Ayushman Bharat: Health Insurance Benefits, Eligibility

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In February 2018, during the budget session at the Parliament, the Prime Minister of India and his cabinet proposed a new health insurance scheme under the name of “Ayushman Bharat Yojana”. This is an umbrella health insurance program geared at insuring 10 crore families or 40% of the population. The launch date of the scheme would be announced on August 15, 2018, but before that let’s take a look at what is Ayushman Bharat? What are its benefits, features, eligibility, documents required, as well as the need for Ayushman Bharat Yojana.

Ayushman Bharat: Health Insurance Benefits, Eligibility

What is Ayushman Bharat Yojana?

India has had several health insurance schemes over the years like the National Rural Health Mission (NRHM), Rashtriya Swasthya Bima Yojana (RSBY), and Senior Citizen Health Insurance Scheme (SCHIS) but none of these insurance schemes have seen much success. To address, this fragmented approach to healthcare, the current government developed the plans for a national health insurance scheme.

Ayushman Bharat Yojana is a comprehensive health insurance program, designed to make quality healthcare accessible to nearly 40% of India’s population, by offering them health insurance worth Rs. 5 lakhs. This scheme was introduced by the Prime Minister and his cabinet, during the budget session in February, 2018. This is the most ambitious project picked up by any government in the world, on the day of its launch, it would be the first of its kind of insurance scheme. This scheme would also be the largest healthcare scheme ever attempted. Even the WHO is following its development with bated breath, as this scheme would end up helping billions of people in one go. However, the Ayushman Bharat Yojana is not the only scheme the government introduced under the National Health Protection Scheme (NHPS).

Along with the Ayushman Bharat Yojana, the government also plans to launch Health and Wellness Centres all across India. 1.5 lakh such centres were proposed in the current budget, these centres would provide healthcare for all communicable and non-communicable diseases, including maternity and child care. These centres will also provide free medicines, as well as diagnostic tests to patients. The aim of these centres is to bridge the gap between quality healthcare and patients, making seeking healthcare more accessible for the poor. The government proposes to inject Rs. 1200 Cr. in the project. The first wellness centre was inaugurated by the Prime Minister in April 2014, at Bijapur, Chhattisgarh.  

Features of Ayushman Bharat Yojana Program:

The Ayushman Bharat Yojana Program has been the talk of the town ever since its inception. It has caught the imagination of everyone, especially, with one proposition being that the name of this program may be changed to  “NaMoCare” or “ModiCare” making it akin to the public health insurance system introduced by the former President of United States of America, Barack Obama under the name of “ObamaCare”. However, this program has been developed and customized for the people of India, and its salient features are:

  • This program will cover 10 Cr. families or 40% of the Indian population, too poor to pay for their healthcare.
  • This program will provide each family with INR 5 lakhs of insurance cover.
  • The central government and the state government would share the premium cost on a 60:40 ratio.
  • The projected premium per family is around INR 2000, the government may increase the premium to INR 5000 in later years.
  • The government will open wellness centres to help provide quality healthcare.
  • While public hospitals have already been roped into the network of hospitals providing the benefits of this scheme, private hospitals will be added on through an empanelment process.
  • NITI Aayog would be working towards developing a robust software, which could help minimise instances of fraud. This software would also have a prompt grievance redressal mechanism.
  • A pre-authorization would be required for treatments which could be potentially misused.
  • The transaction for care provided would be cashless. It is also important to note that the government would decide the cost of the healthcare package given to a patient, this would ensure that private hospitals are not able to tamper with the cost of healthcare. The beneficiary would not be handed over any cash, this is to prevent the beneficiary from misusing the fund by paying for things other than their healthcare. Thus, there would be a direct transaction between the government and the hospital.
  • The government will set up an Ayushman Bharat National Health Protection Mission (AB-NHPM)  Council as well as an Ayushman Bharat National Health Protection Mission Governing Board. In Fact, the Ayushman Bharat National Health Protection Mission would be headed by a full time CEO, dedicated to taking this scheme forward.
  • To facilitate implementation, the centre would also create an Ayushman Bharat National Protection Mission Agency, it would also support the states in creating state level agencies.

