What is Ayushman Bharat Yojana? How to check eligibility?

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a significant national health insurance and assurance scheme launched by the Ministry of Health and Family Welfare (MoHFW) in India. The scheme aims to provide cashless hospitalization care to the poor and vulnerable households across the country. Here are some key features of the scheme:

1. Eligibility Criteria: To avail benefits under AB-PMJAY, households must be included in the Socio Economic and Caste Census (SECC) 2011. The selection criteria are based on various parameters like housing conditions, occupation, gender, caste, etc.

In rural areas, households falling under categories D1 to D7 (except D6) are included, which encompass various vulnerable groups and economically deprived households.

In urban areas, individuals engaged in specific occupational categories like street vendors, domestic workers, artisans, laborers, etc., are eligible.

2. Coverage: AB-PMJAY offers a non-contributory family floater health plan, where the premium is fully borne by the government. The coverage amount is up to INR 5 lakh per family per year. There are no restrictions on family size, age, or gender.

3. Hospital Network: The scheme has a vast network of over 26,055 empaneled hospitals across the country. Beneficiaries can avail cashless treatment at these hospitals by presenting their Ayushman Bharat card.

4. Benefits: AB-PMJAY covers approximately 1,393 treatment procedures, including pre-existing conditions. It also provides coverage for up to three days of pre-hospitalization and 15 days of post-hospitalization expenses, which includes medicines, diagnostic services, physician fees, room charges, surgery costs, ICU charges, etc.

5. Online Registration: Eligible individuals can register for AB-PMJAY through the official website setu.pmjay.gov.in. The registration involves filling up a self-explanatory form and completing the KYC process, which includes verifying Aadhar card details through various methods like OTP, fingerprint, IRIS, or face recognition.

6. Non-Contributory Scheme: The scheme is funded through a partnership between the central government and state governments. The contribution ratio is 60:40 for most states, 90:10 for north-eastern and three Himalayan states, and 100% for Union Territories without legislation.

7. Exclusion and Withdrawal: Some states and UTs have not joined the AB-PMJAY scheme. For instance, Odisha, NCT of Delhi, and West Bengal have different health schemes. However, many states and UTs are integrating the benefits of AB-PMJAY with their existing health schemes to enhance healthcare coverage for their populations.

AB-PMJAY has made significant strides in providing health coverage to a vast number of beneficiaries, as indicated by the verification of 21.9 crore beneficiaries and over 4.3 crore hospital admissions by early 2023. The scheme's focus on reaching the economically deprived and vulnerable sections of society has been instrumental in improving access to healthcare services for those who need it the most.