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Atal Amrit Abhiyan: Benefits, Eligibility, Enrollment & Covered Diseases

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The state of Assam has been actively investing in improving its healthcare system. The Atal Amrit Abhiyan Health Insurance Scheme represents a focused approach by the Assam state government to tackle the specific health challenges faced by its people. A large section of the diverse population lives in remote and rural areas where access to healthcare is limited. It becomes daunting for residents to receive timely and adequate medical care, especially during calamities or when faced with severe health conditions. While national healthcare schemes provide wider coverage, they may not always address the unique needs of every state. Recognising this gap, Assam’s government introduced the Atal Amrit Abhiyan to complement national efforts and provide more targeted support to its citizens.

Overview of Atal Amrit Abhiyan Health Insurance Scheme

The Government of Assam launched the Atal Amrit Abhiyan Scheme to make healthcare more affordable for people from lower-income groups. It is a state-specific initiative created to address the unique healthcare challenges faced by the people of Assam. Here’s why it is focused only on Assam —

1. Geographical and Socio-economic Challenges

Assam, with its diverse population and challenging terrain, faces unique healthcare difficulties. People living in the remote and rural areas of the region lack access to quality healthcare services. The availability of doctors, nurses, and paramedics in this tea-producing state is a major concern. Hence, the Atal Amrit Abhiyan was introduced to bridge this gap.

2. Economic Disparities

A large portion of Assam's population lives below the poverty line. The economy is fundamentally based on agriculture, leading to economic disparity, which means that a significant portion of the population struggles to afford healthcare, making a state-specific scheme essential.

3. Complementing Central Schemes

The Atal Amrit Abhiyan is a mitigating measure by the Assam state government to address its public health challenges. While there are national health schemes available, the state government identified gaps that were not adequately addressed by central initiatives. The Atal Amrit Abhiyan was introduced to complement the national schemes, filling the gaps with a more local approach.

Benefits of the Scheme

Many families fall into poverty because of the high costs of healthcare. Whether it's a long-term, chronic illness or a sudden, severe condition, the expenses can quickly become overwhelming, leading to devastating financial consequences. Even for lower-middle-class and middle-class families, accessing quality treatment for critical illnesses is often out of reach because the costs are simply too high. The primary advantages of the Atal Amrit Abhiyan Scheme include —

1. Accessible Healthcare

The Atal Amrit Abhiyan ensures that even lower-middle-class and middle-class families can access quality medical care without worrying about the high costs.

2. Focus on Health

Families can focus on the well-being of their loved ones without the added stress of managing huge medical bills.

3. Support for Critical Illnesses

People sometimes end up bearing huge expenses towards managing chronic ailments or seeking timely medical attention for critical illnesses. The scheme pitches in right here, helping families avoid financial hardships.

Eligibility Criteria for the Scheme

The scheme is meant for the residents of Assam, especially those who belong to the lower-income group. To be eligible for the scheme, here are some basic criteria —

• Residents of Assam

Only people who live in Assam and have valid identity proof are eligible.

• Income Limit

Families with an annual income of up to INR 5 lakhs can apply. There are two categories of beneficiaries —

1. BPL (Below Poverty Line)

These families do not have to pay anything for the insurance. All BPL families with an annual income of less than INR 1.2 lakhs/annum are eligible.

2. APL (Above Poverty Line)

These families need to pay a nominal fee of INR 100 per year for every individual in the family to avail of the scheme. The families must fall in the annual income bracket of INR 1.2 lakhs and INR 5 lakhs to be eligible for enrolling under the scheme.

Members of APL and BPL families must provide all relevant documents at the time of enrolment for verification.

Former or present employees of the central and state governments are ineligible for enrolling under this scheme.

Diseases Covered Under the Scheme

The Atal Amrit Abhiyan covers 437 diseases and treatments categorised into 6 groups. Illnesses covered by this scheme are —

1. Cancer

Covers treatment costs for various types of cancer.

2. Kidney Diseases

Covers treatments like dialysis and kidney transplants.