Ayushman Bharat Health Insurance Benefits to Indian Citizens:

Currently, in India, the cost of healthcare is generally borne by the individual and his/her family. According, to some estimates, a citizen living in urban India spends nearly 50% of their salaries in healthcare. For those living below the poverty line access to even basic healthcare is restricted, as the government hospitals are overwhelmed as well as overcrowded. Here are some projected benefits of the Ayushman Bharat Health Insurance:

  • Reduction the Cost of Healthcare
  • Accessible healthcare for BPL (Below Poverty Line) families.
  • Health Insurance worth INR 5 Lakhs per family, despite the size of the family
  • Overall health improvement and patient satisfaction
  • Job creation and improvement on quality of life
  • The insurance would cover all secondary and some tertiary care needs of the patient like hospitalization.
  • A patient could go to any public or private hospital in the country and avail of this scheme. The catch being that the said hospital should be in the empanelled network of hospitals.
  • The government has approved 1350 care packages which also include surgeries.
  • A 24×7 helpline number to help patients seek advice and redressal.

Benefits of Ayushman Bharat to Healthcare Systems in India:

Ayushman Bharat Program was launched to benefit not just the poor but it was a bid to alleviate the healthcare crisis in India, especially when it came to accessibility of quality healthcare for the poor. It is projected that the scheme will benefit the healthcare system in the following ways:

  • It will help India achieve Sustainable Development Goals as well as Universal Health Coverage.
  • It would align the health goals of private and public sector health care providers.
  • It would also help control the cost of healthcare and mitigate the dangers of fraudulent healthcare bills.
  • It would help development of health infrastructure as well as financially strengthen public healthcare through the insurance income.
  • It would increase the percentage of healthcare expenditure by government as a percentage of the GDP.
  • Better quality of life for the masses.

Ayushman Bharat Insurance Eligibility:

The Ayushman Bharat Program is an entitlement based program. The basis of this entitlement would be decided by the criteria tabulated in the SECC database of 2011. So, for the government has identified 11 occupations in urban areas as being eligible for the program. In rural areas, the government has defined eligibility based on type of house, age of family members, land measurement, economic status and so on.

To view, the complete list of eligible class/caste groups visit the Ayushman Bharat Health Mission website.

However, it should be noted that instead of registering TB patients in the list of insurance beneficiaries, the government has provisions of sending them a sum of INR 500 per month to supplement their needs.

Documents Required for Ayushman Bharat Health Insurance:

There has been much talk about the documents required to apply for Ayushman Bharat Scheme. It was rumoured once that Aadhaar card would be mandatory for applicants however, earlier this month the central government announced1 that the scheme is for the underprivileged, especially those living below the poverty line. Most of such individuals still do not own an aadhaar card, thus, this requirement has been scrapped. The government said, that a BPL applicant can produce any central or state issued identity card along with a BPL card.

How to Apply for Ayushman Bharat?

While there have been speculations about the application form being just online, the government has set out guidelines for states to encourage more applicants. These instructions include:

  • The state will set up kiosks, centres, web and telephone portals, or any other contact centres which will be available to help the population.
  • Empaneled hospitals will also act as contact points.
  • The state will send invitation letters to the identified families to come register for the yojana.
  • There will be a separate identification verification body constituted to oversee the process2 of registration.
  • If an individual has enough proof of their entitlement, the registration officers are empowered enough to provide them with the insurance card.
  • The state will review the details of those individuals, whose application has been rejected by the verification body.
  • In addition to this, there will also be a provision for online application. The process for online application has still not been shared by the government.
  • It is believed that the launch date of the scheme would be announced on August 15, 2018, along with online application process.

Why Was Ayushman Bharat Yojana Scheme Introduced?

India is growing as a world superpower, yet the healthcare systems in India faces several challenges, the most important of these challenges is cheap and accessible healthcare for all. A country where more than 60% of its citizens are poor, healthcare is an expensive deal. Often, people are forced to sell their properties or incur heavy debts to pay for health care. Part of the problem is that not many people opt for healthcare schemes, lack of knowledge of government insurance schemes, and absence of a central insurance scheme which covers and protects all citizens.

While some states have introduced healthcare insurance schemes, their promotion and implementation have suffered, leading to a lack of awareness among the masses. Not to mention, states have only worked with government hospitals which are mostly overwhelmed. It was thus necessary for the centre to step in and pave roadways for public-private partnerships in healthcare too.

Yet, another problem was the misuse of cash made available to beneficiaries. Some beneficiaries used the cash for other means than healthcare and the ones who did opt for healthcare were often hoodwinked by fraudulent elements, who may overcharge them for simple treatment procedures.

