10 Major Benefits of Ayushman Bharat Yojana

Posted on: Jul 3, 2023 | 3 mins | Written by: HDFC ERGO Team

10 Major Benefits of Ayushman Bharat Yojana

In an era of increasing medical costs and unforeseen healthcare needs, having access to dependable health insurance has become a vital component of a well-rounded financial plan. Health insurance acts as a safeguard, providing individuals and families with the necessary financial security against unanticipated medical emergencies. Recognising the significance of affordable healthcare for all, the Government of India launched Ayushman Bharat Yojana — Pradhan Mantri Jan Arogya Yojana (PM-JAY), a ground-breaking endeavour aimed at revolutionising healthcare access and coverage for millions of Indian citizens. Let’s explore its key features and the 10 significant benefits of Ayushman Bharat Yojana.

What is the Ayushman Bharat Yojana?

Ayushman Bharat Yojana or PM-JAY (Pradhan Mantri Jan Arogya Yojana) is a special health insurance scheme launched by Prime Minister Shri Narendra Modi in September 2018. The scheme focuses on making quality healthcare accessible and affordable to the economically weaker section of society. It is like a Mediclaim policy that reduces out-of-pocket expenses during medical emergencies and protects vulnerable families from exorbitant healthcare expenses.

Key Features of Ayushman Bharat PM-JAY

The primary attributes of Ayushman Bharat Yojana are as follows:

• Ayushman Bharat Yojana policy offers cashless coverage of up to Rs 5 lakh per family in a year. The benefits can be availed by one or all members of the family.

• Covers both secondary and tertiary care hospitalisation as listed in the scheme.

• Covers the cost of nearly 1,929 procedures, including room rent, diagnostic tests, doctors’ fees, surgeon charges, OT and ICU charges, etc.

• Beneficiaries of the Ayushman Bharat Yojana policy can avail of cashless treatment in any of the empanelled public and private hospitals across the country.

• Pre-existing diseases are covered right from the day of enrolment. There’s no waiting period.

• Ayushman Bharat Yojana policy covers up to 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses, including medicines and diagnostics.

• There’s no cap on age, family size, or gender under the Ayushman Bharat Yojana policy.

• Public hospitals receive reimbursement at par with private healthcare institutions.

• More than 2 crore families (nearly 55 crore beneficiaries) belonging to the poor and vulnerable sections of society are eligible for Ayushman Bharat Yojana.

10 Benefits Covered Under PM-JAY

All expenses incurred for the below services or treatments are covered under the Ayushman Bharat Yojana policy:

• Medical consultation, examination, and treatment of the beneficiary

• Pre-hospitalisation

• Post-hospitalisation of up to 15 days

• Cost of medicine and medical consumables

• Non-intensive and intensive care services

• Diagnostic and laboratory tests

• Medical implantation, if required

• Accommodation during hospitalisation

• Food services

• Any complications arising during treatment are covered under the Ayushman Bharat Yojana policy Those eligible for Ayushman Bharat Yojana can avail of the above Ayushman Bharat benefits in any empanelled hospital in India.

PM-JAY Critical Illness Coverage

Apart from covering pre-existing illnesses and daycare procedures, Ayushman Bharat Yojana also provides coverage for critical illnesses. Treatments can be availed in any public or private empanelled hospital pan India up to the sum insured of Rs 5 lakh per year under the Ayushman Bharat Yojana policy.

List of Critical Diseases covered under Ayushman Bharat Health Scheme

The critical illnesses covered under Ayushman Bharat Yojana are:

• Prostate cancer

• Double valve replacement

• Coronary artery bypass graft (ABG)

• Carotid angioplasty with stent

• Anterior spine fixation

• Pulmonary valve replacement

• Skull base surgery

• Laryngopharyngectomy

• Tissue expander in case of disfigurement due to burns

Exclusions

There are some medical conditions which are not covered under Ayushman Bharat Yojana, such as:

• OPD expenses

• Organ transplantation

• Cosmetic surgeries

• Fertility related procedures

• Drug rehabilitation

How can you check Ayushman Bharat Yojana’s eligibility online?

You can check the eligibility for Ayushman Bharat Yojana online by following the steps below:

1. Visit the official website of the Ayushman Bharat Yojana.

2. Locate the “Am I Eligible” tab on the homepage and click on it.

3. Next, enter your mobile number for verification. Enter the OTP and captcha code you receive on your phone and click on the 'Login' option.

4. Once you are logged in, you will be asked for some basic details, such as your name, gender, state of residence, scheme, sub-scheme, etc. Provide the required details and click on the search option.

Once the verification process is complete, the website will display a message indicating your eligibility status. If you are eligible for the Ayushman Bharat Yojana Scheme, the website will display the benefits you can avail of. You can also check your eligibility for the Ayushman Bharat card. If you need further assistance, call the toll-free number 1800-11-4477.

You can also check your eligibility for Ayushman Bharat Yojana offline at the nearest Common Service Centre (CSC). Make sure you carry the required documents for the eligibility check. If you are eligible for the scheme, you can fill out the registration form with relevant information and submit it to the CSC for their review. If everything looks fine and your application is processed successfully, you will receive your Ayushman Bharat Yojana card.

FAQs

1. What are the benefits of Ayushman Bharat Yojana?

Ayushman Bharat Yojana offers a cashless cover of up to INR 5 lakh per family per year for secondary and tertiary healthcare in government and private network hospitals across the country. The scheme covers all members of a family, irrespective of their age and gender. It is like a health insurance plan for a family and comes in handy during medical emergencies and planned procedures.

2. Can I check my eligibility for the scheme online?

Yes, you can check your eligibility for the scheme on the official PM-JAY website https://pmjay.gov.in/. Click on the “Am I Eligible” option and enter the required details to verify your eligibility.

3. Are the beneficiaries covered under the scheme liable to pay anything from their pocket?

No, beneficiaries must not pay anything from their pocket as their entire healthcare expenses are taken care of by the government. The coverage is offered without any premium or fees.

4. What all healthcare expenses are covered under the Ayushman Bharat Yojana scheme?

Ayushman Bharat Yojana covers a range of healthcare expenses, such as hospital bills, pre- and post-hospitalisation expenses, doctor’s consultation fees, medicines, hospital room rent, and more.

5. Which health conditions are covered under Ayushman Bharat Yojana?

The scheme covers a wide range of conditions, including pre-existing conditions and critical illnesses. Some diseases and illnesses covered under the scheme are cancer, heart disease, liver disease, mental illness, neonatal diseases and communicable diseases, among others.

CONCLUSION

With an aim to make healthcare accessible and affordable to the poor and vulnerable, the Government of India launched the Ayushman Bharat Yojana, one of the world’s largest health insurance schemes. Every family under the Ayushman Bharat Yojana policy gets coverage of up to Rs 5 lakh per year, which any one or all family members can utilise. The eligible beneficiaries can avail of the benefits of Ayushman Bharat Yojana in any of the empanelled public and private hospitals across India. Ayushman Bharat Yojana policy is also open to all – there’s no bar on age, number of family members or gender.

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

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