Ayushman Bharat Yojna or ‘Modicare’, a national health protection scheme, was announced by the government earlier this year. This ambitious healthcare program promises to cover over 10 crore poor and vulnerable families and around 50 crore individuals, based on the database of the Socio-Economic Caste Census (SECC). Under this program, underprivileged families will get up to Rs. 5 lakh every year per family for hospitalization and undergoing various medical treatments.

What Are The Benefits Of The Ayushman Bharat Scheme?

The salient features and benefits of this newly implemented government-backed health insurance scheme are:

  • This program provides a defined benefit cover of Rs. 5 lakh per family per year.
  • The beneficiaries will be allowed to take cashless medical facilities from any impaneled public or private hospitals across the country.
  • States would need to set up a State Health Agency (SHA) to implement the Idea.
  • Under the Ayushman Bharat Scheme, all kinds of diseases are covered from the first day of the Ayushman Bharat policy. It includes both pre and post-hospitalization expenses.
  • To avail of the benefits of Ayushman Bharat policy, having an Aadhaar card is not mandatory. But beneficiaries are required to carry a prescribed ID to receive free treatment at the hospital.
  • There is no cap on family size, age, and gender under the Ayushman Bharat scheme to ensure that nobody is left out (especially women, children and elderly).
  • This cover will take care of almost all secondary and most of the tertiary care procedures.

Who Is Eligible For Ayushman Bharat Yojana?

The following individuals would be eligible to avail the benefits under this national Health Protection Policy:

In rural areas:

  • Families having only one room with ‘kuchcha walls and kuchcha roof’.
  • Female-headed family with no male adult member in the 16-59 age group.
  • SC/ST households.
  • Landless households who earn income mainly from manual casual labor.
  • Legally released bonded labors.
  • Families having at least one disabled member and no-able bodied adult members.

In urban areas:

Pradhan Mantri Awas Yojana – PMAY

The government has made a list of these 11 occupational categories of workers who are automatically included in the list:

  • Ragpicker
  • Domestic worker
  • Beggar
  • Cobbler/hawker/street vendor/other service provider working on streets
  • Construction worker/plumber/mason/painter/security guard/coolie and other head load workers
  • Sweeper/gardener/sanitation worker
  • Washerman/chowkidar
  • Electrician/mechanic/assembler/repair worker
  • Driver/conductor/transport worker/helper to drivers and conductors/cart puller/ rickshaw puller
  • Home-based worker/ artisan/ handicrafts worker / tailor
  • Shop worker/helper/peon in small establishments/waiter/delivery assistant/assistant/attendant

How To Enroll In The National Health Protection Scheme?

No application form or registration is required. Eligible individuals will get a letter. As per the latest SECC data, this new health insurance scheme will cover around 50 crore people. The government will also provide transport allowances to the beneficiaries.

What Are The Procedures That Are Covered Under Modi Insurance Scheme?

More than 1,350 medical procedures including chemotherapy, brain surgeries, and life-saving procedures have been integrated into the scheme. The list of Medical treatments along with the rates as fixed by the central government under Ayushman Bharat Scheme is as follows:

  • Knee Implant: Rs. 90,000
  • Heart Stent: Rs. 40,000
  • Bypass Surgery: Rs. 1.10 lakh
  • Replacement of Valve: Rs. 1.20 lakh
  • Arthroscopy Surgery: Rs. 20,000
  • Hip Replacement: Rs. 90,000
  • Knee Surgery: Rs. 25,000
  • Cervical Surgery: Rs. 20,000
  • Hysterectomy Surgery for Removal of Uterus: Rs. 50,000

Under this Ayushman Bharat scheme, treatment packages are being provided at 15 – 20% lower prices as compared to the prices under CGHS (Central Government Health Schemes) for similar packages.

When Will The Scheme Be Rolled Out?

The scheme has been launched on 23rd September 2018 and is effective from 25th September 2018.

Which Hospitals Will Operate Under The Modicare Scheme?

Any private health care and the public hospital can get themselves impaneled for the scheme. The basic empanelment criteria allow the empanelment of a hospital with a minimum of 10 beds, with the flexibility provided to states to further relax this if required. Interested hospitals have already started getting themselves impaneled by applying at the online portal established by the state government. Information about the impaneled hospitals will be made available through government websites and mobile apps. Beneficiaries can call the helpline number at 14555.

As per various sources, at least 6,000 private hospitals and all government hospitals are expected to join the scheme. However, it is not compulsory for all hospitals to join the scheme and hence, many top-quality and accredited hospitals may not get impaneled. The charges specified for the procedures covered under the scheme are quite discounted and it may be unprofitable for large hospitals to join the Modicare scheme.

What Is The Hospitalization Process?

The beneficiaries are not required to pay any charges or premiums for the hospitalization expenses. Each impaneled hospital will have an ‘Ayushman Mitra’ to assist patients and will coordinate with beneficiaries and the hospital. Their work will include: checking documents to verify the eligibility, enrolment to the scheme and running a help desk. The beneficiaries will also be given QR codes which will be scanned and a demographic authentication will be conducted for identification and to check the eligibility as well.

Conclusion : Ayushman Bharat Scheme is being touted as the world’s largest health protection scheme. The benefits of the scheme are portable across the country and are said to cover over 10 crore poor and vulnerable families.

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