The question that will come to your mind is, Ayushman Bharat is a scheme for below poverty line population, so why are you reading it? It is true, but the most noteworthy statement of PM’s Independence Day speech was – Ayushman Bharat will be extended to all social classes after the initial launch. So it will really be a National Health Protection Scheme in times to come. It will cover each one of us. So here are the details, features, eligibility & scope of Ayushman Bharat.
Another reason to discuss Ayushman Bharat is- may be economical conditions separate us but we live & work in a society full of people who need medical help around us. This article will help you – help them and guide. It’s our duty.
Govt is going to bring Pradhan Mantri Jan Arogya Abhiyan under which 10 crore families will get health insurance worth Rs 5 lakh per annum; will launch it on 25th Sept, birth anniversary of Pt Deendayal Upadhyay : PM @narendramodi #IndependenceDayIndia @MoHFW_INDIA @JPNadda pic.twitter.com/laAPm6oclb
— PIB India (@PIB_India) August 15, 2018
The scheme is already been compared to Obamacare – which covered all US citizen on payment basis. It’s now been stalled by Trump Administration and the US is still waiting for a revised scheme. Media has started calling Ayushman Bharat as Modicare. It will be World’s largest government-funded health scheme upon launch.
I am not a political expert, but timing and involvement will surely make this scheme as a front-running issue in 2019 general elections. The scheme first phase will be launched on 25 Sept 2018.
Ayushman Bharat Eligibility
In the current format, Ayushman Bharat is a scheme for around 10.74 Crore families or around 50 crore heads (considering 5 members per family).
The selection of these families is as per income levels surveyed in 2011.
So all family members irrespective of age (children to elderly), gender or location are beneficiaries of this scheme. So no cap on family size too.
Ayushman Bharat Coverage
The scheme cover is Rs 5 Lakh per family per year Floater Coverage Basis. So a family can avail treatment of Rs 5 lakh by one person or multiple people for Rs 5 lakhs in a year.
Ayushman Bharat will cover medical and hospitalization expenses for almost all procedures. The health ministry has included 1,354 packages in the scheme under which treatment for coronary bypass, knee replacements, and stenting among others. Here is the list.
All pre-existing diseases are covered from day 1. No waiting period like private mediclaim policies.
Is it sufficient?
Yes, it is sufficient to cover basic ailments like stroke, minor surgeries or accidents. But major diseases like cancer, organ replacements or major accidents/surgeries will have shortfalls.
How will it work?
The exact modalities are yet to be announced as pilot testing has started in some districts. But this is a cashless scheme. So you should have valid documents of eligibility. The eligibility will be different for rural & urban areas.
The beneficiaries once found eligible will be issued cards. They will not be required to pay any charges for the hospitalization. The benefit will include pre and post-hospitalization expenses.
Each impaneled hospital will have an ‘Ayushman Mitra’ (a desk to help & counsel) to assist patients. These help desks will check documents to verify the eligibility, and enrollment to the scheme.
Also, all the beneficiaries will be given letters having QR codes. A demographic authentication will be conducted for identification and to verify his or her eligibility to avail the benefits of the scheme.
The scheme is portable across the country. Beneficiary covered under the scheme can take cashless benefits from any public or private impanelled hospitals across the country.
A helpline number 1455 has also been launched for benefit of patient & families.
What Next?
As announced by PM the benefits will be extended to the middle class and other social groups.
If Obamacare model is studied, the higher class members will not be getting the benefits FREE. They will be asked to pay/copay a part of the premium and they can then avail the benefits.
So it will be like a government-run mediclaim for us. No doubt government cannot do it alone so they will take help of public & private health insurance companies to roll out this benefit.
Is Ayushman Bharat better than Mediclaim Policy?
Yes, in phase one it is free (There is no cost or premium mentioned ever by PM or program’s website) for eligible families. But if same is extended on a paid basis to other class we need to see if the cost-benefit is adequate to provide a good treatment. Also, it will be interesting to watch if the government allows additional cover (above 5 Lakhs) on payment basis.
Final Words
Ayushman Bharat is a huge step to cover medical coverage in a country which is 7th largest by area and 2nd largest by population. After its first phase, more than 50% (existing government servants + health insurance beneficiaries combines) population will be covered with medical benefits.
For us .. as taxpayers & future beneficiaries, we need to really see if our money is used properly. Hopefully, Ayushman Bharat does not become an election tool and then axed by future governments like it happened in the USA.
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