Ayushman Bharat Yojana : All You Need To Know - Features. Eligibility And All

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You must be heard about the new national health protection mission initiative from Government of India viz. Ayushman Bharat Yojana. With this national health protection scheme, the government has introduced an affordable health insurance scheme for the Indian citizen. This scheme is also known as 'Modicare'

The need of Ayushman Bharat Yojana

In India where the population is growing day by day like anything, it is very hard to manage medical expenses to the poor man. It is generally seen that poor people suffer a lot due to the unavailability of social security especially when it comes to healthcare. It is a step towards providing social security to the poor people of India. The scheme announcement was made by PM Narendra Modi on Independence Day speech. The major objective for this scheme provides the quality healthcare insurance coverrage to poor people in India.

Ayushman Bharat Yojana Benefits and Eligibility

• Insurance Coverage – Maximum 5 Lakh sum assured per family per year
• Type of Insurance – Family floater type insurance policy
• Premium – Premium amount will be reasonable and will be fixed by the state health agencies

Key Benefits of Ayushman Bharat Yojana

• Hospitalization expense benefits 
• Cashless benefits from any public and private empaneled hospitals 
• A defined transport allowance pre-hospitalization will be paid to the beneficiary 
• Daycare treatment benefits (as applicable) 
• Follow-up care benefits 
• Pre and post hospitalization expense benefits 
• Newborn child/ children benefit 
• Pre-existing diseases conditions will be covered with a certain exclusion 

Eligibility Criteria of Ayushman Bharat Yojana (Modicare)

• This scheme will be offered to poor people as per data collected under social economical caste census conducted by the government in 2011. 
• Aadhaar card is not mandatory to avail benefit under this scheme but valid ID is required to get treatment at the hospital. 
• There is no limitation about family member under this scheme. 

How to check eligibility for Ayushman Bharat | PM – Jan Arogya Yojana?

The facility of checking eligibility for Ayshman Bharat Yojana is launched. Follow the process given below to check if you are eligible for Ayushman Bharat Jan Arogya Yojana or not

• Visit – https://mera.pmjay.gov.in/search/

• On the landing page, you need to enter an active mobile number, this will be used to receive an OTP. 
• Click on generate OTP button. 
• Enter received OTP as a text message on the mobile number entered. 
• Enter your demographic information such as State, Name, Age, District, Village etc.

Medical Treatment Location under Ayushman Bharat Scheme (Modicare)

It is claimed that like a normal insurance scheme, a patient can get treatment in most the private hospital as well as government hospitals. However, it is mandatory for that hospital to be part of Ayshman Bharat network. The treatment given under this scheme will be 100% cashless.
In every hospital one, ‘Ayushman Mitra’ will be appointed. A task of Ayushman Mitra will be to guide patient and family about the process. This is to ensure that patient and family get relevant help. Apart from that Ayshman Mitra will also check document to verify eligibility and enrolment to the scheme.
Insurance companies like LIC of India, National Insurance, Oriental Insurance, New India Assurance, United Indian Assurance shall be involved in providing insurance under this scheme.

Process Flow at Empannels Hospital and Grievance Redressal

Detailed process flow at Empaneled hospital is provided on the official website 

Grievances of Ayushman Bharat Yojana 

Grievance against the insurance company, hospital, their representatives or any functionary 

• If a beneficiary has a grievance on issues relating to entitlement, or any other PMRSSM related issue against Insurance Company, hospital, their representatives or any functionary, the beneficiary will approach DGRC. 
• The DGRC shall take a decision within 30 days of receiving the complaint. 
• If either of the parties is not satisfied with the decision, they can appeal to the SGRC within 30 days of the decision of the DGRC. 
• The SGRC shall take a decision on the appeal within 30 days of receiving the appeal. The decision of the SGRC on such issues will be final. 

Grievance against district authorities 

If the beneficiary has a grievance against the District Authorities or an agency of the State Government, it can approach the SGRC for resolution. The SGRC shall take a decision on the matter within 30 days of the receipt of the grievance. The decision of SGRC shall be final.

We shall update you on any of the further development on this!