Ayushman Bharat Yojana: Eligibility, Benefits, Application Process & Latest news

Introduction

Ayushman Bharat Yojana is a flagship health insurance scheme initiated by the Government of India, aimed at providing financial protection against high medical expenses to the economically disadvantaged population. Recently, significant updates have been made to the scheme, particularly concerning senior citizens.

Recent Developments in Ayushman Bharat

On September 11, 2024, the Union Cabinet approved the expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), which now covers all senior citizens aged 70 years and above, regardless of their income status. This decision is expected to benefit approximately 4.5 crore families, encompassing around six crore senior citizens across the country. Each eligible family will receive health coverage of up to ₹5 lakh annually, which is crucial for addressing the healthcare needs of this demographic, especially as they face increasing medical costs and health challenges

Key Features of the Expanded Coverage

1. Universal Coverage for Seniors: The new provision allows all individuals aged 70 and above to access health insurance without any income restrictions, marking a significant shift from the previous criteria that primarily focused on economically weaker sections of society.
2. Distinct Health Cards: Eligible senior citizens will be issued new health cards Ayushman Bharat Card
   to facilitate access to the benefits of the scheme, ensuring that they can easily navigate the healthcare system.
3. Additional Coverage for Existing Beneficiaries: Senior citizens already enrolled in the Ayushman Bharat scheme will receive an additional top-up of ₹5 lakh specifically for their own healthcare needs, separate from the family coverage.
4. Choice for Other Public Health Scheme Members: If you’re currently enrolled in a public health insurance program, such as the Central Government Health Scheme (CGHS) or the Ex-Servicemen Contributory Health Scheme (ECHS), you’ll have to choose between keeping your existing plan or opting for the new AB PM-JAY coverage
5. Financial Implications: The rollout of this expanded coverage comes with an estimated initial cost of ₹3,437 crore, with states contributing to the expenses. For hilly and northeastern states, the central government will bear a larger share of the costs

source: probus Insurance

Ayushman Bharat Eligibility Criteria:

Rural Households

To qualify, rural families must meet one of the following six deprivation criteria based on the Socio-Economic Caste Census (SECC) data:

1. D1: Families living in one room with kucha (temporary) walls and roof.
2. D2: Households with no adult member aged between 16-59 years.
3. D3: Families with no adult male members aged between 16-59 years.
4. D4: Households without an able-bodied adult member or with a disabled member.
5. D5: Scheduled Caste (SC) or Scheduled Tribe (ST) households.
6. D6: Landless households earning a major part of their income from manual casual labor.

Urban Households

Urban families must belong to specific occupational categories, which include:

• Domestic workers
• Street vendors
• Construction workers
• Sanitation workers
• Ragpickers
• Home-based workers/artisans

Additional Criteria

• Families identified through the SECC data as living below the poverty line (BPL) are also eligible.
• Senior citizens aged 70 years and above are now eligible regardless of income, as per the latest updates to the scheme

Ayushman Bharat Documents Required:

1. Aadhaar Card: A valid Aadhaar card serves as proof of identity and age.
2. Proof of Address: This can include documents like utility bills, rental agreements, or any government-issued document that verifies your residence.
3. Income Certificate: This document is necessary to confirm that your family’s annual income is below the specified limit (typically ₹2.5 lakh for eligibility).
4. Ration Card: A valid ration card may be required to establish family details and economic status.
5. Caste Certificate: If applicable, this certificate can help in verifying the socio-economic status of the family.
6. Photograph: A recent passport-sized photograph may be required for the application.
7. Contact Details: You will need to provide your mobile number and email address for communication purposes.
8. Documented Proof of Family Status: This may include information on whether your family is joint or nuclear.

To check if your family is eligible for the Ayushman Bharat Yojana (PM-JAY), you can follow these steps:

Online Verification

1. Visit the Official Website: Go to the Ayushman Bharat PM-JAY website at pmjay.gov.in.
2. Click on ‘Am I Eligible’: Locate the “Am I Eligible” option on the homepage.
3. Enter Your Details: Input your mobile number, select your state, and enter the captcha code. You may also need to provide additional information such as your name, ration card number, or household number.
4. Check Eligibility: After submitting the information, the system will display your eligibility status based on the Socio-Economic Caste Census (SECC) data.

Offline Verification

1. Visit a Common Service Center (CSC): You can also check your eligibility by visiting the nearest Common Service Center. Bring your Aadhaar card or ration card for verification.
2. Empanelled Hospitals: Many empanelled hospitals also have help desks where trained personnel can assist you in verifying your eligibility.

