With a broken and overburdened government healthcare system losing the trust of people in offering reliable diagnoses, Indians started flocking to much costlier private hospitals long back. Rich and Middle-Class can afford them, but it's the poor and needy who have to resort to loans and get entangled in a debt cycle, in search of a reasonable medical solution.
The PMJAY Ayushman Bharat Scheme is basically a medical insurance scheme - the largest in the world - paid for by the government for the poor and needy of this country. They can use this card to pay for their medical bills - up to 5 lakhs per year per family - without really spending a penny from their account. The whole expense will be borne by the government.
Ayushman Bharat Yojana - launched in 2018 - aims to cover more than 50 crore Indian citizens.
Recently, PM Modi distributed 50 lakh Ayushman PVC cards to beneficiaries in Gujarat bringing the scheme once again in media focus. Let's take this opportunity forward to know the ins and outs of this scheme in the context of both the national and the state of Gujarat.
History of Pradhan Mantri Jan Aarogya Yojana
As the then Chief Minister of Gujarat, Narendra Modi had started the "Mukhyamantri Amrutam (MA)" scheme in 2012 to protect poor citizens from the catastrophic costs of medical treatment and illness. In the year 2014, 'MA' Yojana was extended to cover those families who are having an annual income limit of Rs. 4 lakh. Later, this scheme was extended to several other groups as well. The scheme was rebranded as Mukhyamantri Amrutam Vatsalya (MAV) Yojana.
Drawing from the experience of the success of the scheme, Prime Minister launched the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) at a national scale in 2018. It was and still is the largest health insurance scheme in the world providing coverage of up to Rs. 5 lakh per family per year, for primary, secondary and tertiary care hospitalization without any cap on the family size and age.
With the launch of the Ayushman Bharat PMJAY, Gujarat integrated its already existing MA/MAV Yojana with the Ayushman Bharat scheme in 2019 changing its name to PMJAY-MA Yojana. And the beneficiaries of all three were integrated by issuing them co-branded cards under PMJAY-MA.
Some 1.58 crore PMJAY-MA cards have so far been issued in the state of Gujarat.
The difference between PMJAY and PMJAY-MA Scheme
- PMJAY Scheme is known as PMJAY-MA (Mukhyamantri Amrutum) Yojna in Gujarat.
- Though originally intended for below-poverty-line families, this plan was later modified to include lower-middle-class families in the state.
- Mukhyamantri Amrutum Vatsalya Yojana is the modified cover that includes more families in its ambit.
Eligibility: Who are eligible for the PMJAY-MA (Mukhyamantri Amrutum) Yojna
The following eligibility criteria must be met in order to get benefits under Mukhyamantri Amrutum Yojana:
- The total annual income of the beneficiary must be less than Rs.2.5 lakh.
- It is a must to have an income certificate before subscribing to this scheme.
- This cover can be taken for self, spouse, and three dependent children.
List of other Beneficiaries Included in the Scheme:
Apart from families below the poverty line and low-income families, a few more beneficiaries were added to the scheme. Here are the new additions to the scheme:
- In 2016, U-win card holders were also permitted to avail of the benefits under the scheme.
- In the FY 2017-18, fixed-pay state government employees of Class 3 and Class 4, reporters, and rural as well as urban Accredited Social Health Activists (ASHAs) were added as beneficiaries.
- Senior citizens whose families' income is within Rs.6 lakh are also included.
Prominent Features of Mukhyamantri Amrutum Yojana
- The scheme offers a sum insured amount of Rs.3 lakh on a floater basis.
- Five members of a family can avail of the benefits under this scheme.
- There is no cost incurred by beneficiaries as this is a 100% government-funded scheme.
- A quick response coded card (QR-coded card) is issued to families that avail coverage under this scheme.
- Since this is not an insurance policy, there are no intermediaries involved in the coverage process. The state government transfers the benefit amount through RTGS.
- Complete cashless coverage can be obtained under this scheme as the government bears all costs including treatment expenses, follow-up consultation, medicines, transportation etc.
- The claim is settled on a paperless basis to make the claim settlement faster.
What are the hospitals we can avail this scheme in?
- The hospitals partnering with this scheme include private hospitals, government hospitals, and standalone dialysis centres.
Is there any specific time frame for enrollment in this scheme?
- Absolutely Not! You can sign up for this cover at any time of the year.
Where to Enroll for this Scheme?
- Civic Centre kiosks and Taluka kiosks have been set up for the beneficiaries so that they can enrol themselves or make any additions or deletions under the scheme.
- Mega health camps and General Health camps are set up by public and private hospitals - enlisted under this scheme - from time to time for public enrollment.
Any particular medical expense excluded from this scheme?
- Not really. This scheme covers all reasonable medical expenses incurred by the beneficiary and his/her family.
- However, certain things like cosmetic treatments or non-emergency procedures - deemed to be a privilege of the rich - may not be covered under this scheme.
How to Claim the Amount under Mukhyamantri Amrutum Yojana?
PMJAY MA or Mukhyamantri Amrutum Yojana comes with a completely cashless process for all expenses involved in hospitalisation. Once a diagnosis is made, the network hospital will seek pre-authorisation for the treatment. The beneficiary must provide the identity card issued at the time of subscribing to this cover. The hospital will proceed with the treatment after approval is obtained.
Once the treatment is over, the hospital will forward all the documents including medical bills, discharge summary, physician certificate, etc. to the company. For a smooth and transparent transaction, the claim amount is settled by transferring the amount through RTGS.
Awards Won by the Mukhyamantri Amrutum Yojana
There are several awards that the Mukhyamantri Amrutum Yojana has won. Some of these are as follows:
- SKOCH Awards for Smart Governance 2014
- CSI-Nihilent e-Governance Awards 2013-14
- Best Affordable Healthcare Initiative in the Healthcare summit 2016 at Jaipur
- 'Gems of Digital' India Award
- 'Best Accessible Healthcare Initiative' by ELETS