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Ayushman Bharat - common man’s healthcare

It’s been 2 years since the launch of Ayushman Bharat, the much-hyped stalwart other than Make in India of Government of India’s initiatives. The main question is how many of us are aware of it? If you are that’s great and if you aren’t, then I present you Ayushman Bharat’s 101.

Ayushman is a Sanskrit word meaning “ having a long and healthy life”, therefore G.O.I. on 23 September 2018 launched a National Healthcare System for economically vulnerable people of the country, under the name of Pradhan Mantri Jan Arogya Yojna( PMJAY) also known as Ayushman Bharat. Initially, the scheme will cater to the 50 crore people in India, making it one the largest healthcare schemes in the world. 

Why are such initiatives important?

In the modern era State is just a facilitator for fulfillment of every citizen’s dreams and aspirations. This is done through by providing certain key elements required for decent human existence such as protection of life and property, education, health etc. These elements are protected by the way of Fundamental Rights and  Directive Principles of State Policy, which puts an obligation on the state to protect and strive to achieve the ideal standards according to economic growth.

Right to Health and Medical Assistance 

 The Supreme Court for the first time in Parmananda Katara v. Union of India laid the foundation of Right to Health by helping that professional obligation whether private or government to medical aid to injured without for legal formalities under article 21 of Indian constitution. Later in Consumer Education and Research Centre v. Union of India, SC held Right to health and Medical care as fundamental Right under Art.21.

Art. 47 cast a “DUTY OF THE STATE TO RAISE THE LEVEL OF NUTRITION AND THE STANDARD OF LIVING AND TO IMPROVE PUBLIC HEALTH” which is a continuous process.

How it PMJAY works?

It is a cashless system where the beneficiaries get e-card to have access to tertiary and secondary healthcare at empanelled private or public hospitals across the county. The e-card covers the medical expense of a family up to Rs. 5 lakh for a year.

With it you can have walk-in treatment or hospitalised treatment, in it,  will also get coverage for 3 days of pre-hospitalisation and 15 days of post- hospitalisation expenses.

PMJAY eligibility criteria

PMJAY doesn’t have any waiting period for pre-existing diseases compared to other medical insurance available in the market. When recognized as a legitimate beneficiary, you or your family member will be given a health card by a specially qualified Ayushman Mitras, who will provide kiosks in hospitals for those unaware of the PMJAY scheme.

For Rural Area, this facility can be avail by:

  1. Those living in scheduled caste and scheduled tribe households
  2. Families with no male member aged 16 to 59 years
  3. Beggars and those surviving on alms
  4. Families with no individuals aged between 16 and 59 years
  5. Families having at least one physically challenged member and no able-bodied adult member
  6. Landless households who make a living by working as casual manual labourers
  7. Primitive tribal communities
  8.  Legally released bonded labourers
  9. Families living in one-room makeshift houses with no proper walls or roof
  10. Manual scavenger families

For Urban Area, this facility can be avail by:

  1. Washerman/chowkidars
  2. Ragpickers
  3. Mechanics, electricians, repair workers
  4. Domestic help
  5. Sanitation workers, gardeners, sweepers
  6. Home-based artisans or handicraft workers, tailors
  7. Cobblers, hawkers and others providing services by working on streets or pavements
  8. Plumbers, masons, construction workers, porters, welders, painters and security guards
  9. Transport workers like drivers, conductors, helpers, cart or rickshaw pullers
  10. Assistants, peons in small establishments, delivery boys, shopkeepers and waiters

Persons who are not covered by PMJAY:

  1. Those who own a two, three or four-wheeler or a motorised fishing boat
  2. Those who own mechanised farming equipment
  3. Those who have Kisan cards with a credit limit of Rs.50000
  4. Those employed by the government
  5. Those who work in government-managed non-agricultural enterprises
  6. Those earning a monthly income above Rs.10000
  7. Those owning refrigerators and landlines
  8. Those with decent, solidly built houses
  9. Those owning 5 acres or more of agricultural land.

Hospitalization Process and Packages 

PMJAY provides yearly Rs. 5 Lakh insurance cover for family covering Medical and Surgical Treatments. Therefore every member is beneficiary and in the case requires hospitalization they need not pay anything provided admitted to empanelled hospitals.

 

Diseases Covered

This scheme covers 1350 diseases from 23 specialities such as neurology, oncology, cardiology, paediatrics, orthopaedics, etc. https://ayushmanuttarakhand.org/list-of-disease-covered

Reimbursement

  1. medical and surgical expenses cannot be reimbursed simultaneously.
  2. In case of multiple surgeries, the highest package cost is paid for in the first instance followed by a 50% waiver for the second and a 25% discount for the third. 

How to apply?

Open the PMJAY official website and click on Am I eligible and follow the next process. 

As you are now aware of Ayushman Bharat 101, please pass this knowledge to people who need it the most, so that we can contribute a small part in making our nation healthy.

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