The world’s most populous country, India, has always faced a big problem of providing quality healthcare to the poor. This is because of lack of money, these people are not able to receive proper treatment and buy health insurance.
To solve this problem, during the budget 2018, central government had announced Ayushman Bharat Yojana with an objective to provide quality healthcare treatment and insurance cover to the poor reducing the expenses incurred by them.
Ayushman Bharat – National Health Protection Mission (AB – NHPM) scheme which is the largest health care scheme in the world comprises of the following two utilities for poor Indian citizens:
- Health and Wellness Treatment Centres
- National Health Protection Scheme i.e. health insurance for poor
Details of AB-NHPM
Launch Date: 15th August 2018
Target audience: Poor and vulnerable which includes:
- Family living in only one room with kucha walls and kucha roof
- Family with no adult member between age 16 to 59
- Family headed by a female member
- Family having disabled member and no able-bodied adult member
- SC/ST households
- Landless households deriving major part of their income from manual casual labour
- Destitute/ living on alms
- Manual scavenger families
- Primitive tribal groups
- Legally released bonded labour
- Rag picker
- Domestic worker
- Street vendor/ Cobbler/hawker / Other service provider working on streets
- Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/
- Coolie and another head-load worker
- Sweeper/ Sanitation worker / Mali
- Home-based worker/ Artisan/ Handicrafts worker / Tailor
- Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart
puller/ Rickshaw puller
- Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant /
- Attendant/ Waiter
- Electrician/ Mechanic/ Assembler/ Repair worker
- Washer-man/ Chowkidar
Insurance Cover: Rs. 5 Lakhs (sum assured) per family per year will be the given.
Is it a fixed or floater type of insurance?
It is a floater type of insurance policy.
Will it cover pre-existing diseases or conditions?
Yes. But with certain exclusions.
What benefits would be given as a part of this Yojana?
The coverage offered to the beneficiaries of AB-NHPM will include:
- Hospitalization expense benefits
- Day care treatment benefits (as applicable)
- Follow-up care benefits
- Pre and post hospitalization expense benefits
- New born child/ children benefits
Where can beneficiary patient or their family member go for the treatment?
Similar to a normal medical insurance, patient can get treatment in government as well as private hospital which are part of the network. The treatment would be 100% cashless at all the network hospitals.
Who will guide patients to understand the procedure?
Every network hospital will have ‘Ayushman Mitra’ with duty of assisting patients with all the procedures involved. This will help patient and their family members to get treated without any hassles.
In which state this Yojana will be launched?
Although many of the states in India have their own healthcare schemes, Ayushman Yojana will be launched in all the Indian states.
What would be considered as a proof to validate beneficiary?
Aadhaar number would be must to take all the benefits under the scheme. However those who do not have Aadhaar card will have to furnish secondary proof such as ration card, voter ID card. More information on this would be provided by the government soon.
Who will provide insurance?
Preference would be given to government insurance companies over private insurers.
List of government owned insurance companies in India are:
- Life Insurance Corporation of India
- General Insurance Corporation of India
- National Insurance
- Oriental Insurance
- New India Assurance
- United India Insurance
However all the participating insurers should be registered with IRDAI.
Who will pay for the premium?
Premium payment will be done annually by central and state government. Premium will be splitted between the two.
Will there be any separate fees for beneficiary?
No. All benefits offered under the scheme are free of cost.
For the period during which patient is in hospital, what will be included as a part of the cover?
Medications, medical tests, doctors consultation, procedures, room stay and food will be part of the package under AB – NHPM. All this will be provided by the empanelled hospitals.
When would insurance company settle the claim?
As per the guidelines, insurer will have to settle the claim within 30 days of receiving it from the hospital.
Who will file claim?
Claim has to be submitted by the empanelled hospitals within 24 hours of patient discharge.
How much will this Yojana cost government?
Although there is no approximate calculation yet, but the Yojana is estimated to cost Rs. 12,000 Crore.