Know Everything about MODICARE – Ayushman Bharat Health Scheme



When will it Start?

With the roll out of the Centre’s flagship scheme which has been renamed as PM Jan Arogya Yojana (PMJAY), the Narendra Modi-led NDA government aims to provide healthcare facilities to over 10 crore families covering urban and rural poor. All NDA chief ministers launched the scheme from their respective states.

The scheme will become operational from September 25 on the birth anniversary of Pandit Deendayal Upadhyay, Niti Aayog member V K Paul said.

Which Cities will be covered in First Phase?

In the first phase, this pilot programme will be conducted in 106 districts spread across 14 states already on board to implement the scheme, said Dinesh Arora, Deputy CEO, AB-NHPM. The aim is to conduct the tests in at least one hospital in each district, majority of which are concentrated in states like Chhattisgarh, Haryana and West Bengal.

Other states where the technology system will be piloted are Madhya Pradesh, Manipur, Uttarakhand, Chandigarh, Mizoram, Meghalaya, Nagaland, Himachal Pradesh, Arunachal Pradesh, Dadar and Nagar Haveli as well as Daman and Diu

How much Sum Insured ?

The ambitious scheme offers an insurance cover of Rs 5 lakh, which will cover 10 crore poor families or almost 50 crore persons. In his Independence Day speech, Modi had announced that while the scheme would initially cover 10 crore poor families as per the socio-economic census of 2011, it will in the coming days also benefit the lower middle-class, middle-class and upper-middle class by way of jobs in the medical sector as new hospitals will open in Tier-2 and Tier-3 cities.

Who will be the beneficiaries?
The scheme is targeted at poor, deprived rural families and identified occupational categories of urban workers’ families. So, if we were to go by the Socio-Economic Caste Census (SECC) 2011 data, 8.03 crore families in rural and 2.33 crore in urban areas will be entitled to be covered under these scheme, i.e., it will cover around 50 crore people. To ensure that nobody is left out (especially women, children and the elderly), there will be no cap on the family size and age under the AB-NHPS. The scheme will be cashless and paperless at public hospitals and empanelled private hospitals.

How to check your name in it ?

A website and a helpline number has been launched to help prospective beneficiaries check if their name is there in the final list of the Ayushman Bharat scheme. The National Health Agency (NHA), the apex body implementing the scheme announced the launch.

You can call up on the helpline number, 14555, to find out your eligibility. You can also check it online.

Here is how you can check if for eligibility for the scheme through the NHA portal:
Log in to mera.pmjay.gov.in

इस योजना का फायदा आपको मिलेगा या नहीं

अगर आप जानना चाहते हैं कि इस योजना का फायदा आपको मिलेगा या नहीं, तो इसके लिए सबसे पहले आपको सरकार की वेबसाइट mera.pmjay.gov.in पर लॉग इन करना होगा। लॉग इन करते ही आपको होम पेज पर अपना मोबाइल नंबर दर्ज करने को कहा जाएगा। उसके ठीक नीचे आपको कैप्चा दिखाई देगा, जिसमें दिए गए नंबरों को आपको खाली बॉक्स में भरना होगा।

उसके बाद ‘जेनरेट ओटीपी’ ऑप्शन पर क्लिक करिए। वहां क्लिक करते ही आपके मोबाइल पर एक ओटीपी नंबर जाएगा, जिससे वेबसाइट पर जाकर वेरिफाई कर लें।

अब आपके सामने एक नया पेज खुलकर आएगा, जिसमें आपको अपने राज्य के नाम का चयन करना होगा। इसके बाद आप अपना मोबाइल नंबर या कोई दूसरी उपलब्ध जानकारी डालकर अपने नाम को सर्च कर सकते हैं।

वेबसाइट पर एक बार आपका नाम रजिस्टर हो जाए, उसके बाद आप अपने राशन कार्ड या मोबाइल नंबर की मदद से ये पता कर सकते हैं कि आपको इस योजना का लाभ मिल रहा है नहीं मिल रहा है।

