Atal Ayushman Yojana {अटल आयुष्मान योजना}

Atal Ayushman Yojana {अटल आयुष्मान योजना}

Updated on Jun 02, 2020

Atal Ayushman Yojana could also be a neighbourhood of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, the Indian government's National Health Policy which aims to provide free health coverage at the secondary and tertiary level to its bottom 40% poor and vulnerable population. Pradhan Mantri Jan Arogya Yojana is the world's most massive and fully state-sponsored health assurance scheme which covers a population of the combined size of USA, Mexico and Canada. It was launched in September 2018, under the aegis of Ministry of Health and Family Welfare in India. 

Objectives of Atal Ayushman Yojana

The primary objective of Atal Ayushman Yojana scheme is to provide healthcare to 10 crore families, who are mostly poor and have lower middle income, through a health insurance scheme providing a cover of Rs. 5 lakh per family. The 10 crore families comprise 8 crore families in rural areas and 2.33 crore families in urban areas. Broken into smaller units, this suggests the scheme will aim to cater to 50 crore individual beneficiaries.

However, the scheme has certain pre-conditions by which it picks who can avail of the health cover benefit. While in the rural areas the list is mostly categorised on lack of housing, meagre income and other deprivations, the urban list of Atal Ayushman Yojana beneficiaries is drawn up based on occupation.

Implementation

Atal Ayushman Yojana plans to make secondary and tertiary healthcare completely cashless. The Atal Ayushman Yojana beneficiaries get an e-card that can be used to avail services at an empanelled hospital, public or private, anywhere in the country. With it, you'll walk into a hospital and acquire cashless treatment.

The coverage includes 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses. Moreover, around 1,400 procedures with all related costs like OT expenses are taken care of. All in all, Atal Ayushman Yojana and the e-card provide a coverage of Rs. 5 lakh per family, per year, thus helping the economically disadvantaged obtain quick access to healthcare services.

Illness Coverage

Some of the critical illnessess covered are : 

1) Prostate cancer

2) Coronary artery bypass grafting

3) Double valve replacement

4) Carotid angioplasty with stent

5) Pulmonary valve replacement

6) Skull base surgery

7) Laryngopharyngectomy with gastric pull-up

8) Anterior spine fixation

9) Tissue expander for disfigurement following burns

Some of the illnesses that are excluded are :

1) OPD

2) Drug rehabilitation programme

3) Cosmetic related procedures

4) Fertility related procedures

5) Organ transplants

6) Individual diagnostics(for evaluation)

Criteria for Rural people

The 71st round of the National Sample Survey Organisation reveals that a staggering 85.9% of rural households don't have access to any healthcare insurance or assurance. Additionally, 24% of rural families access healthcare facilities by borrowing money. Atal Ayushman Yojana's aim is to help this sector avoid debt traps and avail services by providing yearly assistance of up to Rs. 5 lakh per family. The scheme will come to the help of economically disadvantaged families as per data within the Socio-Economic Caste Census 2011. Here too, households enrolled under the Rashtriya Swasthya Bima Yojana (RSBY) will come under the ambit of the PM Jan Arogya Yojana.

In rural areas, people who can avail the Atal Ayushman Yojana's health cover are : 

1) Those living in scheduled caste and scheduled tribe households.

2) Families with no male member aged 16 to 59 years.

3) Beggars and those who are surviving on alms.

4) Families with no individuals aged between 16 and 59 years.

5) Families having a minimum of one physically challenged member and no able-bodied adult member.

6) Landless households who make a living by working as casual manual labourers.

7) Primitive tribal communities.

8) Legally released bonded labourers.

9) Families living in one-room makeshift houses with no proper walls or roof.

10) Manual scavenger families.

Criteria for Urban People

According to the National Sample Survey Organisation (71st round), 82% of urban households don't have access to healthcare insurance or assurance. Further, 18% of Indians in urban areas have addressed healthcare expenses by borrowing money in one form or the opposite. Atal Ayushman Yojana helps these households avail healthcare services by providing funding of up to Rs. 5 lakh per family, per year. Atal Ayushman Yojana will benefit urban workers' families in the occupational category present as per the Socio-Economic Caste Census 2011. Further, any family enrolled under the Rashtriya Swasthya Bima Yojana will benefit from the Atal Jan Ayushman Yojana as well.

