Ayushman Bharat: Four years on, the scheme continues to broaden horizon and reach

New Delhi, Oct 08: India has completed four years of Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (AB-PMJAY), a free health insurance to India's poor and marginalised families and is deemed to be the largest such scheme in the world. Named Pradhan Mantri Jan Ayogya Yojana or Ayushman Bharat, the scheme was rolled out in Chhattisgarh on 18 April, 2018.

It has continued to broaden its reach and brought in many beneficiaries who have been benefited by it and has also expanded its horizon to include otherwise neglected group like the transgenders into its ambit.

Recently, Prime Minister Narendra Modi shared a citizen's response to Ayushman Bharat Scheme highlighting the health insurance cover of Rs 5 lakhs for all Indian citizens. The Prime Minister also remarked that the benefits of the scheme can be availed all over India. Quoting a tweet by a citizen, the Prime Minister wrote,"It absolutely is. The poor and middle class have greatly benefited."

Since the launch, there has been a remarkable seven-fold increase in PM Modi's flagship Ayushman Bharat Health and Wellness Centres between 2018 and 2022. Union Health Minister Dr. Mansukh Mandaviya also noted that so far over 19 crore Ayushman Cards have been created, extending its coverage in 33 States and UTs, and that more than 25 crore Ayushman Bharat Health Account (ABHA) numbers have also been generated, highlighting PMJAY beneficiaries as the scheme's most significant stakeholder. This is a significant turning point in the nation's health records digitalization process. In addition, he said that the current daily production rate of 4.5 lakh cards would be doubled to 10 lakh Ayushman Cards. In terms of the country's access to healthcare services, he further said that PM-JAY has been successful in closing the gap between the rich and the poor.

The minister continued that in the next coming years, every community in the nation will be connected via high-speed optical fiber, ensuring that everyone has access to connectivity and ongoing healthcare. Additionally, the government is creating an effective legislative framework to protect the information of the health beneficiaries.

Ayushman Bharat, was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC). This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to "leave no one behind."

What is Ayushman Bharat?

Ayushman Bharat is a health insurance scheme under which poor households across India will be eligible for reimbursement of up to Rs 5 lakh per year towards hospitalisation expenses of their family members. Apart from the expenses on in-patient treatment, the scheme also covers pre- and post-hospitalisation costs to some extent.

Key features:

• There is no restriction on family size, age or gender.
• Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician's fees, room charges, surgeon charges, OT and ICU charges etc.
• All members of eligible families as present in SECC database are automatically covered.
• No money needs to be paid by the family for treatment in case of hospitalization
• All pre-existing conditions are covered from day one of the policy. The benefits cover will include pre and post hospitalisation
• 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
• Eligible beneificiares can avail services across India, offering benefit of national portability. Can reach out for information, assistance, complaints and grievances to a 24X7 helpline number - 14555

How to check eligibility

• Go to NHA portal and Log in to mera.pmjay.gov.in
• Enter your mobile number and captcha code.
• A one-time password will be sent to your mobile number.
• After entering the OTP, you will be taken to this screen.
• Select the state: Fill all the fields like name, mobile number, ration card number, or Rashtriya Swasthya Bima Yojna URN number.
• If your name is there in the list, it will show up on the right-hand side of the page.
  Click on 'Family Members' tab to find the beneficiary details

Required documents

1. Respective special category certificates
2. Age proof documents
3. Family structure
4. Identification details
5. Contact information
6. Scanned copy of Aadhar
7. Income certificate
8. Caste certificate

Registration: No registration required. PMJAY will provide cashless and paperless access to services for the beneficiary at the point of service.

How will beneficiary be identified at the hospital

Hospital help desk- Identitity verification through Aadhaar and other ID
Beneficiary identification system using letter with family card
Give e- card and you can meet the doctor

How to access care under PMJAY

• Patient approaches empanelled hostiptals, 'aarogya mitras' to provide support in beneficiary verification, authentication, query management, grievance redressal.
• Confirm eligibility preferably through Aadhaar
• Pre authorisation request and approval- Hospitals selects packages, checks balance
• Submits supporting evidence required for treatment
• Treatment, discharge and beneficiary feedback

Ayushman Bharat PMJAY for transgender

Recently, the Government of India initiated health care services for the transgender community as well. This scheme is signed by an MoU between the National Health Authority and the Department of Social Justice and Empowerment.

The government issues a fund of Rs 5 lakh for insurance to cover per transgender beneficiary per annum.

This comprehensive package prepares transgender categories, including AB PM-JAY packages and specific packages (Sex Reassignment Surgery(SRS) and treatment ) for transgenders. They will be eligible to get any kind of treatment under the AB PM-JAY-picked hospitals across the country.

The scheme is applicable to all transgender persons who are not eligible to receive any benefits from other Centre and state-sponsored schemes.