Benefits of Ayushman Bharat Yojana

As mentioned before, the Ayushman Bharat Yojana is a comprehensive and need-based GOI healthcare scheme to provide free healthcare to vulnerable families. The scheme uses a tiered approach covering prevention, treatment, health promotion and outpatient care at primary, secondary and tertiary levels. The scheme has two main components, namely:

1) Pradhan Mantri Jan Arogya Yojana (PM-JAY): The PM-JAY Scheme is the world’s largest health assurance scheme that provides health insurance coverage of ₹5 lakh per family per year. Eligible beneficiaries can avail of cashless treatments across 33,000 empanelled hospitals across the country using their Ayushman Bharat cards. The scheme covers treatments for a wide variety of diseases, diagnostic tests, ICU charges, surgeries and more. The scheme has no cap on the family size or age for beneficiaries and covers pre-existing diseases from day one.

2) Health and Wellness Centres (HCWs): The Ayushman Bharat Yojana has set up over 1.5 lakh primary healthcare centres called Health and Wellness Centres. These places are designed to provide a range of healthcare services to local populations, including diagnostic services, free essential drugs, maternal care, medical treatments, etc.

Together, these two components aim to provide holistic medical care in India and realise the aspirations behind universal medical coverage.

The table below shows the most notable features of Ayushman Bharat and the PM-JAY health assurance scheme:

The following are some of the biggest PMJAY Ayushman Bharat benefits for the beneficiaries of this government scheme:

Provides Free Health Coverage

The PM-JAY scheme provides health insurance coverage of up to ₹5 lakh per year to every eligible family. The sum insured amount is for the entire family and can be used by one or more members. This allows lower-income households to easily afford medical care without exhausting their finances.

No Cap on Age or Members

Being a government scheme, the Ayushman Bharat insurance scheme offers easy eligibility criteria that can be fulfilled by approximately 40% of the country’s population. There are no restrictions on the family size, age or gender of members, making the scheme accessible to all eligible families.

Secondary and Tertiary Care

The Ayushman Bharat scheme offers multiple tiers of medical care beyond primary or basic care. After getting a referral from a primary care physician, the beneficiaries can get secondary treatments from district and sub-district hospitals. For serious cases, beneficiaries can get tertiary care from medical colleges and specialists.

Comprehensive Treatment

The Ayushman Bharat Yojana covers a large variety of diseases and medical complications across general medicine, cardiology, neonatal care, oncology, orthopaedics, Gynaecology and other specialities. In total, the scheme covers 1929 treatment procedures along with additional expenses.

Cashless Hospitalisation

Upon applying, beneficiaries get an e-PMJAY card, also called an Ayushman card. A notable benefit of the PMJAY card is that it lets eligible persons get cashless treatment across 33,000 empanelled hospitals across India, including 15,380 private and 17,685 public hospitals. Beneficiaries can access cashless treatment of up to ₹5 lakh/year.

Pre-existing Disease Coverage

Pre-existing diseases (PED) refer to any illness, injury or condition that an individual possesses before or at the time of purchasing a health insurance policy. People with pre-existing conditions need to wait for some time before they can file a claim. The PMJAY scheme removes this hassle by offering PED coverage from day one of applying.

Pre and Post-Hospitalisation Expenses

The Ayushman Yojana also covers treatment and medical expenses before and after a 24-hour hospitalisation. It covers up to 3 days of pre-hospitalisation expenses, including doctor visits, medicines and diagnostic tests, and 15 days of post-hospitalisation (follow-up treatment) expenses for beneficiaries.

Covers a Wide Variety of Expenses

Besides treatments, doctor visits and medicines, the Ayushman Bharat scheme covers various expenses related to secondary and tertiary care. Here are some of the expenses covered:

• Diagnostic services
• Examination and consultation
• Medical consumables and supplies
• OT and ICU charges
• Room charges
• Medical implantation services
• Surgery expenses
• Medical implantation procedures

Universal Coverage for Senior Citizens

Since September 2024, the Ayushman Bharat health insurance plan has been covering all senior citizens above the age of 70 years, regardless of their income. This has covered over 86 lakh senior citizens under the free healthcare scheme. Senior citizens from poorer socio-economic backgrounds are now eligible to receive an additional ₹5 lakh coverage over and above their existing ₹5 lakh family floater coverage.

Nationwide Access to Treatments

Another benefit of PMJAY is that its beneficiaries are not tied to a particular hospital. The scheme is portable across the country, meaning that beneficiaries can go to any empanelled hospital or medical college for treatment.