In urban areas, people who can avail Atal Ayushman Yojana's health cover are : 

1. Washerman/chowkidars

2. Ragpickers

3. Mechanics, electricians, repair workers

4. Domestic help

5. Sanitation workers, gardeners, sweepers

6. Home-based artisans or handicraft workers, tailors

7. Cobblers, hawkers and others providing services by working on streets or pavements

8. Plumbers, masons, construction workers, porters, welders, painters and security guards

9. Transport workers like drivers, conductors, helpers, cart or rickshaw pullers

10. Assistants, peons in small establishments, delivery boys, shopkeepers and waiters

People who are not entitled to availing the Atal Ayushman Yojana's Health Cover are : 

1. Those who own a two, three or four-wheeler or a motorised fishing boat

2. Those who own mechanised farming equipment

3. Those who have Kisan cards with a credit limit of Rs.50000

4. Those employed by the government

5. Those who work in government-managed non-agricultural enterprises

6. Those earning a monthly income above Rs.10000

7. Those owning refrigerators and landlines

8. Those with decent, solidly built houses

9. Those owning 5 acres or more of agricultural land

Finances of Medical Packages and Hospitalization

The Rs. 5 lakh insurance cover provided by the Atal Ayushman Yojana scheme is enough to cover both the medical and surgical treatments in 25 specialities among which are cardiology, neurosurgery, oncology, paediatrics, orthopaedics, etc. However, medical and surgical expenses can't be reimbursed simultaneously.

If multiple surgeries are necessary, the highest package cost is paid for in the first instance, followed by a 50% waiver for the second and a 25% discount for the third. Unlike other health insurance schemes, there is no waiting period for pre-existing diseases which comes under the larger umbrella scheme of Ayushman Bharat Yojana.

The cashless treatment and hospitalisation is formed possible thanks to a 60:40 cost-sharing agreement between the Centre and states. Once identified as a real beneficiary, you or your loved one are going to be issued a health card by specially trained Ayushman Mitras.

Application Process

 Atal Ayushman Yojana applies to all beneficiaries as identified by the SECC 2011 and those who are already part of the RSBY scheme. To apply for the same, you have to follow specific steps simply. They are : 

1) (a) Visit https://www.pmjay.gov.in/ and

1) (b) Click on 'Am I Eligible'.

2) Enter your mobile number and the CAPTCHA code and click on 'Generate OTP'.

3) Then select your state and search by name/ HHD number/ ration card number/ mobile number

Based on the search results you can verify if your family is covered under Atal Ayushman Yojana -

Alternatively, to know if you are eligible for Atal Ayushman Yojana you can approach any Empanelled Health Care Provider (EHCP) or dial the Ayushman Bharat Yojana call centre number: 14555 or 1800-111-565.

Atal Bharat Yojana Card Generation 

Once you are eligible for the Atal Ayushman Yojana's benefits, you can work towards getting an e-card. Before this card is issued, your identity is verified at an Atal Ayushman Yojana kiosk with the help of a document like your Aadhaar card or ration card. Family identification proofs which will be produced include a government certified list of members, PM letter and an RSBY card. Once the verification is completed, the e-card is printed alongside the unique AB-PMJAY ID. You can use this as proof at any point in future.

Frequently Asked Questions

Q. What benefits are available under Atal Ayushman Yojana?

Atal Ayushman Yojana provides an insurance cover upto Rs 5 lakh per family, per year for secondary and tertiary hospitalisation. All pre-existing conditions are covered from day 1 of implementation of PM-JAY in the respective States/UTs.

Q. What health services are available under Atal Ayushman Yojana?

The health services covered under the programme include hospitalisation expenses, daycare surgeries, follow-up care, pre and post hospitalisation expense benefits and new child/children services. The comprehensive list of services is out there on the web site.


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WRITTEN BY Varsha Verma

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