Ayushman CAPF Health Insurance Scheme

Key Highlights Of Ayushman CAPF

Why Was Ayushman CAPF Introduced

However, CAPF personnel work in challenging environments like border posts, counter-insurgency missions, and disaster relief services without a portable health insurance cover which could be taken to all locations. In contrast to the armed forces who have facilities for ECHS cover in their areas of deployment, CAPF personnel posted in far-off regions had to incur substantial direct expenditure due to illness.

The Ayushman CAPF Scheme directly solved this issue by incorporating CAPF personnel into the Ayushman Bharat Yojana (PMJAY) system, providing instant access to cashless treatment in 29,000-plus hospitals enlisted under PMJAY (NHA). The same facility, zero premium and pan-India portability of the same PMJAY cover follows all CAPF personnel at every post.

In case CAPF personnel suffer from TB, the Nikshay Poshan Yojana provides an additional financial allowance of ₹1,000 per month on a nutritional basis.

Ayushman CAPF Eligibility- Who Is Covered

The following individuals are covered under the Ayushman CAPF scheme:

• All serving members of BSF, CRPF, CISF, ITBP, SSB, NSG, and Assam Rifles
• Dependants of serving CAPF members, such as spouse, dependant children, and dependant parents
• Members of all ranks, including constables to the Director General

Those who are not covered:

• Retired CAPF members, who can consider the Ayushman Bharat PM-JAY (PMJAY) or other state government health programs as per state criteria
• Civilian members linked with CAPF forces, but not listed as force members.
• Dependants are not included in the beneficiaries list.

How to Apply for Ayushman CAPF

1. Online Registration:

   • Go to the PM-JAY portal on www.pmjay.gov.in or download the Ayushman app.
   • Choose the 'Ayushman CAPF registration' option.
   • Enter the service number and Aadhaar number for authentication.
   • Complete the e-KYC process by verifying OTP.
   • Complete the application process and collect the PMJAY card after approval.

2. Offline Registration:

   • Go to the nearest Ayushman CAPF enrolment centre or the welfare office of your unit.
   • Provide the required documentation- service ID, Aadhaar card, dependent details, etc.
   • Biometric authentication is done at the centre.
   • Collect the Ayushman CAPF card after the verification process.

It is highly recommended that all CAPF personnel get enrolled for an ABHA card (Ayushman Bharat Health Account) along with their Ayushman CAPF enrolment at abdm.gov.in. This ABHA ID card generates an exclusive digital health ID that combines all the health records, such as CAPF treatment records, hospitalisation records, and prescription records in one single digital ID under the ABDM initiative.

Documents Required for Ayushman CAPF

• Service ID card- primary eligibility document
• Aadhaar card- for identity verification and ABHA linkage
• Proof of dependants- marriage certificate for spouse, birth certificate for children
• Recent passport-size photographs of personnel and dependants
• Mobile number- for OTP and updates

What Does Ayushman CAPF Cover

However, if the cost of medical care surpasses the ₹5 lakh threshold for Ayushman CAPF, Rashtriya Arogya Nidhi (RAN) provides financial help to the tune of a one-time payment of ₹15 lakh to be used in government super-speciality hospitals.

In case of CAPF personnel whose family member suffers from Autism, Cerebral Palsy or Multiple Disabilities, the Niramaya Health Insurance Scheme may be taken into consideration as a supplement to the Ayushman CAPF benefits.

How the Claim Process Works

Ayushman CAPF is a purely cashless program:

• Go to any hospital under AB PM-JAY empanelled with your Ayushman CAPF card and Aadhaar.
• The Ayushman Mitra at the hospital verifies your eligibility via the PMJAY portal.
• Pre-authorisation is obtained prior to treatment in case of planned treatment.
• Your treatment will be done cashlessly, as all bills are processed directly between the hospital and NHA.
• In case of emergency, your treatment starts right away, with authorization later.
• Upon discharge, digital updating of your health records will be done on TMS.

Any hospital empanelled that refuses you cashless treatment must be reported immediately to the helpline.

Ayushman CAPF and State Health Schemes- What Families Should Know

Dependants of CAPF staff or retired staff who do not fall under the scheme Ayushman CAPF may consider state health schemes available in their respective states:

Atal Amrit Abhiyan (Assam) provides treatment for families belonging to the BPL and APL categories against six major cost diseases without any or nominal charges. Gopabandhu Jan Arogya Yojana (GJAY) (Odisha) provides assistance for urban families for up to ₹6 lakh. CMCHIS (Tamil Nadu) helps low-income families for up to ₹5 lakh. Mukh Mantri Sarbat Sehat Bima Yojana (Punjab) and Chirayu Ayushman Haryana offer the same type of cashless assistance. MJPJAY (Maharashtra) and Swasthya Sathi Scheme (West Bengal) also offer state health protection. Children admitted in the Mission Vatsalya are eligible for hospitalisation assistance.

Ayushman CAPF Helpline and Support

Ayushman CAPF makes sure that the 28 lakh+ personnel who keep the borders of India and other areas safe from any form of danger, along with their families, will not lack healthcare coverage. Under this scheme, each CAPF personnel is provided with health insurance coverage of ₹5 lakh, no premium, and hospitals across India which are AB PM-JAY empanelled. If you link your ABHA card to Ayushman CAPF enrollment, then you will have your permanent health record in Ayushman Bharat Digital Mission. Apart from that, Rashtriya Arogya Nidhi and Niramaya Health Insurance Scheme offer extra coverage in case of emergencies. For those in particular states, programs such as Atal Amrit Abhiyan, GJAY, CMCHIS, and Chirayu Ayushman Haryana make sure that the whole family has access to healthcare.