Ayushman Bharat: Decoding the world’s largest health assurance scheme

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The Centre has introduced the universal health insurance scheme ‘Ayushman Bharat’ back in 2018 and it is for all people of the country. It had subsumed the Rashtriya Swasthya Bima Yojana launched in 2008 and Senior Citizen Health Insurance Scheme. Ayushman Bharat is the largest health assurance scheme in the world which aims at providing a health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalization to over 10.74 crore poor and vulnerable families. It covers almost 55 crore beneficiaries from the bottom 45% of the Indian population.

Along with various diseases, the scheme also covers Covid-19. The treatment and testing of Covid-19 will be done for free of cost at any of the private hospitals empaneled for the scheme.

Money9 gives you key features of the scheme, benefits, what is covered, and how to check eligibility and others.

Eligibility

Any individual, especially financially backward people are eligible to opt for this central government scheme. Rural households which are included are then ranked based on their status of seven deprivation criteria (D1 to D5 and D7). Urban households are categorised based on occupation.

Rural households include the following categories: D1- Only one room with kucha walls and kucha roof

D2- No adult member between ages 16 to 59

D3- Households with no adult male member between ages 16 to 59

D4- Disabled member and no able-bodied adult member

D5- SC/ST households

D7- Landless households deriving a major part of their income from manual casual labour.

On the other hand, 11 urban occupational categories of workers are eligible for the scheme, like a beggar, domestic worker, street vendor, cobbler, hawker, construction worker, plumber, mason, labourer, painter, welder, security guard, coolie, transport worker, driver, conductor, helper, conductors, cart puller, rickshaw puller, etc.

What’s included

A package consists of all the costs associated with the treatment, including pre and post hospitalisation expenses. The specified surgical packages are paid as bundled care where a single all-inclusive payment is payable to the hospital by the insurer.

The treatment packages are comprehensive, covering treatment for nearly 24 specialties that include super-specialty care like oncology, neurosurgery and cardio-thoracic and cardiovascular surgery, etc.

The process

The beneficiaries will not be required to pay any charge and premium for the hospitalisation expenses. Each empaneled hospital will have an ‘Ayushman Mitra’ to assist patients and will coordinate with beneficiaries and the hospital.

All the beneficiaries will be given letters having QR codes which will be scanned and a demographic authentication will be conducted for identification and to verify his or her eligibility to avail the benefits of the scheme.

If any of the subscribers falls ill and requires hospitalisation, members of the family can just walk to the ‘Ayushman Mitra’ help desk and submit the e-identity card. The rest would be taken care of by the hospital authority.

Documents needed

Every eligible person has to show his/her eligibility with proofs such as an e-identity card, Aadhaar card, Voter ID card, and ration card. They have to submit these documents to the hospital or the nursing home.

Enrollment

The eligible families can enroll themselves by going to the SDO or local panchayat or municipal office. There the person must submit all the required documents and biometric details. The e-card will be created within a minute.

One can also check his/her eligibility and status by calling 14555 and 1800111565 helpline numbers.