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1 lakh patients aided under Ayushman Bharat: Who is eligible and how to avail benefits under the scheme

In a bid to provide comprehensive healthcare and reduce expenses for the same, the centre launched its ambitious Ayushman Bharat scheme in September this year. In the words of President Kovind, “It is the world’s largest healthcare scheme, which will reduce the financial burden of crores of families caused by diseases.”

President tweeted on October 29, that within a month of its launch, more than one lakh patients have received medical facilities under the Ayushman Bharat scheme.

Ayushman Bharat aims to not only pay up to Rs five lakh in hospitalisation costs to poor and vulnerable families but also cover drugs and diagnostic expenses. As per the scheme guidelines released on August 31, 2018, approximately 10.74 crore identified families ( approximately 50 crore beneficiaries) will be entitled to get the benefits.

But are you eligible under the scheme? Let’s find out.

Who is eligible under Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (PMJAY)?

The first thing which needs to be noted here is that ‘the scheme is entitlement based’, meaning there is no formal enrolment process. There is no cap on family size and age as well as restriction on pre-existing conditions.

PMJAY will target poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) 2011 data, both rural and urban. Additionally, all such enrolled families under Rashtriya Swasthaya Bima Yojana (RSBY) that do not feature in the targeted groups as per SECC data will be included as well.

The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization.

Now let’s point out the criteria or categories of people covered under the ambitious healthcare scheme of Narendra Modi led central government.

For rural areas, you will be included in the Ayushman Bharat if:

  • You have only room with kucha walls and kucha roof
  • Your household doesn’t have a shelter
  • Your family doesn’t have any adult member between age 16 to 59
  • Your household is headed by a woman with no adult male member between age 16 to 59
  • You are disabled and there is no able-bodied adult member in the family
  • You lie under SC/ST household
  • You survive under a landless household which earns a major part of its income from manual casual labour
  • You belong to primitive tribal groups
  • You are what is defined as destitute or you live on alms
  • You belong to a manual scavenger family
  • You are legally released bonded labour

For urban areas, you will be included in the Ayushman Bharat if:

  • You belong to occupational categories of workers
  • You are a rag picker or a beggar
  • You are a domestic worker, a sweeper, a sanitation worker or a mali
  • You are a home-based worker, artisan, handicrafts worker or tailor
  • You are a construction worker, a plumber, a mason, a labour, a painter, a welder, or a security guard
  • You are a coolie or earn a living by another head-load work
  • You are a street vendor, a cobbler, a hawker, or provide some other service on streets
  • You are a transport worker, a driver, a conductor, a helper to drivers and conductors, a cart-puller or a rickshaw puller
  • You are a shop worker/assistant/peon in a small establishment, a helper, delivery assistant, attendant, or a waiter
  • You are an electrician, mechanic, assembler or repair worker
  • You are a washer-man or chowkidar

People not included in PMJAY

As per SECC 2011, following beneficiaries are automatically excluded from Ayushman Bharat or Pradhan Mantri Jan Arogya Yojana (PMJAY):

  • Households having motorized 2/3/4 wheeler/fishing boat
  • Households having mechanized 3/4 wheeler agricultural equipment
  • Households having Kisan Credit Card with credit limit above Rs. 50,000
  • A member of the household is a government employee
  • Households with non-agricultural enterprises registered with the government
  • Any member of household earning more than Rs. 10,000 per month
  • Households paying income tax
  • Households paying professional tax
  • House with three or more rooms with pucca walls and roof
  • Owns a refrigerator
  • Owns a landline phone
  • Owns more than 2.5 acres of irrigated land with 1 irrigation equipment
  • Owns 5 acres or more of irrigated land for two or more crop season
  • Owning at least 7.5 acres of land or more with at least one irrigation equipment

What if you are under both eligible and non-eligible list?

It is possible that a person features in both eligible and excluded lists of Ayushman Bharat. For instance, a street vendor who lies under Ayushman Bharat’s eligible list happens to belong to a household where another family member earns more than Rs 10,000 per month; in that case, the street vendor will be deemed not eligible under the scheme.

The PMJAY guideline also advices the states to authorize the District Collectors/ District Magistrates or Deputy Commissioners to exclude such beneficiaries from the eligible list.

Beware of fake websites and fake WhatsApp claims

As always, there are several messages doing rounds on WhatsApp propagating false information about Ayushman Bharat or PMJAY. The message claims a final date to apply for the Ayushman Bharat scheme along with a website to apply for the same.

How to check enrollment under PMJAY

You can visit the website mera.pmjay.gov.in or call up the helpline 14555 to check your enrolment.

On the website, you need to put your mobile number, enter the Captcha code and click on Generate OTP. After you enter the OTP sent on your mobile, you will be redirected to a page which will ask your state and give you three options to search your enrolment:

  • By Name
  • By Ration Card Number
  • By Mobile Number
  • By RSBY (Rashtriya Swasthya Bima Yojana) URN

How to avail benefits of Ayushman Bharat scheme

After identifying the eligibility under PMJAY, a patient will have to go to the PMJAY Kiosk at the hospital which will the Pradhan Mantri Arogya Mitra (PMAM) will verify his identity and eligibility using the beneficiary’s identity and eligibility using the Beneficiary Identification System (BIS) and create a e-card (golden record) for the beneficiary unless he/she already has an e-card.

As per the information released by the government over the PMJAY portal, The PMAM informs the beneficiary that they are eligible for free treatment under PMJAY only if they are hospitalized and are not required to bear any expenses. Additionally, the beneficiary is informed of the amount of charges they may have to bear in case they are not hospitalized e.g. diagnostics (if any) etc.

The hospital will not collect any money from the beneficiary before the diagnosis and shall ensure that the empanelled diagnostic provider also does not collect any money from the beneficiary.

After that, the beneficiary receives consultation from a general doctor or a specialist as per the case and the patient shall be prescribed medical drugs, directed for further diagnostics or hospitalization. Beneficiaries prescribed medical drugs (and not requiring hospitalization) will pay relevant consultation and drug charges if and as applicable.

If a patient is hospitalized, the medical coordinator (a medical doctor) will fill the standard template for pre-authorization and he will be responsible for providing the necessary documents to the PMAM while acting as the bridge between the treating doctor and the former.

PMAM will click the picture of the patient on the hospital bed and upload it on TMS (transition management system) portal, and repeat the same during treatment or post-surgery. PMAM will also take care of other things related to collection of necessary documents etc. and inform the beneficiary about any entitlements he receives at the hospital like relevant medication and diagnostics as per the package for up to 15 days as applicable.

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