On September 23, 2018, India’s Prime Minister, Mr. Narendra Modi, launched the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (PM-JAY), the world’s largest health insurance scheme with the aim to provide accessible and affordable healthcare.
People eagerly visited banks, post offices, and other government centers for information, only to be confused and unclear. Today, the scenario remains much the same. Even the government’s helpline often redirects people to their nearest Common Service Center (CSC) regardless of whether it is functional.
If you are struggling to apply for your Ayushman Bharat card or find clear information, then read this blog to learn everything you need to know about eligibility, enrollment, and how to make the most of this scheme.
Table of Contents
What is Ayushman Bharat Jan Aarogya Yojana (AB-PMJAY)
Ayushman Bharat, also known as Pradhan Mantri Jan Arogya Yojana (PM-JAY), was launched in 2018 by Prime Minister Narendra Modi. It is the world’s largest health insurance scheme, aiming to provide a health cover of ₹5 lakhs per family annually.
Which type of health expenses are covered under Ayushman Bharat scheme
The expenses include medical consultation and treatment, pre-hospitalization services, intensive and non-intensive care, medication and medical consumables, diagnostic and laboratory tests, accommodation, medical implants when necessary, and post-hospital expenses for up to 15 days.
Medical expenses that are not covered under PMJAY
The following medical expenses are not covered under PMJAY:
- Outpatient Department (OPD) services
- Addiction treatment
- Cosmetic procedures
- Fertility treatments
- Organ transplants
- Unnecessary diagnostics
- Medical equipment expenses
If you want to know whether you are eligible for the scheme or not, then this drives us too……..
Who can benefit from the Ayushman Bharat scheme?
One of the most common questions about the scheme is, “Who is eligible?” The government has defined eligibility criteria based on geographical location (urban or rural) and age (70 and above). A key eligibility set by the government is that a family’s income should not exceed 2.5 lakh per annum. When the government talks about “family,” it doesn’t count senior citizens when looking at income limits. Let’s take a closer look at these categories one by one.
Let’s begin with the eligibility criteria for senior citizens under the scheme:
- All senior citizens aged 70 and above, regardless of their socioeconomic status, are eligible.
- A senior citizen with private health insurance can still benefit from the scheme in addition to their existing coverage.
- Government pensioners can choose between their existing health benefits provided by the government or switch to the Ayushman Bharat scheme.
Let us take a look at the eligibility criteria for people in rural areas:
- An individual who falls under the Scheduled Caste or Scheduled Tribe category.
- Beggars and those surviving on alms.
- A family with no members between the ages of 16 and 59.
- Families have at least one physically challenged member and no able-bodied adults.
- Landless households that make a living by working as casual manual laborers.
- Primitive tribal communities.
- Legally released bonded laborers.
- Manual scavenger families.
Eligibility criteria for people in urban areas:
A person living in an urban area works as a:
- Washerman/watchman
- Rag pickers
- Mechanics, electrici6ans, repair workers
- Domestic help
- Sanitation workers, gardeners, sweepers
- Hoem-based artisans or handicraft workers, tailors
- Cobblers, hawkers and other service provided on street pavements
- Plumbers, masons, construction workers, porters, welders, painters and security guards
- Transport workers like drivers, conductors, helpers, cart or rickshaw pullers
- Assistants, peons in small establishments, delivery boys, shopkeepers and waiters
While the grass may always seem greener on the other side, it’s important to also consider the challenges that come with it. One such challenge is………..
Limitations in the Eligibility Criteria of Ayushman Bharat
Here are some key limitations:
- This scheme will only aid families recorded in the below poverty line data of the Socio-Economic Census of 2011 or households enrolled under the Rashtriya Swasthya Bima Yojana (RSBY). Currently we are near the end of 2024, how reliable is 13 year old data?
- Even if an older person can afford private health insurance, Ayushman Bharat can still be applied. With government debt reaching an all-time high, this coverage is a liability for future generations.
