Ayushman Bharat health insurance scheme

Ayushman Bharat health insurance scheme lanuched on September 23, 2018, the Prime Minister Narendra Modi launched Ayushman Bharat, world's largest government-funded healthcare scheme. Every person listed in the Socio Economic Caste Census (SECC) database will automatically be enrolled in the scheme.

• Ayushman Bharat aims to provide healthcare facilities to over 10 crore families covering urban and rural poor.
• PMJAY-Ayushman Bharat is the biggest government-sponsored healthcare scheme in the world.
• The scheme offers an insurance cover of Rs 5 lakh, which will cover almost 50 crore citizens.

• Ayushman Bharat - National Health Protection Mission will have a defined benefit cover of Rs. 5 lakh per family per year.
• If you are eligible under the health insurance scheme, you get automatic coverage. Eligibility is based on Socio-Economic Caste Census (SECC) database.
• Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
• The beneficiaries can avail benefits in both public and empanelled private facilities.
• All pre-existing diseases covered. Hospitals cannot deny treatment
• Cashless and paperless access to quality health care services.
• Hospitals will not be allowed to charge any additional money from beneficiaries for the treatment.
• Having an Aadhaar card is not mandatory to avail of Ayushman Bharat benefit but beneficiaries need to carry a prescribed ID to receive free treatment at the hospital.
• 1,350 medical packages covering surgery, medical, day care treatments, cost of medicines and diagnostics.
• To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis.
• One of the core principles of Ayushman Bharat - National Health Protection Mission is to co-operative federalism and flexibility to states.
• For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister.
• States would need to have State Health Agency (SHA) to implement the scheme.
• To ensure that the funds reach SHA on time, the transfer of funds from Central Government through Ayushman Bharat - National Health Protection Mission to State Health Agencies may be done through an escrow account directly.
• In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless transaction.

- In Rural Area

1. Households living in only one room with kucha walls and kucha roof.
2. Households with no adult member between age 16 to 59
3. Female headed households with no adult male member between age 16 to 59
4. Households having at least one disabled member and no able-bodied adult member
5. SC/ST households
6. Landless households deriving major part of their income from manual casual labour
7. Households without shelter
8. Destitute/ living on alms
9. Manual scavenger families
10. Primitive tribal groups
11. Legally released bonded labour

- In Urban Area

The following occupational categories of workers are automatically included in the list

1. Rag picker
2. Beggar
3. Domestic worker
4. Street vendor/ Cobbler/hawker / Other service provider working on streets
5. Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and another head-load worker
6. Sweeper/ Sanitation worker / Mali
7. Home-based worker/ Artisan/ Handicrafts worker / Tailor
8. Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller
9. Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter
10. Electrician/ Mechanic/ Assembler/ Repair worker
11. Washer-man/ Chowkidar