3. Cardiovascular Diseases

Includes treatments for heart conditions, such as surgeries and angioplasty.

4. Neonatal Diseases

Covers treatments for newborns with severe health issues.

5. Neurological Conditions

Includes treatments for brain and nerve disorders.

6. Burns

Covers treatment for severe burn injuries.

The scheme covers all costs related to hospitalisation, including surgery, medication, and follow-up treatments. You can receive treatment at empanelled hospitals without having to pay upfront, as the scheme offers cashless treatment and covers your medical bills.

Enrolment Process

Enrolling in the Atal Amrit Abhiyan is a simple process that ensures you and your family are covered when it comes to healthcare.

1. Visit a Health Centre or CSC (Common Service Centre)

The first step is to go to your nearest Health Centre or CSC. If you have any questions regarding enrolment, you can connect with a dedicated team there.

2. Submit Required Documents

You’ll need to bring along basic documents. This usually includes identity proof, where you live, and your income. Don’t worry if you’re not sure which documents to bring — the staff at the centre can help you figure it out.

3. Receive Your Health Card

After you’ve completed the paperwork and submitted your documents, you’ll be given a health card, commonly referred to as the Atal Amrit Card or Atal Amrit Abhiyan Card. This card is your key to the scheme. Whenever you or a family member needs medical care, you must present this card at the hospital, and it will cover the cost of treatment, so you won’t have to pay out of pocket.

You can also obtain the form from the government’s official website (nhm.assam.gov.in/). Scroll down to Atal Amrit Abhiyan Application Format, download, and print the form. Submit the duly filled out form along with the requisite supporting documents to the Office of the Joint Director of Health Services in your district. You can also attain the form at the District Enrolment Centre.

While healthcare is essential, it can also be expensive, leading many to avoid opting for a policy that assures quality healthcare. The Atal Amrit Abhiyan scheme makes sure such choices of neglecting healthcare due to lack of affordability and accessibility do not exist. By following these steps, you can ensure you and your loved ones have access to the healthcare you need without the financial stress.

Coverage Limit and Claims Process

The Atal Amrit Abhiyan Scheme provides a coverage limit of up to INR 2 lakhs per year for each family member. This amount helps cover the costs of treating severe illnesses, making it easier for families to manage their healthcare expenses.

Claim Process

• Hospitalisation

The scheme covers costs when you are admitted to an empanelled hospital for treatment.

• Cashless Treatment

You can get treated without paying upfront at any of the empanelled hospitals under the scheme.

• Claim Assistance

Hospital staff (an Arogya Mitra) will help you with the claim process, so you don’t have to worry about paperwork.

• Immediate Coverage

The claim process is straightforward and designed to provide quick financial support during medical emergencies.

Conclusion

The Atal Amrit Abhiyan Health Insurance Scheme is not just another government programme — it’s a promise that no one has to choose between their health and savings. Imagine a family dealing with a severe illness; the stress of arranging funds for treatment can be overwhelming. This scheme steps in to ease that burden, ensuring that when you or your loved ones need medical help, it’s there without putting you in debt.

Although this scheme covers six major categories of ailments, investing in an individual health insurance policy or health insurance plans covering all household members is essential if you need more extensive coverage that meets your healthcare requirements.

FAQs

Here are a few FAQs about the Atal Amrit Abhiyan Scheme, explained in simple terms —

1. Who can benefit from this scheme?

This scheme benefits anyone who lives in Assam and has a family income of less than INR 5 lakhs per year.

2. What does the scheme cover?

The scheme covers the treatment of severe illnesses like cancer, heart disease, and kidney ailments. It helps pay for the treatment, so you don't have to worry about huge bills.

3. How much coverage do I get?

Each member of your family can receive up to INR 2 lakhs per year to cover the costs of his/her treatment.

4. Do I have to pay anything at the hospital?

No, you don’t have to pay anything upfront if you go to an empanelled hospital that is part of the scheme. You can avail of cashless treatment.

5. How can one make a claim?

The hospital staff will help you with the claim process. All you need to do is provide your Atal Amrit Card, and they’ll take care of the rest.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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