- The definition of a senior citizen covers individuals aged 60 years and above, yet the scheme limits benefits to those 70 years or older. Why are those aged 60-69 systematically excluded from this essential healthcare support?
- What if a disabled person from a low-income family who studied hard, joined a big MNC, and now earns crores is still eligible for the Ayushman Bharat scheme? Decades-old census data should not be used for eligibility.
After going through the eligibility criteria, if you believe you qualify for the scheme, and your name should be on the portal, this takes us to…
How to check your name on the PMJAY portal for an Ayushman card
To check your name and your family’s name on the Ayushman Bharat portal, follow the steps outlined below: if you think you are eligible for an Ayushman card then you can check your eligibility in the following ways:
- Go to https://www.pmjay.gov.in/
- Click on the “Am I Eligible” button.
- You will find a white box in the right corner.
- Enter the captcha and your mobile number in the respective fields. You will see the “Verify” text highlighted in purple; click on it.
- After clicking on “Verify,” you will receive an OTP on your mobile. Enter the OTP and captcha, then click on the highlighted purple “Login” button.
- In the next step, you will be directed to a new page where you need to select your state and choose the appropriate sub-category. The sub-category is based on your employment type (such as ASHA, Anganwadi worker, helper, or government employee), and if you belong to a special category (like Deen Dayal Upadhyaya, tribal, etc.), select the relevant option.
If your family’s details are not found on the Ayushman Bharat portal, you’ll need to await the next census update for potential inclusion. Once your name appears on the portal, you can easily download your Ayushman card by following a few simple steps:
- Click on the download icon under the ‘Action’ column to download the Ayushman card of any family member.
- Your Aadhaar number will be displayed on the screen. Click on the “Verify” tab to proceed.
- A consent form will be displayed. Check the box at the bottom of the form, then click on the ‘Allow’ tab to proceed.
- Click on ‘Authentication Mode’ and select ‘Aadhaar OTP’. You will receive an OTP on your registered mobile number. Enter the OTP and fill in the necessary details.
- You will be directed to the download card page, where you can select the family member’s card you wish to download. Then, click on the ‘Download’ tab.
If these steps are too complicated, you can download your card from a nearby Common Service Center, which brings us to…
How to find a Common Service Center (CSC)?
Individuals can also visit centers called Common Service Centers (CSCs). These are physical facilities that serve as access points for delivering digital and electronic government and private services to citizens.
The irony is that to check for a CSC, you need to search for the center online. Below is a step-by-step guide on how to search.
- You can simply Google ‘CSC locator’ or click on the link: https://locator.csccloud.in/
- This will take you directly to the CSC page.
- Fill in the required details and click the ‘Search’ button.
- A list of CSC centers will appear, with their addresses displayed next to their names.
Limitation of CSC
- Unfriendliness to Old People: Older or illiterate people cannot use this website, which increases the risk of them falling victim to scams.
- Unclear CSC Address: The portal lacks a clear address for Common Service Centers, which complicates locating these centers.
- Qualification for CSC: To obtain a CSC ID, individuals are required to complete a Telecentre Entrepreneur Course (TEC) and pass an online test. However, since both the course and the test are conducted online, it raises concerns about the validity of their qualifications and whether these individuals are genuinely literate, as there have been many real-life incidents where individuals running CSCs have entered incorrect details.
- CSC Charges: Despite the scheme being free to enroll, service centers charge fees from customers and may potentially treat customers rudely.
How to apply for an Ayushman card
If you are a senior citizen aged 70 or above and do not have an Ayushman Bharat card, you can follow these steps to obtain one:
- Visit the Beneficiary Identification System (BIS) website at https://beneficiary.gov.in/
- You will be directed to the following page
- Enter the captcha and your mobile number in the respective fields. You will see the “Verify” text highlighted in purple; click on it.
- After clicking on “Verify,” you will receive an OTP on your mobile. Enter the OTP and captcha, then click on the highlighted purple “Login” button.
