Ayushman Bharat along with various diseases health insurance Kovid-19 is also included in this plan. According to the NHA, any private hospital empaneled for the scheme will provide treatment and testing for COVID-19 free of cost. Quarantine in a private hospital will also be covered under this insurance.
Here’s a look at the plan’s key features, benefits, what’s covered, and how to check eligibility.
Who is eligible for Ayushman Bharat?
Rural households that are included (not excluded) are then ranked based on their status on seven deprivation criteria (D1 to D7). Urban households are classified on the basis of occupation categories.
Rural Beneficiaries:
Out of a total of seven deprivation criteria for rural areas, PM-JAY covered all households that fall in at least one of the following six deprivation criteria (D1 to D5 and D7) and automatic inclusion (disappointing). / Families living on alms, manual scavengers), primitive tribal groups, legally issued bonded labour) Norms:
- D1- Only one room with kutcha walls and kutcha ceiling
- D2 – No adult member between the ages of 16 and 59
- D3- Families with no adult male member between the ages of 16 to 59
- D4 – Disabled member and no able-bodied adult member
- D5- SC/ST families
- D7- Landless households who derive a major part of their income from manual casual labor
urban beneficiary
For urban areas, the following 11 occupational category workers are eligible for the scheme:
- Ragpicker
- petitioner
- domestic servant
- Street vendors / cobblers / hawkers / other road service providers
- Construction Workers / Plumbers / Masons / Laborers / Painters / Welders / Security Guards / Porters and other head-load workers
- Sweeper / Sanitation Worker / Owner
- Home Based Worker / Artisan / Handicraft Worker / Tailor
- Transport worker/driver/conductor/helper to driver and conductor/car puller/rickshaw driver
- Shop worker / assistant / peon / assistant / distribution assistant / attendant / waiter in small establishment
- Electrician / Mechanic / Assembler / Repair Worker
- washerman/watchman
What is the hospitalization process?
Beneficiaries will not be required to pay any fee and premium for hospitalization expenses. The benefit also covers pre and post hospitalization expenses.
Each empaneled hospital will have an ‘Ayushman Mitra’ to assist the patients and coordinate with the beneficiaries and the hospital. They will run a help desk, check documents to verify eligibility and enroll in the scheme.
Also, all the beneficiaries will be given letters containing QR codes which will be scanned and demographic authentication will be done for identification and to verify their eligibility to avail the benefits of the scheme.
The benefits of the scheme are portable across the country and the beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private hospital across the country.
what is included?
To ensure that hospitals do not overcharge and rates do not vary across hospitals, empaneled health care providers (EHCPs) are paid based on specified package rates. A package covers all costs associated with the treatment, including pre and post hospitalization expenses. The specified surgical package is paid as bundled care (explained below) where a single inclusive payment is payable by the Insurer/SHA to the EHCP. However, medical packages are payable to EHCP at the rate per day depending on the admission unit (general ward, HDU, ICU) with some pre-determined add-ons payable separately. Day-care packages are payable in the same way as surgical packages. The treatment packages are comprehensive, covering treatment for around 24 specialties which include super specialty care like oncology, neurosurgery and cardio-thoracic and cardiovascular surgery etc. The package rate (in the case of surgical or defined day-care benefits) includes:
- registration fee
- Bed Fee (General Ward)
- Nursing and boarding fee
- Fees of Surgeons, Anesthetists, Medical Practitioners, Consultants etc.
- Anesthesia, blood transfusion, oxygen, OT charges, cost of surgical instruments, etc.
- Medicines and drugs
- Cost of prosthetic devices, implants (unless payable separately)
- Pathology and Radiology Tests: Radiology including but not limited to X-rays, MRI, CT scans, etc. (as applicable)
- food to the patient
- Pre and post hospitalization expenses: Expenses incurred for consultation, diagnostic tests and medicines before admission of the patient in the same hospital, and up to 15 days after discharge from the hospital for the same illness/surgery
- Any other expenses related to patient’s treatment in EHCP
Required Documents
to receive benefits under Ayushman Bharat YojanaEligible person has to show his/her eligibility with proofs like Aadhar Card, Voter ID Card or Ration Card.
How to check whether you are eligible for PMJAY or not?
- Go to official government website
- ‘Am I eligible?’ Click on the tab.
- Enter your phone number, captcha code and click on ‘Generate OTP’
- Submit the details including state, your name, ration card number and house number
- If your family is covered under PMJAY, your name will flash on the screen
You can also check by calling the helpline numbers 14555 and 1800111565.
What is the enrollment process? Is there any time period for enrollment?
PM-JAY is an entitlement based mission. There is no enrollment process. Deprived using the SECC database in both rural and urban areas and households identified by the government on the basis of occupational criteria are entitled to PM-JAY.
Will the card be given to the beneficiary?
A dedicated PM-JAY Family Identification Number will be allotted to the eligible families. In addition, an e-card will also be given to the beneficiary at the time of hospitalization.