Atal Ayushman Uttrakhand Yojana

Why was Atal Ayushman Uttarakhand Yojana Introduced

Prior to the Atal Ayushman Uttarakhand Yojana, during the time of medical emergencies, people used to incur heavy out-of-pocket medical expenses, in which the rural poor living in isolated regions were more vulnerable. While the central Ayushman Bharat (PM-JAY) scheme provided financial protection to roughly 5 lakh socio-economically vulnerable families identified via the SECC database, it left approximately 18 lakh households in the state uninsured and unprotected against costly hospital treatments.

To bridge the gap and achieve universal health coverage, the Government of Uttarakhand launched the Atal Ayushman Uttarakhand Yojana on December 25, 2018. The scheme ensures cashless secondary and tertiary hospitalisation cover across government and empanelled private hospitals.

Key Highlights: Atal Ayushman Uttarakhand Yojana

Who is Eligible for Atal Ayushman Uttarakhand Yojana

• Status of Domicile: Must be a family permanently residing in Uttarakhand.
• Economic Status: Applies to APL (Above Poverty Line) and BPL (Below Poverty Line) families. It is inclusive of not just the beneficiaries enlisted in the central Socio-Economic Caste Census (SECC 2011) but also other families which are not covered under it.
• Identification of Family: The family should be registered as a beneficiary in the state’s beneficiary database (Ration Card, SECC Family ID, CM Health Insurance Card, or through Aadhaar).

What Atal Ayushman Uttarakhand Yojana Covers

• Annual Cover: Offers up to ₹5 lakh per year per family on a family floater basis under Atal Ayushman Uttarakhand Yojana.
• Inpatient Hospitalisation Benefit: Provides coverage for inpatient hospitalisation at all government and private hospitals approved by the scheme for secondary and tertiary care.
• Hospital Accommodation Benefit: Guarantees the provision of accommodation in the hospital General Ward.
• Nationwide Portability: The beneficiaries are guaranteed to get cashless treatment in any PM-JAY-approved hospital anywhere in India.
• Inpatient Cashless Expenditure Benefit: Pays off all covered expenses of hospitalisation of the beneficiary, including surgery, consultation, nursing, ICU treatment, and ward expenses without having to pay anything up front.
• Pre-Hospitalization Benefits: It includes all healthcare costs, including diagnostic procedures and consultations for the 3 days prior to admission to the hospital.
• Post-Hospitalization Benefits: It covers the necessary medicines, test procedures and consultations for up to 15 days post-discharge from the hospital.
• Pre-existing Diseases: Covers all pre-existing diseases immediately without having to wait for any waiting period.
• Diagnostic Procedures and Medications: All the required laboratory testing, scans, X-ray procedures and medicines used during the hospitalisation are covered under this scheme.
• Special Treatment Procedures: It covers a large number of specialities including oncology, cardiology, neurosurgery, orthopaedics, paediatrics and emergencies.

What Atal Ayushman Uttarakhand Yojana does not cover

• OPD Care: OPD is independent consultations with a physician, independent visits to clinics on a daily basis, and independent pharmacy visits are not covered under this scheme .
• Cosmetic or Elective Surgeries: This involves cosmetic surgeries, cosmetic or plastic surgeries (unless required after trauma injury).
• Routine Dental & Vision: Dental check-ups and routine eye care are not covered as per new amendments in the state policy.
• Non-Empanelled Hospitals: It is for treatments undertaken in private hospitals which are not included in the network of the scheme.

Documents Required to Apply for Atal Ayushman Uttarakhand Yojana

• Aadhaar Card: It is compulsory for all family members to do biometric authentication or OTP verification.
• NFSA / Tri-Color Ration Card: Main family document to prove the eligibility of the family.
• PM/CM Family Letter or SECC Family ID: Government letter/ID with the unique ID number of the household.
• Active Mobile Number: Essential for OTP verification and linking of the profile during e-KYC.
• Passport Size Photos: Essential in case of offline registration in CSCs/Enrollment camps or hospitals.

How to Apply Step by Step for Atal Ayushman Uttarakhand Yojana

Step 1: Verify Eligibility Online

Go to the beneficiary website - beneficiary.ha.gov.in or setu.pmjay.gov.in

• Enter your mobile phone number to get an OTP.
• Select the state as Uttarakhand.
• Search for your household record using any one of the following:
  • Aadhaar Number
  • Ration Card Number (Family ID)

Step 2: e-KYC Verification

• After your family's record appears, you have to choose the family member who requires the card.
• Now click on e-KYC.
• Select one of the following verification options:
  • Aadhaar OTP - OTP sent to your mobile number.
  • Biometric - Fingerprint/Iris scan through a connected biometric device.
  • Face verification - Through the mobile application.
• Verify the details and upload a live photo if prompted.

Step 3: Review and Approve the Application

• Submit your fully filled e-KYC application form.
• The system will automatically send the application to State Health Authority Uttarakhand (SHAUK).
• You can log in to the website anytime to check your approval status.

Step 4: Downloading Ayushman/Golden Card

• Once you are approved, log in to the website using your mobile number.
• Find your family profile on the website.
• Then click Download Card under the beneficiary name.

Process for Offline Application

In case you are not able to apply online or have biometric/database mismatches:

• Step 1: Go to the nearest CSC (Common Service Centre), Jan Seva Kendra, or help desk at the Arogya Mitra empanelled government/private hospital.
• Step 2: Bring your original Aadhaar card, ration card, and mobile number which is operational.
• Step 3: The personnel there will authenticate your documents and take your biometrics for e-KYC to submit your application.

Support and Contact Information

Other Government Health Insurance Schemes

State Government Schemes

• State Government Health Scheme (SGHS/Golden Card Scheme): Provides unlimited medical services to all employees of the State Government, pensioners, and their dependents.
• Mukhyamantri Swasthya Bima Yojana (MSBY): It is a cashless insurance scheme that provides an annual coverage of ₹1.25 lakh per family to provide medical services to poor families and covers secondary hospitalisation and surgery, among others.
• Nishulk Swasthya Jaanch Yojana: Free Tests and Services. This scheme is aimed at providing free testing services so that there is no cost involved in early diagnosis of the disease.

Central Government Schemes

• PMJAY Ayushman Bharat Scheme: Health Insurance Scheme providing insurance cover up to ₹5 lakhs per year per family.
• Employees State Insurance Scheme (ESIC): Insurance Scheme which provides health benefits, maternity benefits, and disability benefits to employees.
• Central Government Health Scheme (CGHS): Health Insurance Scheme providing insurance cover to government employees and pensioners.
• Pradhan Mantri Suraksha Bima Yojana (PMSBY): Accident Insurance Scheme providing insurance cover to poor people from accidents and disabilities.