Ayushman Bharat Yojana: Free Insurance for Poor with 5 Lakh Cover

Ayushman Bharat Yojana is a step towards providing social security to poor people of India. Ayushman Bharat Yojana is proposed under Pradhan Mantri Yojana that will provide free medical insurance coverage up to 5 Lakh to poor people. Another name given to this scheme is Modicare. It is generally seen that due to lack of money and unavailability of any social security poor people suffer a lot especially when it comes to healthcare. In order to solve this problem, during Budget 2018 central government had announced “Ayushman Bharat Yojana”. The prime objective of this Yojana is to provide quality healthcare insurance coverage to poor people in India. Key feature and details about Ayushman Bharat Yojana are given below.

Ayushman Bharat

Ayushman Bharat Yojana Key Features and Details

Proposed Launch Data of Ayushman Bharat Yojana – 15th Aug 2018 or 2nd Oct 2018

Insurance Coverage – Maximum 5 Lakh sum assured per family per year

Type of Insurance –  Family floater type insurance policy

Key Benefits of Ayushman Bharat Yojana – 

  • Hospitalization expense benefits
  • Daycare treatment benefits (as applicable)
  • Follow-up care benefits
  • Pre and post hospitalization expense benefits
  • Newaborn child/ children benefits
  • Pre-existing diseases conditions will be covered with a certain exclusion 

Eligibility Criteria of Ayushman Bharat Yojana (Modicare)

  • This scheme will be offered to poor people as per data collected under social economical caste census conducted by the government in 2011.
  • Aadhaar based biometric will be used so valid Aadhaar is mandatory for this insurance scheme.
  • There is no limitation about family member under this scheme.

Target Audience – Poor and economically backward class people which includes –

  • Family with no adult member between 16 to 59 years.
  • Family only headed by female member
  • SC/ST household
  • Casual Labor
  • Primitive tribal groups
  • Domestic worker/ Street vendor/ Cobbler/Hawker/ Other service provider working on streets
  • Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard
  • Transport worker/ Driver/ Conductor/ Helper
  • Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant /
  • Attendant/ Waiter

Above professions are tentative and subject to change.

Medical Treatment Location under Ayushman Bharat Scheme (Modicare) 

It is claimed that similar to normal insurance scheme, a patient can get treatment in most the private hospital as well as government hospitals. However, it is mandatory for that hospital to be part of Modicare network. The treatment given under this scheme will be 100% cashless.

In every hospital one ‘Ayushman Mitra’ will be appointed. A task of Ayushman Mitra will be to guide patient and family about the process. This is to ensure that patient and family get relevant help. This yojana will be launched in every state of India.

The government will be making 1.5 Lakh health and wellness center across country for this program. Total budget allocated for this program is 1200 Cr.

Insurance companies like LIC of India, National Insurance, Oriental Insurance, New India Assurance, United Indian Assurance shall be involved in providing insurance under this scheme.

Cost/Premium for Ayushman Bharat Policy

The policy premium under Ayushman Bharat Scheme will be paid by the government. It will be paid by central and state government equally. This means half payment shall be done by central government and half by state government.

All benefits offered to the beneficiary will be free. No charge is applicable to beneficiary. All medicines, medical tests, doctors consultation, procedures, room stay and food will be part of the package under AB – NHPM (Ayushman Bharat – National Health Protection Mission).

The claim under this scheme needs to be settled within 30 days of receiving claim from the hospital. The claim needs to filled by hospital within 24 hours of patient discharge.

The information given above is collected from various sources including internet. This information is subject to change.

Article by Raviraj

Raviraj is the man behind moneyalpha.com. He is graduate in finance, engaged in blogging since 6 years. He is not affiliated with any financial product, service provider, agent or broker. The purpose of this blog is to spread financial awareness and help people in achieving excellence for money. Please note that the views expressed on this Blog/Comments are clarifications meant for reference and guidance of the readers to explore further on the topics. These should not be construed as investment advice or legal opinion.

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