It is a matter of great concern that approximately 63% of India's population still pays for health and hospitalization expenses by their own pocket. The large part of our population use income, savings, borrow money or sell their assets to meet their healthcare expenses.
So Prime Minister Narendra Modi launched the ambitious Ayushman Bharat Yojna in the Ranchi district of the Jharkhand on the 23 September 2018.
The prime objective of Ayushman Bharat Yojna is to provide benefit cover of Rs 5 lac per family (approx. 50 crore beneficiaries) per year to the poor people of the country.
The Ayushman Bharat Yojana will be cashless & paperless at public hospitals and selected private hospitals. The beneficiaries of Ayushman Bharat Yojana need not required to pay any charges for the hospitalization expenses. The benefit also includes pre and post-hospitalization expenses.
Now let us understand the step by step process to apply under the Ayushman Bharat Yojana.
First of all we need to check who is eligible for this Yojana. The beneficiaries can check his/her eligibility through these methods;
Step 1: Check the Eligibility
For the identification as a PM-JAY beneficiary, the patient can do any of the following:
1. You can ask the staff at the Empanelled Health Care Providers (EHCP) registration desk to check your eligibility through the ‘Am I Eligible’ application either through mobile, app or website.
2. You can check your eligibility by the PM-JAY Kiosk and check through the ‘Am I Eligible’ application.
3. Call to the call centre number 14555 of the Ayushman Bharat yojna.
Step 2: Patient Card Generation
Once it is cleared that the patient is eligible for the yojna then the patient will be directed to the PMJAY Kiosk where the Pradhan Mantri Arogya Mitra (PMAM) will verify the beneficiary’s identity and eligibility using the Beneficiary Identification System (BIS).
If the patient doesn’t have an e-card then his/her e-card (golden record) will be created.
Step 3: Expenses of the Treatment
PMAM informs the beneficiary about the expenses. The beneficiary is informed about amount of charges they may have to bear in case they are not hospitalized e.g. diagnostics (if any) but given other medical treatment.
Step 4: Here the beneficiary is guided by the doctor about his/her disease and treatment.
Step 5: The beneficiary shall be either be prescribed medical drugs or hospitalised in case of severe disease.
Here it need to be kept in the mind that if Beneficiaries are not hospitalised and general medicine is given then he/she will have to pay relevant consultation and drug charges, if applicable.
Step 6: For a beneficiary who has been suggested hospitalization:
a. The beneficiary will avail the diagnostic facility within the Empanelled Health Care Providers (EHCP) or hospital.
b. The hospital or its associated centres will not take money from the beneficiary before the diagnosis.
c. The concerned doctor will provide necessary documents (filled pre-authorization form, diagnostic reports, clinical notes etc.) to the PMAM.
d. The PMAM shall click a picture of the beneficiary / patient on the hospital bed and upload the picture on the Transaction Management System portal for government verification.
e. Once the treatment is completed and the beneficiary is ready to be discharged.
Points to be Noted: The PMAM shall collect the necessary documents such as the discharge summary, clinical notes, medical scans etc. for filing claims.
The PMAM shall click another picture of the beneficiary / patient at the time of discharge and upload the picture on the Transaction Management System portal. A discharge copy can also be given to the patients.
Step 7: Post-discharge, the hospital will provide required medication and diagnostics as per the package for upto 15 days as applicable to the beneficiary.
So in the conclusion it is wise to say that the inception of the Ayushman Bharat Yojana is a very good step in the area of universal health care of the country. This Yojna will not only save many families from being bankrupt but also provide a good treatment to the poor sections of this country.
FAQs on the Ayushman Bharat Yojna
Question 1:- What benefits are available under PM-JAY?
Answer: PM-JAY provides an insurance cover upto Rs. 5 lakh/family/year for secondary and tertiary hospitalization. All pre-existing conditions are covered from day 1 of implementation of PM-JAY in respective States/UTs.
Question 2:- What health services are available under the PM-JAY?
Answer: (PM-JAY) has defined 1,350 medical packages covering surgery, medical and day care treatments including medicines, diagnostics and transport.
The health services include hospitalization expenses, pre and post hospitalization expense benefits, day care surgeries, follow-up care, and new born child/children services etc.
Question 3:- Who is eligible to avail the benefits of the PM-JAY?
Answer: PM-JAY covers more than 10 crore poor and vulnerable families (around 50 cr beneficiaries) across the country.
The beneficiaries of this yojna are deprived rural families and occupational categories of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data.
Every member of a family is covered irrespective of family size, age, gender and seniority.
Question 4:- Will beneficiaries have to pay anything to get treatment from this scheme?
Answer: No. All eligible beneficiaries can avail free services for secondary and tertiary hospital care for identified packages under PM-JAY at public hospitals and registered private hospitals.
Beneficiaries will have cashless and paperless access to health services under PM-JAY.
It is worth to mention that if any patient gets just diagnosis then he has to pay the doctor's fee and medicine expenses as well. So a patient needs to get hospitalised to get the free treatment under this yojna.
Question 5:- What is the enrolment process? Is there any time period for enrolment?
Answer: Ayushman Bharat is an entitlement based mission. There is no enrolment process. Families who are identified by the government on the basis of deprivation and occupational criteria using the socio-economic database both in rural and urban areas are eligible for PM-JAY. In the rural areas the eligible families has already got the card of PM-JAY Yojna.