The Ayushman Bharat Yojana focuses on remedying all of these problems. The yojana is a central scheme which would cover all states. It plans to introduce new wellness centres which will be equipped to deal with all medical emergencies and needs. The transfer of money would be electronic, preventing its misuse. On top of that, the state has already fixed the prices of over 1500 medical packages which also include surgery, preventing exploitation at the hands of corrupt healthcare professionals.

This scheme is also referred as Modicare or NaMoCare, however, the official name of the Yojana till date remains Ayushman Bharat Yojana.

FAQs:

  • What is Ayushman Bharat Yojana?

Ayushman Bharat Yojana is an umbrella healthcare insurance scheme which is aimed at making quality healthcare available to the masses. The scheme aims at providing insurance to nearly 10 crore family or nearly 40% of the Indian population. Each family would be insured for INR 5 lakhs, the size of the family notwithstanding.

  • Who are eligible for Ayushman Bharat Yojana?

Persons living below the BPL like beggars, daily wage workers and so on are automatically eligible for the scheme. Apart from these groups, the government has shortlisted certain groups based on the SECC parameters which qualifies them as at risk groups.

  • How does Ayushman Bharat Yojana Work?

The yojana is very structured. The state and centre bear the premium cost at 60:40 ratio. The states are responsible and receive appropriate guidance for hospital empanelment, promotion and enrollment for the scheme. Since, it’s a national scheme, any patient, could avail benefits in any empaneled hospital in the country. The benefits would be electronically exchanged, the hospital would create a bill according to the treatment package cost, pre-approved by the government and send it to the concerned insurance company, which would disburse the amount electronically, preventing misuse and abuse of benefits.

  • What is the launch date of Ayushman Bharat Scheme?

The launch date of the scheme would be announced on August 15, 2018.

  • Ayushman Bharat yojana official website?

More information and updates about the scheme can be accessed at www.abnhpm.gov.in

News on Ayushman Bharat Yojana:

In Less Than 2 Weeks Karnataka Government Provides Ayushman 

Bharat Scheme Benefits to Over 600

– 5th Dec 2018

Karnataka government was already running a successful program known as Arogya Karnataka, which has now been clubbed with the Ayushman Bharat Scheme, to create a new scheme called Ayushman Bharat Arogya Karnataka. In the 2 weeks since the Karnataka signed an MOU with concerned national bodies for the implementation of Ayushman Bharat Scheme, it has already provided benefits to over 600 poor families. Karnataka already has  900 hospitals under its Arogya scheme, which would now be a part of the Ayushman scheme. Of these hospitals, nearly 500 hospitals are private hospitals, although, a patient in Karnataka has to get a written letter from a government hospital identifying the disease and declaring its incapacity in dealing with the disease, post which a patient could approach a private hospital for treatment. This unique feature is something, the Ayushman Bharat Scheme handlers request other states to copy.

Karnataka government had issued nearly 4.5 lakh Arogya Karnataka Identity Cards, which will now be converted to Ayushman Bharat Arogya Karnatak Indentity Cards, giving poor patients more access to quality healthcare, all over India.

Modicare Will Create 10 Lakh Jobs, says Ayushman CEO

– 30th Oct 2018

With the Modi government claiming the success over the Ayushman scheme, the government states that this will create 10 lakh jobs in the health and insurance sector. The scheme was built on an effort to improve the quality of healthcare services. The scheme revealed that 6 crore people in India become bankrupt due to the fact of over-expenditure on medical services.

However, the Pradhan Mantri Jan Arogya Yojana (PMJAY) provides Rs 5 lakh annual insurances for over 10.7 crores BPL families. The central government will provide 60% of the funding while the state governments will have to pitch in the remaining 40% of the funding.

Indu Bhushan, CEO of PMJAY said, India has a very high rate of health care expenditure and this needs to be put in good use. He also added that this excessive expenditure will benefit BPL families and the needy, thus providing them with quality healthcare services.

Ayushman Invites Private Players to Run District Hospitals

– 30th Oct 2018

The Ayushman health scheme by the Modi government has given an opportunity for the private sector firms to provide health care services in district hospitals. The major think tank of the Modi govt, NITI Aayog put forth a list of guidelines that will monitor these private players into district hospitals.  

As per these guidelines, private players will be chosen on the basis of transparent and competitive bidding and the state governments will be given the opportunity to customise these guidelines based on the situation and culture of each state

With the aim of providing world-class healthcare facilities, the Modi govt has introduced private players to play an important role in Indian medicine.

