrolment process. Identified families & urban workers’ families (list already shared with State Governments) would be automatically covered for the benefits. Beneficiaries will have cashless & paperless (online) access to health services under this Scheme.

Is ADHAR information Mandatory?

Aadhaar Card information would be “preferable” to use but not “mandatory”.

What is the upper age limit or Health Profile for Ayushman Bharat Yojna?

No. There is no capping on family size & age of members which will ensure that all family members (specifically girl child & senior citizens) will get coverage.

All pre-existing health conditions are covered from day 1 of the implementation of this scheme in respective states/union territories.

Does it need to be renewed every year?

This coverage is valid for 1 year from the date of effect.

Are lab tests mandatory?

No.

Is there any tax benefits available with Ayushman Bharat Scheme?

No. Since the health benefit package premium are to be apportioned between Central Government & State Government, this health benefit package comes free.

Do they have a provision for issue of policy/smart card?

The Central Government will print & hand-deliver the respective FAMILY CARDS in a major public contact programme by organizing AYUSHMAN PAKWARAS in villages as it seeks to implement the Scheme. The delivery of Cards will made be made through ASHA workers.

The Card will carry names of all those eligible for the Health Insurance Scheme & where they need to go to receive the services

Distribution of ayushman cards/information letters and work of call centres/complaints

The service provider will print the information Letters upon getting the beneficiary information from the National Health Agency (NHA) while adhering to Data Safety Standards, sort them into bundles by Area-code & deliver thewm to the District Headquarters of the beneficiary.

The Information Letters would then be sent to Gram Panchayats & distributed to the families through functions like Ayushman Pakwaras organized in villages & door-to-door by Health Workers.

The Call Centre service provider can use the hub-and-spoke model & establish Zonal Call Centre in other parts of the country. The call centre will facilitate access to National Portability Benefits of the Scheme for beneficiaries outside their Home State. It will have geo-tagging capabilities, which will enable the Government to serve the citizens in efficient & effective ways as per a Bid Document. This capability will enable a call from a citizen to be automatically identified by location & routed to the nearest identified Call Centre location according to the document.

The Central Government will set up a 24 x 7 call centre in Delhi to attend to complaints & queries from citizens & later set up Zonal Call Centres.

The beneficiaries can call the HELPLINE NO. 14555 to access information about Empanelled Hospitals, in addition to other means such as Government website & mobile app (to be launched soon).

 

Divya Patwal

VOICE

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