- After logging in you will be directed to a new page, you will find a click here to enroll button click on the button
- You will be directed to a new page. Enter your Aadhaar number and the captcha, and the search button will appear. After filling in the details, click on the search button.
- After this, you will see a ‘Click Here’ link in blue font. Click on it.
- You will be directed to a new page where you will need to complete your e-KYC. Enter your Aadhaar number and verify it. Next, a consent form will appear in both Hindi and English. Read it carefully and click on the ‘Allow’ button.
- An OTP will be sent to your mobile. Enter the OTP in the respective field. After that, a declaration will appear on your screen. Select the scheme you are a beneficiary of; if none applies, you can click on ‘None of the Above’ and then click on ‘Proceed’.
- You will now be directed to a new page where you will need to capture your picture and fill in the necessary details, such as your mobile number, category, area pin code, district, and whether you live in a rural or urban area.
- In the next section, enter the details of your family members. If you don’t have any family members to add, you can click on the respective icon. If you do, fill out the necessary details. After that, click on ‘Submit’. You will then be shown your enrollment status.
Limitation of the Ayushman Bharat scheme and its impact
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a groundbreaking healthcare initiative with significant potential, yet it faces notable challenges that affect the public.
Let’s explore the key impacts and challenges of this healthcare scheme:
Beneficiary
- Since this scheme does not cover outpatient department (OPD) services, it can be difficult for economically disadvantaged individuals to pay out-of-pocket every time. While 40% of India’s population is covered under this scheme, a report shows that India has the highest percentage of out-of-pocket healthcare expenses, nearly 35%.
- Verifying accounts becomes a major challenge, especially with a poorly designed website. They often need assistance to navigate the process, and the support is frequently inadequate!
- Fraudulent practices, such as doctors unnecessarily prescribing medications or treatments and private hospitals conducting unnecessary procedures without medical audits, are common.
Taxpayer
- Private hospitals often engage in double billing—charging patients for services already covered under insurance—thereby increasing the financial burden on taxpayers each year and looting the beneficiary.
- Many individuals are also paying out-of-pocket for outpatient services, raising the question of how much funding has been allocated to the scheme and how much is being used for the benefit of individuals.
- Fraudulent practices, such as doctors unnecessarily prescribing medications or treatments and private hospitals conducting unnecessary procedures without medical audits, are common.
- Additionally, people may assume that the government is covering the costs, which leads them to overlook whether hospitals are charging excessively, allowing these scams to go unnoticed. More healthcare, but with limited results.
Societal impact
- The scheme does not specify the number of family members eligible to apply. A report by the Comptroller and Auditor General of India (CAG) revealed that 7.5 lakh beneficiaries were linked to a single phone number under the health scheme, with some even being associated with the number 9000000000. This raises concerns about potential corruption.
- Even if you aren’t paying income-tax, all those indirect GST taxes you pay on nearly everything, go into the scheme to get scammed.
Conclusion
The Ayushman Bharat scheme is a benevolent step toward improving healthcare access for India’s most vulnerable populations. While its ambitious vision includes comprehensive health coverage, there are areas where it falls short.
One limitation of the Ayushman Bharat scheme is its exclusion of medication expenses. While the government introduced Jan Aushadhi with the vision of providing affordable medicines to every citizen of India, this vision has been diluted due to incompetence and corruption. As a result, many Jan Aushadhi medicines fail to meet CDSCO’s quality standards. Don’t fall into the trap of blindly choosing between Jan Aushadhi or branded medicines. Empower yourself by asking for a medicine test report. At SayaCare, we uphold the same vision of affordable healthcare by offering generic medicines at upto 80% off that are first tested in NABL-certified laboratories and then delivered to you. We are here to support and educate you every step of the way.
Additionally, while the scheme aims to provide seamless access to benefits, there is a need for greater clarity regarding eligibility criteria and the application process. To bridge this gap, SayaCare provides a simple, one-page guide to help users easily navigate eligibility checks and the application process for Ayushman Bharat cards.
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