Ayushman Bharat | The World’s biggest Health Insurance [Modicare] Policy

The Ayushman Bharat Yojna is a health protection scheme which aims to provide health insurance policy to around 10.74 crores family comprises of around 45-50 crores people of all the age and gender group across India. Under this policy, there are mainly two objectives. These are: creating a health and wellness infrastructure across the nation to provide primary health care services and second, to provide health insurance coverage to not less than 40 percent of India’s population. In this article, we will go through the policy feature, its benefits, eligibility and how to avail the benefits of the policy.

What is Ayushman Bharat Insurance Policy

On 23rd March 2018, The prime minister Shri Narendra Modi has approved the launch of a new Ayushman Bharat (National Health Protection Mission (AB-NHPM). The scheme has a benefit cover of Rs. 5 lakhs per family per year. The covered population under this scheme is more than 10 crore families belonging to poor and vulnerable population based on the SECC database. With the launch of this scheme, the existing schemes  -RashtriyaSwasthyaBimaYojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS), will be discontinued.

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The government will provide Rs. 5 lakhs to each family for secondary and tertiary hospitalization under this scheme. Around 10 cr0re families comprise of 50 lakhs population will be covered under this scheme. The program will be the world’s largest health policy launched by any country.

To ensure nobody is left out, there will be no cap on family size and age in the scheme. The policy also covers the pre and post hospitalization expenses. All pre-existing conditions will be covered from day one of the policy. Under the policy, the defined transport allowance per hospitalization will also be paid to the beneficiary.

Under this scheme, the beneficiary can avail the benefits in both public and empanelled private facilities. All public hospitals in the state insurance corporation (ESIC) will be empanelled based on the bed occupancy ratio parameters. There will be a fixed package for the particular disease. The same will be defined by the government in advance. The cost will be shared between central and state government.

Eligibility Criteria

The beneficiary should be included under the SECC (Socio-economic caste census) data which was conducted across rural and urban parts of the country in the year 2011. The SECC data includes various parameters like:

• Literacy rates
• Median household income
• Poverty levels
• Nature of occupational profiles
• Predominant location
• Access to schooling
• Access to housing
• Sanitation, drinking water, and electricity
• Valid Aadhar card

Note:- The scheme does not mention the limitation of family size.

Required documents for enrolling into Ayushman Bharat scheme

The following documents must be furnished for registration:

• Aadhar ID linked with a valid bank account
• Respective special category certificates
• Age proof documents
• Family structure
• Identification details
• Contact information
• Scanned copy of Aadhar
• Income certificate
• Caste certificate

Key benefits of Ayushman Bharat scheme

• A cover of Rs. 5 Lakhs per family per year for secondary and tertiary care.
• No restriction on family size, age or gender.
• All members of eligible families as present in SECC database are automatically covered.
• Cashless treatment in case of hospitalization.
• All pre-existing conditions are covered from day one of the policy. The benefits cover will include pre & post hospitalization
• You can go to public or empanelled private hospitals across the country and get free treatment.
• You need to carry any prescribed ID to receive treatment at the hospital.
• Priority to the girl child, women and senior citizens.
• Covers secondary and tertiary care hospitalization.
• 1350 medical packages covering surgery, medical and day care treatment.
• Covers the cost of medicine and diagnostics.
• The hospital will not be allowed to charge any additional charges from the beneficiaries for the treatment.
• The scheme is offering the benefit of national portability.
• 24X7 helpline number – 14555 for any information, assistance, complaints, and grievances.

Major Impact

In India, the in-patient hospitalization has increased around 300% in last 10 years. More than 80% of the expenditure is met by out of pocket(OOP). Only a few people have opted for health insurance plan in India. The out of pocket expenditure in India is around 60% which leads to 6 million families getting into poverty. This scheme will have a major impact on the out of pocket expenditure in terms of:

• Increased benefit cover of around 40% of the population.
• Coverage of almost all secondary and many tertiary hospitalizations.
• Coverage of 5 lakhs for each family with no restriction of family size.

Some other benefits are:

• This scheme will ensure access to and affordability of health care services through a mix of private and public hospitals.
• Significantly reduce the out of pocket expenditure for hospitalization.
• Improved health outcomes.
• improved quality of life of the population.
• Enhance productivity and efficiency of the population.

Implementation Strategy:

To manage the scheme, at the national level The Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA) will be put in place. The states will be advised to implement the scheme by having a dedicated entity called the state health agency (SHA). The states can decide to implement the scheme through an insurance company or directly through the trust/society.

