What is Prime Minister health insurance scheme?

Introduced by the Prime Minister Narendra Modi, the health insurance scheme with a grand vision is named as Ayushman Bharat providing the subscribers a medical expenses cover of up to Rs 5 lakh.

Here is what you must know about the scheme and the eligibility criteria that will help you benefit from the scheme.

Called by other names such as the National Health Protection Mission (AB-NHPM) or Modicare, this government-sponsored health insurance scheme offers free coverage of up to Rs 5 lakh per family per year for medical care availed of at any government hospital or an empanelled medical care facility in India. The scheme is meant only for poor families and the economically deprived segments of the society. The scheme aims to cover about 10.74 crore beneficiary families and around 50 crore Indian citizens.

Key aspects of Ayushman Bharat scheme

The medical insurance cover will provide a maximum of about Rs 5 lakhs per family per year on secondary as well as tertiary medical care availed of from medical facilities.

Eligibility is strictly based on the Socio-Economic Caste Census (SECC) database and those that are eligible will be covered by the program automatically without having to register for it.

If a person from an eligible family is hospitalized, the family need not spend on the treatment when they visit a government or an empanelled private hospital for treatment.

The policy covers all kinds of diseases and the benefit offers coverage both for pre and post hospitalization expenses. Unlike other kinds of medical insurance schemes, there is no waiting period for pre-existing ailments.

Though Aadhaar card is not a mandated requirement for availing of the medical care under the Ayushman Bharat scheme, the beneficiaries will have to produce a prescribed ID at the hospital to receive free treatment.

Eligibility criteria for Ayushman Bharat scheme in rural areas

1. Families inhabiting a single room or a domicile with “kuchcha walls and kuchcha roof"

2. Families in which there is no adult member in the age group 16 and 59

3. Family headed by a female with no adult male member belonging to the 16-59 age group

4. Families in which there is at least one disabled member and no able-bodied adult member

5. SC/ST households

6. Landless households making a majority of their earnings from manual casual labour

7. Extremely poor and those individuals surviving on alms

8. Families of manual scavengers

9. Families belonging to primitive tribal groups

Eligibility criteria for Ayushman Bharat scheme in urban areas

As per the guidelines issues as part of the Ayushman Bharat scheme, the following 11 occupational categories of workers are included in the list automatically.

1. Domestic worker

2. Street vendor, cobbler, hawker, and other service providers working on the streets

3. Construction worker, plumber, mason, labour, painter, welder, security guard, coolie and other head-load workers

4. Sweeper, sanitation worker, and gardener

8. Home-based worker, artisan, handicrafts worker, and tailor

9. Transport worker, driver, conductor, helper to drivers and conductors, cart puller, and rickshaw puller

10. Shop worker, assistant, peon in small establishment, helper, delivery assistant, attendant, and waiter

11. Electrician, mechanic, assembler, and repair worker

12. Washer-man, and chowkidar

13. Homeless people