हालांकि वेबसाइट पर सिर्फ उन्हीं लोगों का नाम दिखाई देगा, जिन्होंने अपना मोबाइल नंबर या राशन कार्ड नंबर जमा कराया था। दरअसल, हाल ही में इस योजना के लिए एक अभियान चलाया गया था, जिसमें सामाजिक-आर्थिक जाति जनगणना डाटाबेस के आधार पर लोगों से उनका मोबाइल नंबर और राशन कार्ड नंबर मांगा गया था।

अगर आपका नाम वेबसाइट पर नहीं दिख रहा है तो ज्यादा घबराने की जरूरत नहीं है। इसके लिए आपको डाटाबेस में अपना नाम, पिता का नाम, लिंग और राज्य का नाम अंकित करना होगा। इसके बाद सर्च करने पर आपका नाम आ जाएगा, फिर आप ‘गेट एसएमएस’ ऑप्शन पर क्लिक करें, जिसके बाद आपके पास एक मैसेज जाएगा, जिसमें आपको एक नंबर मिलेगा। उस नंबर को आप संभाल कर रख लें, क्योंकि यह भविष्य में बहुत काम आएगा।

अगर ये सब करने के बाद भी आपका नाम सर्च करने पर नहीं आ रहा है तो तो आप ‘आयुष्मान मित्र’ से संपर्क करें और इसके लिए जरूरी दस्तावेज जमा कराएं। इसके बाद आप चेक कर सकते हैं कि आपको इस योजना का लाभ मिलेगा या नहीं।

How will the entitlement be decided?
AB-NHPM will be an entitlement based scheme where it will be decided on the basis of deprivation criteria in the SECC database. The beneficiaries are identified based on the deprivation categories (D1, D2, D3, D4, D5, and D7) identified under the SECC database for rural areas. For the urban areas, the 11 occupational criteria will determine entitlement. In addition, Rashtriya Swasthya Bima Yojna (RSBY) beneficiaries in states where it is active are also included.

Who is the scheme aimed at?
The scheme is targeted at poor, deprived rural families and identified occupational category of urban workers’ families. So, if we were to go by the Socio-Economic Caste Census (SECC) 2011 data, 8.03 crore families in rural and 2.33 crore in urban areas will be entitled to be covered under these scheme, i.e., it will cover around 50 crore people.

AB-NHPS will have a defined benefit cover of Rs 5 lakh per family (on a family floater basis) per year for secondary and tertiary care hospitalisation. It will offer a benefit cover of Rs 5 lakh per family per year. It will subsume the existing Rashtriya Swasthya Bima Yojana (RSBY), launched in 2008 by the UPA government.

How much will it cost?
Ayushman Bharat may cost the exchequer around Rs 5,000 crore this year because of the time taken to rollout the scheme. The scheme will cost Rs 10,000 crore when its rolled out across India next year. While this year there are likely to be 8 crore beneficiaries, the target is to cover 10 crore by FY 20.

What will happen to RSBY ?

In the first year, out of the total expenditure of Rs 5,000 crore, the central government may bear the burden of around Rs 3,000 crore which will increase to almost Rs 7,000 crore in FY20. The scheme aims to provide a benefit cover of Rs 5 lakh per family per year. It will subsume the existing Rashtriya Swasthya Bima Yojana (RSBY), launched in 2008 by the UPA government.

What does International Agency saying ?

According to international rating agency Moody’s, Ayushman Bharat is credit positive for insurance companies as it will aide in higher premium growth. “The launch of universal health coverage is credit positive for the country’s insurers because it will help grow health premiums and provide insurers with cross-selling and servicing opportunities,” Moody’s said in a report last month

Extreme outreach
Perhaps, possible electoral benefits of the scheme is one reason behind its aggressive promotion by the government. All states were asked to set up kiosks at all empanelled hospitals with PM-JAY branding, cover such hospitals with publicity material like banners on the scheme, give uniforms to Arogya Mitras who will guide people about the scheme at hospital and distribute pamphlets to the incoming patients. The states were also asked to go for outdoor advertising for visibility and hold panchayats in villages. “We want to create a brand so that beneficiaries know where to go and whom to contact to get the services under PMJAY. The publicity, especially the audio and visual communication, helps in reaching the beneficiaries effectively,” said Indu Bhushan, the CEO of PMJAY.

Disclaimer :- You are requested to verify the given information from an Authorised PMJAY official as there are modifications in the scheme on regular basis.