What is Ayushman Bharat Health Insurance ? Explain the features and benefits of the Scheme.
CS Professional · Banking and Insurance - Laws and Practice · PYQS · June 2024
What is Ayushman Bharat Health Insurance ? Explain the features and benefits of the Scheme.
Answer & Explanation:
Ayushman Bharat Health Insurance Scheme: Ayushman Bharat is a health protection scheme to provide health insurance to citizens. It provides insurance coverage of up to ₹5 lakhs on a family floater basis to beneficiaries every year to receive primary, secondary, and tertiary healthcare services. The scheme was earlier referred to as Ayushman Bharat National Health Protection Scheme (AB-NHPS) as it is an initiative under the existing National Health Protection Scheme (NHPS). Currently, it is known as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY). The government plans to distribute this scheme through national insurance companies. The scheme subsumes the existing senior citizen health insurance scheme as well as the Rashtriya Swasthya Bima Yojana. Features and Benefits of Ayushman Bharat - National Health Protection Scheme (AB-NHPS) are as under: A cover of up to ₹5 lakh is available for the beneficiary family every year. The scheme can be utilised to get primary, secondary, and tertiary healthcare services. The benefits of the scheme can be availed at any government hospital or empanelled private hospital. The eligibility of beneficiaries targeted towards the poor, deprived rural families and identified occupational category of urban workers' families based on the Socio-Economic Caste Census (SECC) 2011 data. Package model are followed to make payments. The package is defined by the government-in-charge in terms of payment of total costs, specific services, and procedures. An Ayushman Bharat National Health Protection Mission established for effective coordination between the Central and the state governments. The scheme covers about 40% of the country's population who are poor and vulnerable. All expenses incurred by the beneficiary from his pocket during the hospitalisation are also covered. The cost incurred during the pre and post-hospitalisation period are covered. The insurance provides a cash-less hospitalisation facility. Daycare treatment expenses are covered by the scheme. The insurance scheme covers all pre-existing health conditions. Follow-up of medical examinations upto 15 days are also covered to ensure that the patients have recovered completely.
Topics: Health Insurance Schemes
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