Ayushman Bharat Yojana – Key Features and Eligibility

Ayushman Bharat Yojana is new initiative under National Health Protection Mission. It is an affordable health insurance scheme for the Indian citizen. 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 second name to this scheme is Modicare.

It is generally seen that poor people suffers a lot due to unavailability of social security especially when it comes to healthcare. To solve this problem, new scheme called as “Ayushman Bharat Yojana” is launched. The prime objective of this Yojana is to provide quality healthcare insurance coverage to poor people in India. Key feature and details about Ayushman Bharat Yojana are given below.

Ayushman Bharat Yojana

Ayushman Bharat Yojana  

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

Also Read – Buying a Health Insurance – 15 Key Factors to Consider

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.

Target Audience – Poor and economically backward class people which includes –

  • Family with no adult member between 16 to 59 years.
  • Family only headed by female member
  • SC/ST household
  • Casual Labor
  • Primitive tribal groups
  • Domestic worker/ Street vendor/ Cobbler/Hawker/ Other service provider working on streets
  • Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard
  • Transport worker/ Driver/ Conductor/ Helper
  • Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant /
  • Attendant/ Waiter

Above professions are tentative and subject to change.

Medical Treatment Location under Ayushman Bharat Scheme (Modicare) 

It is claimed that like 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.

The details given above are from public domain and subject to revision. Updates and Amendment will be added

Article by Raviraj

Raviraj is the man behind moneyexcel.com. He is graduate in finance, engaged in blogging since 6 years. Moneyexcel blog is ranked as one of the Top 10 Personal Finance Blog in India. He is not affiliated with any financial product, service provider, agent or broker. The purpose of this blog is to spread financial awareness and help people in achieving excellence for money. Please note that the views expressed on this Blog/Comments are clarifications meant for reference and guidance of the readers to explore further on the topics. These should not be construed as investment advice or legal opinion.

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