See Also: Benefits of Health Insurance in India

Let us look at the benefits of the PMJAY scheme from the perspective of the nation and its public healthcare system:

Protects the Most Vulnerable

Many healthcare programs in middle and lower-income countries struggle to include the poorest and most vulnerable members of society. Usually, it’s difficult to reach them or get them to follow complex instructions. That’s why the Ayushman Yojana employs a tiered approach, utilising local centres to provide secondary and tertiary healthcare directly to those who need it most.

Helps Achieve Public Health Goals

Due to the very high population in the country and various economic and healthcare challenges, the risk of communicable diseases is quite high. By proactively treating sick patients, the Ayushman Bharat Yojana helps prevent the spread of diseases in densely populated areas, lowering the risk of a pandemic.

Safeguards Against Catastrophic Bills

Rising healthcare needs, coupled with inflation of medical expenses in India makes proper healthcare prohibitively expensive to lower-income families. Due to catastrophic medical bills and a lack of medical insurance plans, many poor people have to bear out-of-pocket expenses that exhaust their savings, pushing them into poverty. Free healthcare provided by PMJAY strives to prevent people from falling into poverty.

Supports the Public Health Sector

Many public sector hospitals in India struggle with constant underfunding and high patient traffic, leading to worsening medical outcomes. The PMJAY scheme aims to tackle this problem by providing funding for building additional medical infrastructure. It also provides payouts for public hospitals, providing them with incentives to prioritise lower-income patients.

Boosts the Private Sector

The PMJAY Ayushman Yojana is constantly funding the growth of medical facilities in the country, which incentivises the private sector to expand into Tier 2 and Tier 3 cities. The increased funding of the public healthcare sector also leads to greater demand for drugs, medical devices and diagnostic centres, which boosts the private sector.

Being an entitlement-based medical insurance scheme, the PMJAY does not require any enrolment by the beneficiaries. Every family listed under the latest SECC database will be automatically covered under PMJAY. Beneficiaries simply have to check their Ayushman Bharat Yojana eligibility to avail of its benefits.

After finding out whether you are eligible for the benefits of PMJAY, follow these steps to apply for the PMJAY e-card or Ayushman card:

Offline Process

• Step 1: Visit your nearest empanelled hospital or community service centre (CSC) with documents, such as a ration card, Aadhaar card or other government ID. You can also bring your family member’s ID.
• Step 2: Provide the necessary information to the concerned official (Arogya Mitra), such as your name, mobile number, location, ration card number or the Rashtriya Swasthya Bima Yojana URN.
• Step 3: Wait for the official to search your details on the BIS application. Once your name appears on the list of eligible beneficiaries, the Arogya Mitra will validate your identity.
• Step 4: Submit the required documents (original) and wait for the official to scan and upload them to the insurance company/trust before handing your documents back.
• Step 5: After the insurance company/trust approves your application for PMJAY beneficiaries. Rejected applications are sent to the respective state health agency (SHA) for final verification. Following the final approval, you will get your Ayushman card.

Online Process

• Step 1: Visit the official Ayushman Bharat PMJAY website to check your eligibility.
• Step 2: Click on the ‘Am I Eligible’ icon on the top menu.
• Step 3: Enter the captcha code as shown on screen and your PMJAY-registered mobile number. Then, click on ‘Verify’.
• Step 4: A one-time password (OTP) will be sent to your mobile number. Enter the OTP and another captcha code to verify.
• Step 5: Enter the other required details, such as name, Aadhaar number, etc., and submit your application. You will now be able to download your Ayushman card.

The Ayushman Bharat health insurance scheme offers government-funded coverage of up to ₹5 lakh per family per year for lower-income families and senior citizens above 70 years.

Let’s compare PMJAY with individual health insurance plans:

The Ayushman Bharat Yojana is a lifeline for crores of families in lower-income brackets and an essential tool for the nation’s progress towards prosperity. The benefits of PMJAY include free healthcare services for lower-income families, prevention of catastrophic financial costs and essential medical care to millions. However, the scheme doesn’t include middle-income families or provide individualised healthcare coverage.

In such cases, you can buy health insurance plans for yourself and your family from TATA AIG. Our health plans offer customisable insurance, higher sum insured limits and wider network hospitals.

If you are looking for a health plan tailored to your unique needs, TATA AIG’s Individual Health Insurance is the perfect choice. It allows you to cover treatment costs of up to ₹3 crores, ensuring you can get cutting-edge medical care facilities at an affordable cost. Buy now to secure your future health.