AYUSHMAN BHARAT-- A NATIONAL HEALTH CARD.

 

AYUSHMAN BHARAT

A NATIONAL HEALTH CARD

SARASIJ MAJUMDER

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), a flagship health insurance scheme of the Government of India, has recently expanded its eligibility criteria to include senior citizens above the age of 70 years

The PM Jan Arogya Yojana beneficiaries get an Ayushman card to avail of services at an empanelled hospital, public, or private, anywhere in the country. With the PMJAY scheme, you can enjoy the benefit of walking into a hospital and enjoy cashless treatment. The Ayushman Bharat card provides access to high-quality healthcare services at these facilities.

The scheme provides up to ₹5 lakh per family per year for listed secondary and tertiary care conditions. You must check for this in the web site, or at Ayushman Mitra.

To Find A Hospital On The Ayushman Bharat List, You Can:

1. Go to the official PMJAY website,
2. Click Find Hospital on the menu bar,
3. Select your state and district,
4. Choose hospital type,
5. Search hospital, 

You can register for a PMJAY card at your nearest empaneled hospital or Ayushman Mitra. You will need to provide your identification documents, such as your Aadhaar card, to complete the registration process.

All CGHS , or CGHS empaneled private hospital accept this card.

THIS SCHEME HAS TWO COMPONENTS:-

1.0  Health and Wellness Centers (HWCs):-

In February 2018, the Government of India announced the creation of 1,50,000 Health and Wellness Centres (HWCs) by transforming the existing Sub Centres and Primary Health Centres. These centres are to deliver Comprehensive Primary Health Care (CPHC) bringing healthcare closer to the homes of people. They cover both, maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.

2.0. Pradhan Mantri Jan Arogya Yojana (PM-JAY):-

The second component under Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojana or PM-JAY as it is popularly known. This scheme was launched on 23rd September, 2018 in Ranchi, Jharkhand by the Hon’ble Prime Minister of India, Shri Narendra Modi.

Ayushman Bharat PM-JAY is the largest health assurance scheme in the world which aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 12 crores poor and vulnerable families (approximately 55 crore beneficiaries) that form the bottom 40% of the Indian population. The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively. PM-JAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened. It subsumed the then existing Rashtriya Swasthya Bima Yojana (RSBY) which had been launched in 2008. The coverage mentioned under PM-JAY, therefore, also includes families that were covered in RSBY but are not present in the SECC 2011 database. PM-JAY is fully funded by the Government and cost of implementation is shared between the Central and State Governments.

What Is Not Covered:-

Outpatient department (OPD) is not covered under the Ayushman Bharat Card. The Ayushman Bharat Card, also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY), does not cover OPDs. Some other treatments and procedures that are not covered by PMJAY include: Individual diagnostics for evaluation, Organ transplants, Fertility related procedures, Cosmetic related procedures, and Drug rehabilitation program. 

HOW TO APPLY FOR CARD?

You can apply ONLINE, and DOWNLOAD, as well as off line.

For on line—refer the URL furnished at Sl.4 for detailed step by step guidance.

For offline: VISIT ANY GOVERNMENT HOSPITAL,  or CSC, with the following documents:-

Aadhar card, proof of domicile, income certificate, photograph, and category

An authorized person at the CSC will verify your details and issue the card, which you may collect a few days later.

INTEGRATION  &  COMBINATION:-

“While the annual floater health coverage of Rs 5 lakh per family can help in managing a wide range of secondary and tertiary medical expenses, it may not be sufficient to cover certain high-cost treatments for age-related illnesses,” said Siddharth Singhal, Head - Health Insurance, Policy bazaar.

Senior citizens can take advantage of both private insurance and the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to create a more comprehensive healthcare safety net. By combining the two, they can enhance their coverage and avoid financial strain during medical emergencies.  The good news is that there is no restriction on combining Ayushman Bharat with private health insurance schemes. 

This integration means that senior citizens can use their private insurance as their primary coverage and treat Ayushman Bharat as a backup for additional expenses. Essentially, the government-provided coverage complements their private insurance, offering a wider safety net. This approach ensures that they have access to multiple sources of funds when dealing with medical bills, creating a more comprehensive healthcare plan.

 “Those who can comfortably afford a personal health cover should definitely go for it over and above the Ayushman Bharat coverage. Independent policies typically also offer broader benefits, such as OPD services, wellness programs, and coverage for critical illnesses, which are vital for seniors who require more frequent and specialised healthcare. A personal health cover also ensures continuity of care, especially for those with pre-existing conditions, and guarantees access to quick and seamless care,” Siddharth Singhal said.

NOTE: I was requested by quite a few persons  over 70+ years of age, personally known to me,  to prepare a BLOG on this. I personally have not used this scheme, nor I am eligible. I prepared the BLOG based on my documentary research, investigations, and discussions with two Medical Parishioners of Government hospitals, who wanted to remain ANONYMUS.

I request the reader to share this as much as possible.

REFERENCE:

1.0  https://www.bajajfinserv.in/insurance/ayushman-bharat-yojana-are-you-eligible-for-the-pmjay-scheme#:~:text=The%20PM%20Jan%20Arogya%20Yojana,hospital%20and%20obtaining%20cashless%20treatment.

2.0 https://www.business-standard.com/finance/personal-finance/why-senior-citizens-should-combine-ayushman-bharat-with-private-insurance-124100300971_1.html

3.0 https://nha.gov.in/PM-JAY

4.0 https://www.bajajfinserv.in/insurance/how-to-apply-for-ayushman-card#:~:text=Ayushman%20card%20online%20apply%3A%20Step%2Dby%2Dstep%20process&text=Step%201%3A%20Visit%20the%20official,the%20%22Generate%20OTP%22%20button.

IMAGE:-- GOOGLE