Are you eligible for PM Modi’s Ayushman Bharat health insurance? Check benefits, eligibility criteria

Since the scheme is meant only for poor and economically-deprived people, not everyone is eligible to get free medical insurance under Ayushman Bharat scheme.

During his Independence Day speech from Red Fort, Prime Minister Narendra Modi today announced that Pradhan Mantri Jan Arogya Abhiyaan, also known as Ayushman Bharat or the National Health Protection Mission (AB-NHPM) or Modicare, will be launched on 25 September. The government-sponsored health insurance scheme will provide free coverage of upto Rs 5 lakh per family per year at any government or even empanelled private hospitals all over India.

However, since the scheme is meant only for poor and economically-deprived people, not everyone is eligible to get free medical insurance under Ayushman Bharat scheme. Modicare will be available for 10.74 crore beneficiary families and about 50 crore Indian citizens.

Key features of Ayushman Bharat scheme:

1. Once rolled out across the country, Ayushman Bharat will provide a cover of Rs 5 lakhs per family per year for secondary and tertiary medical care facilities.

2. If you are eligible under the health insurance scheme, you get automatic coverage. Eligibility is based on Socio-Economic Caste Census (SECC) database.

3. In case of hospitalization, you or your family members do not need to pay anything under the scheme provided you go to any government or empanelled private hospital.

4. Ayushman Bharat is unlike other medical insurance schemes where there is a waiting period for pre-existing diseases. All kinds of diseases are covered from day one of the Ayushman Bharat policy. The benefit cover includes both pre and post hospitalization expenses.

5. Having an Aadhaar card is not mandatory to avail of Ayushman Bharat benefit but beneficiaries need to carry a prescribed ID to receive free treatment at the hospital.

Eligibility criteria for Ayushman Bharat scheme:

In rural areas:

1.Families living in only one room with “kuchcha walls and kuchcha roof”

2.Families with no adult members aged between 16 and 59

3.Female-headed family with no adult male member in the 16-59 age group

4.Families having at least one disabled member and no able-bodied adult member

5.SC/ST households

6.Landless households deriving major part of their income from manual casual labour

7.Destitutes and those surviving on alms

8.Manual scavenger families

9.Primitive tribal groups

10.Legally-released bonded labourer

In urban areas:

The government has made a list of these 11 occupational categories of workers who are automatically included in the list:

1.Rag picker

2.Beggar

3.Domestic worker

4.Street vendor/cobbler/ hawker/ other service provider working on streets

5.Construction worker/ plumber/ mason/ labour/ painter/ welder/ security guard/ coolie and other head-load workers

6.Sweeper/ sanitation worker / gardener

7.Home-based worker/ artisan/ handicrafts worker / tailor

8.Transport worker/ driver/ conductor/ helper to drivers and conductors/ cart puller/ rickshaw puller

9.Shop worker/ assistant/ peon in small establishment/ helper/ delivery assistant / attendant/ waiter

10.Electrician/ mechanic/ assembler/ repair worker

11.Washer-man/ chowkidar