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HEALTH INSURANCE

Who Is Eligible Under Pradhan Mantri Ayushman Bharat Yojana?

Joan Mathews Joan Mathews 24 May 2019
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In order to provide good quality healthcare services to the poor and rural households, the government introduced the Pradhan Mantri Ayushman Bharat Yojana in 2018. This article sheds light on which groups of people qualify for availing the benefits under this government-backed program.

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On 23 September 2018, the Government of India introduced an ambitious government-sponsored health scheme, termed the Pradhan Mantri Ayushman Bharat Yojana (now called the Pradhan Mantri Jan Arogya Yojana (PMJAY)). The program was introduced with the intent to reduce the financial burden on poor and vulnerable groups as a result of hospitalization and ensure they get access to quality healthcare. PM-JAY aims to accelerate the country’s progress towards achievement of Universal Health Coverage and Sustainable Development Goal - 3.

The Ayushman Bharat health scheme offers financial protection to 10.74 crore poor, rural families and identified occupational categories of urban workers’ families. The project offers an annual health cover of Rs. 5,00,000 per family (on a family floater basis). It covers medical and hospitalization expenses for nearly all secondary care and tertiary care procedures. The government-backed program has defined 1,350 medical packages covering surgery, medical and day care treatments, including medicines and transport.

Features of Pradhan Mantri Ayushman Bharat Yojana

The features of Pradhan Mantri Ayushman Bharat Yojana are as follows:

  • Health insurance cover of up to Rs. 5,00,000 per family per year.
  • Over 10.74 crore poor and vulnerable families are covered across the country.
  • Households listed in the SECC database as per defined criteria are covered.
  • No limit on family size and age of members.
  • Priority is given to girl child, women and senior citizens.
  • Free treatment can be availed at all public and empanelled private hospitals.
  • Covers the costs associated with secondary and tertiary care hospitalization.
  • 1,350 medical packages included, covering surgery, medical and day care treatments, cost of medicines and diagnostics.
  • All pre-existing diseases are covered.
  • Cashless and paperless access to quality health care services

Source: Official website of Pradhan Mantri Jan Arogya Yojana

Who is Entitled for Pradhan Mantri Ayushman Bharat Yojana?

Rural - Categories Covered

The following entities are covered under the Ayushman Bharat health scheme:

  • Residing in only one room with kuccha walls and kuccha roof
  • Landless households finding their income from manual casual labour
  • Female-headed households (where no adult male member between the age group of 16-59 years)
  • Disabled member and no able-bodied adult member
  • Scheduled Caste/Scheduled Tribe households
  • Households without shelter
  • Destitute/ living on alms
  • Manual scavenger families
  • Primitive tribal groups
  • Legally released bonded labour

Urban - Categories Covered

The following entities are covered under the Ayushman Bharat health scheme:

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

Source: The Times of India

Excluded Categories

The following entities are not covered under the Ayushman Bharat health scheme:

  • Motorized 2/3/4 wheeler/fishing boat owner
  • Mechanized 3 or 4 wheeler agricultural equipment owner
  • Kisan credit cardholder with credit limit of over Rs. 50,000/-
  • Household member of government employee
  • Households with non-agricultural enterprises registered with government
  • Any member of family with income more than Rs. 10,000 per month
  • Paying income tax
  • Paying professional tax
  • 3 or more rooms with pucca walls and roof
  • Owns a refrigerator
  • Owns landline phone
  • Owns over 2.5 acres of irrigated land with 1 irrigation equipment
  • 5 acres or more of irrigated land for two or more crop season
  • Owning at least 7.5 acres of land or more with at least one irrigation equipment

Source: Socio Economic and Caste Census (SECC) 2011 website

How to Check if you’re Eligible?

To find out whether you or someone else is eligible to be covered under this program, go to the website of Pradhan Mantri Jan Arogya Yojana and click on ‘Am I Eligible’. Enter the mobile number to receive a one-time password. Once the OTP is generated, it needs to be entered on the slot provided for verification purpose. There is also the option of dialling toll-free helpline number 14555 or visiting the nearest Common Service Centres (CSC) to check one’s eligibility for Pradhan Mantri Ayushman Bharat Yojana.

Conclusion

The Ayushman Bharat Health insurance scheme, targeted at poor and vulnerable families, has reportedly received tremendous response in the initial phases. Through this program, the government has shown its commitment towards strengthening the Indian healthcare ecosystem.

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Joan Mathews
Written by Joan Mathews
Joan has over 4 years of experience writing for the BFSI industry. She enjoys watching mystery TV series, listening to 80s classics and spending time with her furbabies.
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