Ayushman Bharat is a national health protection scheme initiated by the government of India in early 2018. Based on the data of the Socio-Economic Caste Census, the program promises to cover 10 crore low-income families and around 50 crore individuals. The scheme will provide up to Rs. 5 lakhs cover each year to each family for the hospitalization and medical services to underprivileged families.
The two main objectives of this health insurance scheme are:
- Create infrastructure of health to provide comprehensive primary healthcare services.
- To provide health insurance to a major section of the population which is deprived of secondary and tertiary health care services.
Some key benefits of Ayushman Bharat Scheme are:
- Under the scheme, all kinds of diseases are covered from the first day of policy, and it covers both post and pre-hospitalization expenses.
- The cover takes care of all the secondary and most of the tertiary healthcare services.
- To make sure nobody is left out, the scheme has no bar based on age, gender, or family size.
- Under the program, state governments are required to form the State Health Agency.
In rural areas:
- SC/ST households
- Family with a female head and no male in the age of 16-59.
- Bonded labourers who are released legally.
- Family with dis-abled member and no able-bodied adult.
- Families with one room which has a ‘kutcha wall and roof’.
- Domestic Workers and ragpickers
- Beggar, sweeper, gardener and sanitation worker
- Electrician and mechanic
- Home-based worker, handicraft worker and tailor
- Construction worker, plumber, painter, cart puller, a rickshaw puller.
No application form is required, the eligible people will get the letter, and the government will also provide transport allowances to these beneficiaries.
Procedures under the Scheme
Ayushman Bharat scheme covers over 1,350 medical procedures including brain surgery, chemotherapy and other life-saving procedures. A small list of some medical treatments along with their rates as fixed by the government are:
- Knee Surgery: Rs. 25,000
- Bypass Surgery: Rs. 1.10 lakh
- Hip Replacement: Rs. 90,000
- Knee Implant: Rs. 90,000
- Arthroscopy Surgery: Rs. 20,000
- Cervical Surgery: Rs. 20,000
- Replacement of Valve: Rs. 1.20 lakh
- Heart Stent: Rs. 40,000
Hospitals under the Scheme
Both public and private hospitals can get themselves empanelled for this scheme. The basic criteria of empanelment is that the hospital should have at least 10 beds. The state has the authority to relax the criteria further. The interested hospital could apply through the online portal established by the respective state government. The helpline number for beneficiaries is 14555. The information with regards to the empanelled hospitals is shared through the website of the government and mobile apps.
The government is expecting at least 6000 hospitals to apply for the impanelment. However, it is to be noted that there is no compulsion for the hospitals to join. Thus, many large hospitals are not expected to apply, and besides the prices of various services are considerably discounted, which will not be profitable for big hospitals.
The scheme has been implemented from 25th September 2018. The beneficiaries are not required to pay for any hospitalization expense or premium. The empanelled hospital will have an ‘Ayushman Mitra’ to the assistance of patients.
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