However, the government will pay these private players based on the procedure or service offered as per competitive bidding. The agreement between the government and private players will be for a term of 15 years and in case a private player need to renew this agreement, it has separate guidelines that are also listed under the guidelines.

This was an aim to benefit the poor who cannot afford western medicine and reduce expensive medicines. Ayushman is currently the biggest government-funded health scheme in the country that aims to cover over 10 crore people and below poverty line families.

Ayushman Bharat Acquires 1 Lakh Subscribers in 30 Days

– 22nd Oct 2018

The centers most prestigious health insurance scheme Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) has successfully been registered for about 1 lakh subscribers in a time span of just 30 days. The Ayushman Bharat Scheme is showing promising results in the first month that can help boost the investment for the same.

The chief executive officer of Ayushman Bharat, Mr. Indu Bhushan said that the scheme will completely be hassle free and smoothly functioning within three months. He also added that the scheme will show its real impact on the population within a year or two. The IT system behind the scheme which is the crux of the plan is running in a satisfactory fashion and is still in a phase of troubleshooting as the influx of beneficiaries keeps on increasing.

The center until now has distributed about two lakh cards under the Ayushman Bharat Scheme, they also gave out information for people who are trying to find out if they are eligible for Ayushman Bharat scheme, you can call the hotline number of 14555 to give your details and confirm your eligibility. Active efforts are in place to identify the the deserving population who regularly visits the hospital. As of now according to the card issuing management of PGIMS Rohtak Haryana, the selection is done based on the Socio-Economic Caste survey done in 2011.

As per the recent reports about 7000 hospitals are empanelled within the Ayushman Bharat Pradhan Manti Jan Aarogya Yojana and about 8000 hospitals are in the process of being empanelled. This comes as a good news as the implementation of the plan across many more hospital will enable the eligible candidates to attain emergency medical care from nearby hospitals rather than travelling far away for it.

The IT-based reporting system makes it easier for the government to track the patient and his/her records eliminating or highly reducing the chances for fraud. Since the IT section is facing performance issues due to the limited availability of fast internet in remote locations, the government is also working on an offline module to ensure that this does not come in the way of the efficient implementation of the scheme.

The malfunction of the IT system recently caused a real problem at Rohtak’s PGIMS where Ramesh a an eligible candidate died of lung disorder. Ramesh’s widow claimed that they were told to pay the initial amount and keep the bills so that it can be reimbursed under the scheme, but due to technical problems were denied the claim.

The government does take this issue very seriously and is doing everything they could as soon as possible to eradicate such mishaps during the implementation of the scheme.

Ayushman Bharat Implementation to be Overseen by the Parliment

– 15th Oct 2018

The parliamentary standing committee on health led by Ram Gopal Yadav of the Samajwadi Party has decided to pay close attention to the implementation of the prestigious Ayushman Bharat Scheme all across India.

Hailed as the worlds largest insurance program, PM-JAY (Ayushman Bharat) is set to fulfil two main objectives. It aims at providing wellness and health infrastructure throughout the country providing better access to health care even in the remote regions. The second aim is to provide an ambitious insurance coverage of Rs 5 Lakhs for rural and urban poor which is set to help more than 10.74 crore families.

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was implemented for the first time in Jharkhand and has till now been availed by about 50,000 below poverty line patients.

However there are some doubts regarding the successful implementation of the plan, and hence the standing committee on health has decided to maintain a strict observation on the implementation of the yojana. The parliamentary standing committee on health is also set to probe into the functioning of central government hospitals such as AIIMS and also the affordability of treatments for Cancer and DMD.

Prime Minister Narendra Modi is counting on the new scheme to provide India with a strong foot in the global health statistics. However, the lack of funding has become a thorn on the way from the beginning, hence the new panel overlooking the implementation of the scheme can be a sign of good things to come.

Govt. Plans To Initiate Ayushman Scheme In Tier-II Cities

– 11th Oct 2018

In order to boost the central government’s health insurance scheme (Ayushman Bharat) in Tier-II cities, more nurses and doctors have been recruited for the cause. This is said to bring in more money that can be used to recruit more doctors.  

Rajnesh Trivedi, President and head of sustainable investment banking at Yes Securities, said, “ price has always been a barricade in medicine and thus the poor cannot afford medicines. In order to overcome this by recruiting professional doctors with quality and great expertise”.

