10 Major Benefits of Ayushman Bharat Yojana

Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the second component under Ayushman Bharat Scheme. PM Narendra Modi launched this scheme on September 23, 2018, in Ranchi, Jharkhand.

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    Ayushman Bharat Yojana is the world’s largest health insurance scheme that provides a health insurance cover of Rs 5 lacs to each Indian family who is eligible. The scheme caters to nearly 50 crore beneficiaries and provides them access to tertiary and secondary care hospitalization, which is 40% of the Indian poor and vulnerable families. Ayushman Bharat Yojana eligibility is divided among the households in both rural and urban areas, which are categorized based on the occupational and deprivation criteria of Socio-Economic Caste Census 2011.

    It was launched with a vision to help mitigate exorbitant medical expenses that push close to 6 Crore Indians towards poverty annually.

    Before it was rechristened the scheme was termed as the National Health Protection Scheme. It subsumed the current Rashtriya Swasthya Bima Yojana that was launched in 2008. It also covers the families that were covered under RSBY but are not present in the SECC 2011 database. This scheme is funded by the Indian Government.

    Key Features of Ayushman Bharat PM-JAY

    • It is the world’s largest medical insurance scheme that is financed by the Govt. of India
    • It covers close to 1,393 procedures including the treatment cost, room charges, doctor’s fees, Operation theatre, ICU, diagnostic services, surgeon charges, etc.
    • 3 days of pre-hospitalization cover is for 3 days and post-hospitalization cover is for 15 days including medicines and diagnostics
    • The coverage amount is up to Rs 5 Lakh
    • Both secondary and tertiary care hospitalization is covered
    • Hospitalization cover across private and public panel hospitals in India
    • Cashless hospitalization cover is offered to the beneficiaries
    • The scheme does not put restriction age, family size and gender
    • It covers pre-existing diseases from day one
    • Benefits of the scheme are available PAN India; you can avail cashless treatment in any of the empanelled public or private hospital in India

    10 Benefits Cover Under PM-JAY

    Most of the Government-funded medical insurance schemes offer a limit cover up to Rs 3 Lakh only. However, Ayushman Bharat Yojana or PM-JAY provides cover up to Rs 5 Lakh along with cashless medical treatment facility to the beneficiaries in both public and private hospitals in India.  Each family in India who fit the Ayushman Bharat Yojana eligibility criteria can avail this sum insured for defined secondary as well as tertiary care conditions.

    This scheme recompenses all the expenses incurred on the following medical treatments.

    • Medical examination, treatment and consultation
    • Pre-hospitalization expenses
    • Post-hospitalization follow-up care up to 15 days
    • Diagnostic procedures and lab investigation charges
    • Cost of Medicine and medical consumables expenses are covered
    • Non-intensive and intensive care services
    • Accommodation benefits
    • Medical implantation services (where necessary)
    • Food services
    • Treatment resulting in complications

    PMJAY Critical Illness Coverage

    It helps the families by giving access to healthcare services and also offers assistance for day care procedures, including pre-existing illnesses. The scheme covers nearly 1,350 medical packages at both public and private network hospitals across India.

    List of Critical Diseases covered under Ayushman Bharat Health Scheme

    Some of the Critical illnesses that the policy covers are as follows:

    • Double valve replacement
    • Prostate cancer
    • Coronary ABG
    • Carotid angioplasty with stent
    • Anterior spine fixation
    • Pulmonary valve replacement
    • Skull base surgery
    • Laryngopharyngectomy
    • Tissue expander for disfigurement in case of burns

    Ayushman Bharat Health Scheme has limited exclusions, which are as follows:

    • Drug rehabilitation programme
    • OPD expenses
    • Organ transplants
    • Cosmetic procedures
    • Fertility related procedures

    In a Nutshell

    While RSBY covered only five members, PM-JAY does not put any capping on the age, size and the number of insured members. The benefits offered under this scheme are up to Rs 5 lakh and can be availed on a family floater basis. The eligible households can be covered under a single plan and can avail cashless hospitalization cover up to the coverage amount.

    It implies that any person who is eligible to get coverage under Ayushman Bharat scheme and suffering from health issues before PMJAY can avail treatment benefits under this scheme right from the day of enrolment.

    Written By: PolicyBazaar - Updated: 30 June 2021
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