Changing healthcare system of India- Ayushman Bharat health scheme

Considered as a game changer in the field of health care program covering more the 50 crores of the beneficiaries

Words by: Aabha Tiwari


Ayushman Bharat- Pradhan Mantri Jan Aayogya Yojna (AB-PMJAY) or Modicare is the largest government-funded health care program, aims to aid the unprivileged section of the country. This scheme funds an annual health cover of ₹ 5 lakh per annum over a spectrum of 100 million families targeted, belonging to the poor and vulnerable sections of the population who are susceptible to the diseases and devoid of medical facilities. The funding for such families is based on socio-economic caste, implemented by the ministry of health and family welfare. The funding is aided majorly by central government (60%) and remaining 40% by the state. This scheme is non-selective in terms of the number of members of the family. The annual health cover fund will allow beneficiaries to redeem the benefits cashless from either public or private empanelled hospitals in India.
As per the survey conducted by the ministry of health, more than 70% of the population of the rural household and 80% of the urban households have no access to health care insurance and benefits. Due to rise in the cost of the medical facilities and jumbled paperwork, people belonging to the unprivileged sectors find it difficult to access such medical aid, during the time of need. This scheme of Ayushman Bharat intends to change the scenario of the health care system of the country.

Key Features of AB-PMJAY Scheme
– Launched on 25th September 2018, it will roll out a cover of ₹5 lakhs per family for the secondary and tertiary level of medical care facilities.
– If eligible, based on the SECC database, the coverage will be automatic under the health-care scheme.
– In the case of hospitalisation, there will be no paperwork under public and empanelled private hospitals.
– All kinds of diseases are covered from day one in the policy, unlike other medical insurance where there is a waiting period for the pre-existing diseases. The benefits cover both pre and post hospitalisation expenses.
– Aadhar card is not mandatory in the process.
Eligibility criteria in Rural and Urban areas
– Families living in only one room in slums (kuchcha walls and roof)
– Female head family with no adult member (between age 16 and 59). Disabled and no able-bodied member.
– Primitive tribal, SC/ST household.
– Landless households, destitute and legally released bonded labourer.
11 Occupational categories of workers who are automatically included in the list:
– Ragpicker/Beggar/street hawker or other service providers on the streets
– Domestic worker
– Construction worker/plumber/ painter/welder/security guard and other head load workers.
– Sweeper/sanitation worker/gardener
– Transport workers/conductor/driver helpers/rickshaw pullers