Common Service Centre (CSC) will check and register beneficiary of Ayushman Bharat Yojana. CSC will be the major player for implementing the scheme across the states.

The beneficiary can have below benefits for registering through CSC.

• The CSC will help to check the name of the beneficiary in the Ministry of Health database and scheme eligibility list.
• The beneficiary can find the nearest CSC center to avail the benefits.
• The CSC will help scan and upload the beneficiary’s ID proof and other relevant documents to verify and claim their entitlement.
• The beneficiary can get the print of their Ayushman family cards at CSC.
• The CSC will promote the scheme in the nearby area where it is located so that the maximum number of people can take the benefit of the scheme.

The CSC will get a payout of Rs. 30/- for assisting, uploading documents and printing the Ayushman Bharat health card.

Ayushman Bharat Beneficiary Registration process through CSC

1. Beneficiary needs to visit the nearby CSC center the check the eligibility.
2. CSC will then check the eligibility under NHPS.
3. If eligible, CSC person will upload the documents like Aadhaar card, Ration card, PAN card etc.
4. Now CSC will submit the details to respective state authorities for further verification and approval.
5. The approval process will be done in real time
6. Then the CSC will print the Ayushman Bharat card and handed over to the beneficiary.
7. The beneficiary can use this card to avail the policy benefit at any of the listed hospital.

How to check the eligibility under Ayushman Bharat scheme?

Here is the step-by-step guide for checking your eligibility under Ayushman Bharat scheme.

1. Go to National Health Agency
2. Enter your mobile number and CAPTCHA
3. Click on the generate OTP button
4. Enter the OTP you have received and click on verify OTP
5. On submitting the OTP, you will be directed to the below page.
6. Here you have to check your eligibility by selecting your state and enter the name/ration card no/mobile no.
7. Submit the details and click on the search button
8. If you are eligible then your details will be shown on the right side of the screen.
9. Click on the family member button to check the names of your family members who are covered under the policy.

The alternate method for checking the eligibility

Toll-free no: 14555 & 1800111565

Email ID: pm-nhpmission@gov.in

Facebook Page: Ayushman Bharat

Twitter Account: Ayushman Bharat

You can check the status by visiting individual state level websites as per below details.

1. Log on to the official website of Ayushman Bharat here.
2. Select “Urban” or “Rural” based on your location.
3. Enter your mobile number to receive a one-time password.
4. Once the OTP is entered the list can be downloaded.
5. You may save the list for future reference.

Only BPL households are included in this scheme, hence the BPL list can be checked to know if you are eligible or not. The state-wise BPL list is as below. click on the link for your respective state and find your name if you are eligible or not.

Treatment Package Rates under Ayushman Bharat Yojna

Central Government has approved the treatment package rates under Ayushman Bharat Yojna. Under this, the government has finalized the rate of 1352 medical inspection and surgeries. The complete list of the treatment packages will soon be available on the portal of NHPM.

The list of Medical treatments along with the rates as fixed by the central govt. under National Health Protection Mission is given as follows:-

Under this policy, the treatment for coronary bypass, knee replacement, and stenting would be cheaper by around 20% as compared to Central Government Health Scheme (CGHS).

Moreover, the government will also provide the transport allowances to the beneficiary. For the beneficiary, the treatment will be cashless and all the public and private empanelled hospitals will get the amount directly into their account.

When will the scheme be available for registration?

Today, on the occasion of Independence day the prime minister Mr. Narendra Modi has announced his flagship project Ayushman Bharat to be launched on 25th September 2018 (On the birth anniversary of Mr. Deendayal Upadhyay). In his speech, Mr. Modi said: ” Its his core project and want to see a maximum number of people will take the advantage of the scheme.” Affordable health care was one of the main agenda of Modi government since the government took charge.

The policy was initially announced by the finance minister during his Union Budget 2018 in February this year. The ambitious scheme is also known as “Modicare”.

8 states which have agreed to implement the Ayushman Bharat scheme are Himachal Pradesh, Haryana, Jammu-Kashmir, and Uttrakhand. There are 4 union territories who also took part in implementing the scheme.

Other states like, Gujarat, Madhya Pradesh, Uttar Pradesh, Bihar, Andhra Pradesh, Kerala, Tamil Nadu are among those where the talks are going on and will soon sign the agreement.