Ayushman Bharat Apply Online

Step-by-Step Application Process

1. Check Eligibility:
   • Before applying, verify your eligibility by visiting the Ayushman Bharat PM-JAY website. Click on the “Am I Eligible” option and enter your mobile number, state, and captcha code. This will help you confirm if your family qualifies based on the Socio-Economic Caste Census (SECC) data.
2. Visit the PM-JAY Website:
   • Go to the official PM-JAY website at pmjay.gov.in.
3. Register or Apply:
   • Look for the ‘Register’ or ‘Apply’ section on the homepage. Click on it to start the application process.
4. Fill in Your Details:
   • Enter the required information, including your Aadhaar card number, mobile number, and other relevant details. Make sure to provide accurate information to avoid any issues.
5. Upload Required Documents:
   • You will need to upload scanned copies of necessary documents, which may include:
     • Aadhaar card or another government-issued ID
     • Ration card for family verification
     • Proof of address (like utility bills)
     • Income proof (if required by your state)
6. Submit Your Application:
   • After filling in all the details and uploading the documents, review your application for accuracy and then submit it.
7. Track Your Application:
   • After submission, you can track your application status online. Return to the PM-JAY website, enter your registered mobile number and captcha code to see the current status of your application.
8. Receive Your Ayushman Bharat Card:
   • Upon successful verification and enrollment, you will receive your Ayushman Bharat Card (PM-JAY card). This card is essential for accessing healthcare services under the scheme and should be presented at empanelled hospitals when seeking treatment.

Also read: PMAY Urban Scheme 2024: Eligibility, Details, Benefits and Latest Updates

Offline Application submission:

• Common Service Centers (CSCs): Visit your nearest CSC where operators can assist you in filling out the application and submitting it electronically.
• Empanelled Hospitals: Many hospitals have dedicated help desks to help with the application process. You can present your documents, and the staff will facilitate your enrollment.

Coverage and Benefits

1. Ayushman Bharat Yojana:
   • Coverage: Provides health insurance coverage of up to ₹5 lakh per family per year for secondary and tertiary care hospitalization.
   • Eligibility: Targets approximately 10 crore families identified through the Socio-Economic Caste Census (SECC), focusing on low-income households in both rural and urban areas.
   • Cashless Treatment: Provides the cashless and paperless treatment at empaneled hospitals across India.
   • No Premiums: There are no premiums to be paid by beneficiaries, as the scheme is funded by the government.
2. Private Health Insurance Plans:
   • Coverage: Coverage varies widely among plans, with sum insured options ranging from ₹2 lakh to ₹6 crore depending on the insurer and plan type.
   • Eligibility: Generally available to individuals aged 18 to 65 years, with varying terms for senior citizens.
   • Premiums: Beneficiaries must pay premiums, which depend on factors like age, medical history, and coverage amount.
   • Inclusions: Typically includes hospitalization, pre and post-hospitalization expenses, daycare treatments, and sometimes outpatient department (OPD) coverage.

Accessibility

• Ayushman Bharat Yojana:
  • Focuses on providing access to healthcare for economically weaker sections, ensuring that financial constraints do not hinder access to necessary medical services.
  • Offers portability, allowing beneficiaries to access services anywhere in India.
• Private Health Insurance Plans:
  • While they provide extensive coverage, access can be limited by financial constraints due to premium costs.
  • Some plans may have waiting periods for pre-existing conditions and other exclusions.

Claim Process

• Ayushman Bharat Yojana:
  • The claim process is streamlined, with cashless treatment available at empaneled hospitals, reducing the administrative burden on beneficiaries.
• Private Health Insurance Plans:
  • Claims can be either cashless or reimbursement-based, and the process may involve more paperwork and waiting periods, depending on the insurer’s policies

Summary of Comparison

Feature	Ayushman Bharat Yojana	Private Health Insurance Plans
Coverage Amount	Up to ₹5 lakh per family/year	Varies (₹2 lakh to ₹6 crore)
Eligibility	Low-income families	Individuals aged 18-65 years
Premiums	None (government-funded)	Required (varies by plan)
Cashless Treatment	Yes	Yes (varies by hospital)
Portability	Yes	Yes (within network hospitals)
Claim Process	Simplified, cashless	Can be cashless or reimbursement

Scheme	Empaneled Hospitals (approx.)
Ayushman Bharat Yojana	27,000+
Central Government Health Scheme (CGHS)	1,200
Employee State Insurance Corporation (ESIC)	1,500

Also read: PMAY Urban Scheme 2024: Eligibility, Details, Benefits and Latest Updates

Online Tracking

1. Visit the Official PM-JAY Website:
   • Visit Ayushman Bharat PM-JAY portal at pmjay.gov.in.
2. Access the Status Check Option:
   • You can see the option “Check Status” or “Am I Eligible” on the homepage.
3. Enter Required Details:
   • Now Enter your mobile number, Aadhaar number, or ration card number as prompted. You may also need to fill captcha code
4. Submit the Information:
   • Click on the “Check Status” to get the application status. The system will display whether your application is “Approved,” “Not Generated,” or in another status.

Offline Tracking

1. Contact Customer Service:
   • You can call the Ayushman Bharat customer service helpline at 14555 or 1800-111-565 for assistance regarding your application status.
2. Visit Common Service Centers (CSCs):
   • Go to the nearest CSC where trained personnel can help you check your application status.
3. Inquire at Empaneled Hospitals:
   • Many hospitals have dedicated help desks for PM-JAY, where you can ask about your application status.

PM-JAY Kiosks

• The government has Provided PM-JAY kiosks in hospitals and district collector offices, operated by Pradhan Mantri Arogya Mitra (PMAM). You can visit these kiosks to check your status by providing your details to the operator.

Frequently Asked Questions:

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