Benefits of Ayushman Bharat Scheme
Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families
Key Takeaways
- The scheme provides coverage of up to five lakh rupees per family per year for secondary and tertiary care hospitalization.
- Beneficiaries can access nationwide portable, cashless treatment across any empanelled public or private healthcare facilities.
- Treatment payments to empanelled hospitals will be processed on a predefined government package rate basis to control costs.
- The operational system utilizes a robust, modular, scalable, and interoperable IT platform to ensure paperless and cashless transactions.
- Over ten crore poor and vulnerable families are entitled to receive care based on deprivation criteria in the SECC database.
Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization. Ayushman Bharat – National Health Protection Mission will subsume the on-going centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).
Silent Features:
- Ayushman Bharat – National Health Protection Mission will have a defined benefit cover of Rs. 5 lakh per family per year.
- Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
- Ayushman Bharat – National Health Protection Mission will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database.
- The beneficiaries can avail benefits in both public and empanelled private facilities.
- To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis.
- One of the core principles of Ayushman Bharat – National Health Protection Mission is to co-operative federalism and flexibility to states.
- For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister.
- States would need to have State Health Agency (SHA) to implement the scheme.
- To ensure that the funds reach SHA on time, the transfer of funds from Central Government through
- Ayushman Bharat – National Health Protection Mission to State Health Agencies may be done through an escrow account directly.
- In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless transaction.
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Frequently Asked Questions
How are hospital treatments reimbursed under the Ayushman Bharat scheme?+
To control costs, payments for treatment will be done on a package rate basis, which will be defined by the Government in advance. Empanelled private and public hospitals provide cashless benefits to eligible beneficiaries, with transactions facilitated through an interoperable IT platform established in partnership with NITI Aayog for cashless and paperless administration.
What level of care and coverage amount does the scheme support for patients?+
Ayushman Bharat provides a defined benefit cover of up to five lakh rupees per family per year. This coverage is specifically designed for secondary and tertiary care hospitalization, allowing eligible beneficiaries to receive necessary medical care without out-of-pocket expenses at both public facilities and empanelled private hospitals across the country.
Can patients from other states receive cashless treatment at our empanelled hospital?+
Yes, the benefits of the Ayushman Bharat scheme are portable across the country. A beneficiary covered under the scheme is allowed to take cashless benefits from any public or private empanelled hospital across India, ensuring patients can access covered secondary and tertiary healthcare services regardless of their home state.
Which existing government health insurance schemes are subsumed by Ayushman Bharat?+
Ayushman Bharat – National Health Protection Mission subsumes two on-going centrally sponsored schemes, which are the Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS). The unified mission provides expanded coverage to over ten crore poor and vulnerable families for secondary and tertiary care hospitalization.
What IT infrastructure supports claims and transactions for empanelled hospitals?+
In partnership with NITI Aayog, a robust, modular, scalable, and interoperable IT platform will be made operational for the scheme. This system will entail a paperless and cashless transaction process, facilitating efficient service delivery and administration for empanelled public and private hospitals managing secondary and tertiary care hospitalization treatments.
Written by
I&D Team
Healthcare Consulting Team
The I&D Hospital Solution team helps hospitals across India with empanelment, NABH accreditation, TPA tie-ups, hospital setup and growth consulting.