However, in terms of problems faced by investors, Amit Varma, Managing Partner of Quadriga Capital said, “when dealing with a government scheme, Investors will face problems such as lack of digital records and the quality of manpower”.

Many investors prefer to join such an initiative only based on existing records by the hospital executing the scheme. Moreover, Mr Varma said, “Digitisation is the key which can be used for everything-insurance, patients and doctors data.

In a first, Kashmir to receive Ayushman Bharat Yojana Via Bajaj Allianz General

– 09th Oct 2018

In a first on its kind, the state of Jammu and Kashmir is witnessing something monumental. The private assurance party, Bajaj Allianz general, which was incorporated under the Ayushman Bharat Scheme on September 22, 2018, has announced that it will start implementing the Ayushman Bharat Yojana in the state of Jammu and Kashmir. The private investment provider plans to provide access assistance to the citizens of 22 districts of the state. This is the first time Jammu and Kashmir will be receiving access to and benefits of any government scheme.

The Ayushman Yojana plans to provide health insurance to nearly 10 crore families or 40% of the country’s population within the first few years of implementation and a larger focus would be on keeping the transactions electronic.

Ayushman Bharat Scheme To Be Launched On September 25, 2018

– 21st Aug 2018

On August 15, 2018, the Prime Minister of India announced the launch date of the Ayushman Bharat Scheme. The scheme will be launched on September 25, 2018, to commemorate the birth of the ideologue of RSS, Pt. Deen Dayal Upadhyaya. The health scheme aims to provide benefits to 10 crore poor families or as the PM put it, the combined population of the USA, Canada, and Mexico or the entire European Union. In a bid to appease his biggest supporters, the Middle Class, the PM also assured that although the program is being piloted to target BPL families, it would eventually cover and provide benefits to people of all classes. Earlier, it was speculated that the scheme would be launched on August 15, 2018. However, the PM confirmed that this 5 week delay is intentional as the government wants to test and fine tune the technology aspect of the scheme in these five weeks. Over 106 districts would join the testing phase, aimed to make the scheme fool proof, and transparent. The ambition and enormity of this program and the cost involved is not hidden from the public, leading many to speculate if the launch of this scheme could help the PM’s return in 2019.

GOI Launches the Empanelment Process of Hospitals

– 07th Aug 2018

The apex body for implementing the Ayushman Bharat Yojana Program, the National Health Agency (NHA), recently launched the process for empanelment of both public and private hospitals under the Ayushman Bharat Yojana. Instructions and guidelines have been sent to State Health Agencies (SHA) to aid them with the empanelment process of hospitals in specific states. The NHA claims that it aims to finish the process in stipulated time to help push the launch of the program forward. However, this does not mean that any hospital or agency would be empaneled. The NHA and SHAs would perform strict quality check on all applicants and empanel them according to the desired skills and specialities mentioned in the guidelines. Apart from hospital empanelment, the SHAs and NHA are also responsible for developing infrastructure for the promised health centres as well as providing healthcare professionals at those health centres. The process for the same was launched in July, 2018. It is hoped that public and private hospitals and healthcare providers would join the program to make it a success.

There has been some confusion regarding the future of state run, health insurance provided to the underprivileged; nearly 24 states in India provide some or the other kind of health insurance. These schemes would be merged into the Ayushman Bharat Yojana.

Hospitals registered under the Rashtriya Swasthya Bima Yojana (RSBY) need to apply for Ayushman Bharat again, as they would be automatically empanelled.

1.
Ayushman Bharat – Ministry of Finance: Press Release. Ministry of Finance. https://cdn-b.medlife.com/2018/08/ayushman-bharat-ministry-of-finance-press-release.pdf. Accessed August 2018.
2.
Guidelines for Pradhan Mantri Rashtriya Swasthya Suraksha Mission (PMRSSM). PM-RSSM. https://cdn-b.medlife.com/2018/08/guidelines-pradhan-mantri-rashtriya-swasthya-suraksha-mission-pmrssm.pdf. Accessed August 2018.

11 COMMENTS

  1. You have not mentioned age limits even for bpl families. Or is it covered by family so that all persons are covered irrespective of age of the family members.

    • Hi, Thank you for your comment. We haven’t mentioned an age limit because no age limit has been prescribed by the Government of India as of yet. For now, it seems that the scheme is for all family members without any discrimination on age or size of family. More will be clear once the scheme is formally launched. Keep watching out this space for further details.

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