Govt may double Ayushman Bharat reach, increase health cover to Rs 10 lakh

Imagine having a safety net that catches you when life throws unexpected medical expenses your way. The Indian government is planning just that by expanding its flagship Ayushman Bharat health insurance scheme over the next three years. The exciting part? They’re looking to include all individuals over 70 and increase the insurance coverage to Rs 10 lakh per year. If implemented, it will come as a major relief as medical expenditure is one of the biggest reasons that push families to indebtedness.

According to a report by the news agency PTI, these proposals, or parts of them, are likely to be announced in the upcoming Union Budget, set to be presented on July 23.

Interim Budget 2024

In the interim Budget for 2024, the government increased the allocation for the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). This scheme, which offers health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to 12 crore families, received an allocation increase to Rs 7,200 crore. Additionally, Rs 646 crore was assigned for the Ayushman Bharat Health Infrastructure Mission (PM-ABHIM).

NITI Aayog's 2021 report: Key takeaways

Over three years ago, NITI Aayog's report titled 'Health Insurance for India's Missing Middle' suggested extending the scheme. The report, published in October 2021, stated that about 30% of the population lacks health insurance, highlighting significant gaps in coverage.

“The AB-PMJAY scheme aims to provide comprehensive hospitalisation cover to the bottom 50% of the population. Around 20% of the population is covered through social health insurance and private voluntary health insurance designed for high-income groups. However, the remaining 30% of the population, termed as the "missing middle," still lacks coverage. This group primarily includes the self-employed, informal sector workers in rural areas, and various occupations in urban areas,” the report stated.

The report emphasised the need for a low-cost, comprehensive health insurance product for the missing middle. It highlighted that low financial protection for health in this segment is a significant policy issue, with health insurance identified as a potential solution.

What is PMJAY (Ayushman Bharat Yojana)?

Launched in September 2018, Ayushman Bharat Yojana is considered one of the world's largest healthcare schemes, aiming to cover over 500 million Indian citizens, particularly those from economically weaker sections. The scheme offers health insurance with a maximum sum insured of Rs 5 lakh, covering most medical treatment costs, medications, diagnostics, and pre-hospitalisation expenses. Beneficiaries can access cashless hospitalisation services through the Ayushman health card at any empanelled hospital nationwide.

Eligibility for PMJAY

The scheme aims to provide healthcare to 100 million families, including 80 million in rural areas and 23.3 million in urban areas, targeting a total of 500 million individual beneficiaries. Applicants must belong to specified categories such as SC/ST, Lower Income Group, or Economically Weaker Sections (EWS). Eligibility can be checked using the ‘Am I Eligible’ feature on the official website.

PMJAY in rural and urban areas

PMJAY Rural

In rural areas, the scheme targets:

— Scheduled caste and scheduled tribe households

— Beggars and those surviving on alms

— Families with no individuals aged between 16 and 59 years

— Families with at least one physically challenged member and no able-bodied adult member

— Landless households working as casual manual labourers

— Primitive tribal communities

— Legally released bonded labourers

— Families in one-room makeshift houses without proper walls or roof

— Manual scavenger families

PMJAY Urban

In urban areas, eligible groups include:

— Washermen, watchmen

— Rag pickers

— Mechanics, electricians, repair workers

— Domestic help

— Sanitation workers, gardeners, sweepers

— Home-based artisans, handicraft workers, tailors

— Cobblers, hawkers, and other street service providers

— Construction workers, porters, welders, painters, security guards

— Transport workers like drivers, conductors, helpers, cart or rickshaw pullers

— Assistants, peons in small establishments, delivery boys, shopkeepers, and waiters

Exclusions from PMJAY

Certain groups are not eligible for the scheme, including those who:

— Own motorised vehicles

— Own mechanised farming equipment

— Have kisan cards with a credit limit of Rs 50,000

— Are government employees

— Work in government-managed non-agricultural enterprises

— Earn a monthly income above Rs 10,000

— Own refrigerators and landlines

— Have solidly built houses

— Own 5 acres or more of agricultural land

Coverage under Ayushman Bharat Yojana

The Ayushman Bharat Yojana Scheme offers comprehensive coverage of up to Rs 5 lakh per family annually for secondary and tertiary hospitalisation care. It covers various medical services, including examinations, consultations, treatments, pre-hospitalisation services, non-intensive and intensive care, medications, diagnostics, accommodation, medical implants, food services, treatment-related complications, and post-hospitalisation expenses for up to 15 days.

Exclusions from coverage

The scheme does not cover:

— Out-Patient Department (OPD) expenses

— Drug rehabilitation

— Cosmetic surgeries

— Fertility treatments

— Individual diagnostics

— Organ transplants

Checking eligibility online

To check your eligibility for the Ayushman Bharat Yojana online:

1. Visit the official Ayushman Bharat Yojana website at [https://www.pmjay.gov.in/](https://www.pmjay.gov.in/).

2. Go to the "Am I Eligible" section on the homepage.

3. Enter your mobile number and captcha code, then click "Generate OTP."

4. Enter the OTP received on your mobile and click "Verify OTP."

5. Provide your details such as name, state, age, family members, and income.

6. Click "Submit" to check your eligibility.