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Ayushman Bharat Yojana (Ayushman Card): A Comprehensive Overview

Ayushman Bharat Yojana (also known as Pradhan Mantri Jan Arogya Yojana or PMJAY) is a flagship health insurance scheme launched by the Government of India. The scheme was launched in 2018 with the primary goal of providing accessible and affordable healthcare to the underprivileged sections of the society. It aims to reduce the financial burden on families who have to pay for medical expenses, particularly those requiring hospitalization.

Under the Ayushman Bharat Yojana, eligible families are provided with health insurance coverage up to ₹5 lakh per family per year for secondary and tertiary hospitalization. The scheme is a significant step in India’s effort to provide universal health coverage (UHC) and is part of the broader Ayushman Bharat Mission, which includes the creation of health and wellness centers across the country.

1. Background of Ayushman Bharat Yojana

The Ayushman Bharat Yojana was launched on September 23, 2018, by Prime Minister Narendra Modi with the aim of addressing the gap in access to quality healthcare services for the vulnerable population. Prior to its introduction, a large section of India's population was either uninsured or underinsured, making it difficult for them to afford necessary healthcare services.

Before Ayushman Bharat, the majority of health insurance schemes in India were either limited in their coverage or did not cater to the economically weaker sections of the society. The government aimed to provide health insurance to around 50 crore (500 million) people or roughly 10 crore families, making it the largest government-funded healthcare program in the world.

2. Key Features of Ayushman Bharat Yojana

• Health Insurance Coverage: Ayushman Bharat Yojana provides health coverage of up to ₹5 lakh per family per year for secondary and tertiary healthcare. This includes medical expenses for hospitalization, surgeries, treatments, and other health services.
• Cashless Facility: Beneficiaries under the scheme can avail cashless treatment at any of the empanelled hospitals, both public and private. This eliminates the need for upfront payment and offers a more convenient healthcare experience.
• No Age or Gender Restriction: The scheme covers people of all age groups and genders, including children and elderly people. It is designed to be inclusive, ensuring that no one is left out based on age, gender, or type of illness.
• Pre-Existing Diseases Covered: Under Ayushman Bharat, pre-existing medical conditions are covered. This is a significant feature as it provides health coverage for individuals who may already have medical conditions, which is not typically covered under many private insurance schemes.
• Empanelled Hospitals: The scheme has a network of empanelled private and government hospitals where beneficiaries can avail cashless treatment. The hospitals are spread across urban and rural areas, ensuring wide accessibility.
• No Premium Payment: Unlike traditional health insurance schemes, Ayushman Bharat does not require individuals or families to pay premiums. The scheme is funded by the government through budgetary allocations, thus making it free for the eligible population.
• Portable Benefits: The Ayushman Bharat benefits are portable, meaning that beneficiaries can access healthcare services under the scheme from any empanelled hospital across the country, regardless of their home state.

3. Eligibility Criteria for Ayushman Bharat

The scheme is aimed at providing health coverage to economically disadvantaged families. The selection of eligible beneficiaries is based on socioeconomic and demographic criteria:

• Eligibility Based on SECC Data: The government has used the Socio-Economic Caste Census (SECC) data of 2011 to identify eligible families. The SECC data takes into account various factors like family income, education, occupation, and other social determinants to determine eligibility.
• Identification of Eligible Families: Households belonging to the Below Poverty Line (BPL) category, which includes marginalized and vulnerable populations, are eligible for the Ayushman Bharat Yojana. Additionally, families that do not have any other health insurance or social security coverage are prioritized.
• Rural and Urban Coverage: The scheme also includes families from rural and urban areas. It aims to ensure that the benefits of health coverage reach those who need them the most, especially in rural regions where healthcare infrastructure is often inadequate.
• Exclusions: Families with a member working in government or semi-government services, families who own a significant amount of property, and high-income groups are excluded from the scheme. Specific exclusion criteria are also based on the socio-economic status of the family.

4. Ayushman Bharat Registration Process

• Ayushman Card (PMJAY Card): To avail the benefits of the scheme, eligible families must register under Ayushman Bharat and obtain an Ayushman Card. This card acts as proof of eligibility and facilitates access to healthcare services under the scheme.
• Online Registration: Eligible individuals can check their eligibility on the official Ayushman Bharat website or through the Ayushman Bharat mobile app. They can also visit Common Service Centers (CSCs) or health centers for registration. The process involves providing personal details and linking them with the SECC database.
• Verification: After registration, the eligibility of the family is verified based on the data available in the SECC. Once verified, the Ayushman card is generated and sent to the beneficiaries. This card can then be used to avail health benefits from empanelled hospitals.
• Ayushman Card Benefits: The Ayushman Card provides a unique identification for the beneficiary. It contains all the details necessary to access healthcare services at the networked hospitals. The card is essential for availing the benefits of the scheme, such as cashless hospitalization and reimbursement of medical expenses.

5. Benefits of Ayushman Bharat Yojana

• Financial Protection for Families: Ayushman Bharat provides financial protection against catastrophic health expenditures. With up to ₹5 lakh coverage per family per year, families do not have to worry about high medical bills.
• Reduced Out-of-Pocket Expenditure: Healthcare costs in India can be prohibitively high, especially for surgeries or long-term treatments. The scheme greatly reduces the out-of-pocket expenditure for families who otherwise would have to borrow money or sell assets to pay for medical treatment.
• Improved Health Access: The scheme ensures that all sections of society, particularly economically weaker families, have access to quality healthcare. It improves accessibility to both urban and rural healthcare facilities.
• No Gender or Age Discrimination: Ayushman Bharat is designed to be inclusive and caters to all age groups, including children, women, and the elderly. This ensures that everyone, irrespective of their age or gender, can avail of necessary treatments.
• Focus on Secondary and Tertiary Care: The scheme focuses on providing support for secondary and tertiary care, which includes major surgeries, cancer treatments, and other complex procedures. This helps in reducing the financial burden of serious health conditions.

6. Challenges and Limitations

• Awareness and Accessibility: While Ayushman Bharat is a great initiative, awareness about the scheme is still limited in certain rural areas. Some people may not know how to apply for the scheme or where to access benefits.
• Identification and Data Issues: In some cases, discrepancies in the SECC data or mismatches between the household information and the official database have caused confusion regarding eligibility, preventing some individuals from availing benefits.
• Hospital Network and Quality: Though the scheme covers a large network of hospitals, there may be challenges in ensuring the quality of care across all empanelled institutions. Some beneficiaries may face difficulties in accessing hospitals in remote areas.

7. Conclusion

The Ayushman Bharat Yojana is a landmark initiative that addresses the critical need for healthcare access and financial protection for India’s poor and vulnerable population. By providing cashless, comprehensive health insurance coverage up to ₹5 lakh, it aims to ensure that no one is left behind when it comes to receiving necessary medical treatment. As the scheme continues to grow and evolve, its implementation will be key to transforming India’s healthcare landscape, improving the health outcomes of millions, and moving the country closer to universal health coverage.