Everything You Need to Know About the Ayushman Bharat Health Insurance Scheme

Sep 26, 2018 | 3 months ago | Read Time: 4 minutes | By iKnowledge Team

India is pioneering with the world’s largest healthcare program and here is everything you might need to know about it.

Ayushman Bharat - Health Insurance Scheme

An NSSO survey shows that 86% of India’s rural population and 82% of its urban population is not covered under any kind of public or private scheme to support their health expenditure [1]. Now, compare this to the United States which spends nearly 17% of its GDP on healthcare expenditure. Most countries in Asia spend an average of 6% of their GDP on the healthcare of their population [3]. So, what can India do to make sure the healthcare scenario here works?

This is exactly the question that the government addressed in the 2018 Annual Budget where they announced the launch of the world’s largest public healthcare scheme: Ayushman Bharat, i.e. the National Healthcare Protection Scheme(NHPS). It is a step towards achieving the goal of universal health coverage in our country.

Ayushman Bharat Health Insurance Scheme - Aegon Life

Source: NSSO

What is the NHPS?

The Ayushman Bharat Scheme promises to cover the healthcare expenditure of 10 crore families, providing coverage of up to 5 lakhs for secondary and even tertiary care hospitalisation [4]. This scheme is designed to be an entitlement in which case, the beneficiaries will be determined using the government’s pre-determined socio-economic classification database.

The scheme plans to provide coverage for individuals availing services of both government and private facilities. This National Health Protection Mission will subsume all ongoing centrally sponsored schemes including Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

How will Ayushman Bharat be implemented?

The Ayushman Bharat Scheme aims to be a flagbearer of cooperative federalism and flexibility to states. While at the central level an Ayushman Bharat National Health Protection Mission Council will be set up, chaired by the Union Health and Family Minister; all states are required to set up a State Health Agency to implement the scheme.

The Centre has given the State bodies the liberty to decide the course of action required to implement this scheme. The States can work jointly with insurance companies to improve the penetration of health insurance in India. They can also work through an existing Trust or society or even use an integrated model using both these sources.

How can I apply for Ayushman Bharat Scheme?

There is no application process for the scheme. All eligible individuals are automatically enrolled in the scheme.

Who are eligible to apply for Ayushman Bharat Health Insurance?

The eligibility for the scheme is as per the deprivation criteria under the Socio-Economic Caste Census database. The deprivation categories for rural areas are D1, D2, D3, D4, D5 and D7. For urban areas, the entitlement depends upon occupational criteria.

Eligibility can be checked by calling the helpline number 14555. Alternately, you can also visit the official website: mera.pmjay.gov.in. As a first step, you need to verify your number mobile via an OTP. After this, you must select your State. Post this, you may check for eligibility by entering either of name, mobile number, ration card number, or Rashtriya Swasthya Bima Yojna URN number.

How can I avail of the scheme?

To avail the scheme, approach an empanelled hospital. ‘Arogya Mitras’ will assist in admitting you. After this, a software based verification will be carried out to ensure that the patient is on the beneficiary list. The patient’s identity will be cross-checked using identification such as the Aadhaar card. The hospital selects an appropriate package and checks the balance. It provides any supporting evidence required for the treatment to the relevant authority. The treatment begins post this. The process is streamlined for the customer, with no cash payment expected from them.

Meanwhile, plans such as Aegon Life’s iTerm Plus are helping provide comprehensive and cost-effective coverage to users by combining the benefits of a term plan and health insurance. Its Life & Health Plus option offers cover against 36 critical illnesses and death benefits under one umbrella at only Rs. 932 per month*.

How much will it cost to buy Ayushman Bharat Health Insurance?

The first question that might come to our minds is how does the government plan to finance the world’s largest healthcare programme?

Even at a modest premium of Rs. 200 for each person in a household of five, this amounts to Rs. 10 lakhs crores for the 10 crore households the government is promising to cover. Considering the current outpatient costs, which are far more than inpatient costs, realistic costs per person will be much higher.

The Rashtriya Swasthya Bima Yojana dated April 1, 2008 which covered only hospitalisation showed that people would be willing to pay for a health insurance cover that covers both outpatient and inpatient costs. Therefore, the program must outline that those who contribute towards a health insurance plan will benefit from a government subsidy on the same.

By applying for contributions, India will create a two-tier financing model which is the international standard everywhere.

What has been the experience with such schemes?

Those who expect that remotely managed health coverage would bring quick results should consider the experience with previous programmes, as well as with the (very low) voluntary uptake of the Pradhan Mantri Fasal Bima Yojana.

The NHPS offers a unique opportunity to innovate, by harnessing best-practice lessons from many pilots. There is a large community of experts and specialists with field experience in India standing by to assist NHPS to succeed.

The NHPS is, therefore, a step closer to making India a more developed, healthy and productive nation. 

At the national level, the National Health Protection Mission will have a major impact on the reduction of Out of Pocket (OOP) expenditure in terms of providing an increased benefit cover to nearly 40% of the population. This will lead to increased access to quality health and medication for everyone in India.

II/Sep 2018/4439


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