Pradhan Mantri Ayushman Bharat Yojana Benefits, Features, Inclusions and Exclusions Under PMABY

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Updated on Oct 07, 2022

What is Pradhan Mantri Ayushman Bharat Yojana (PMABY)?

Pradhan Mantri Ayushman Bharat Yojana was launched by PM Narendra Modi on 23 September 2018. Are you aware of its various features and benefits? Read on to know more.

Pradhan Mantri Ayushman Bharat Yojana aka Pradhan Mantri Health Insurance was initiated by the government of India with the aim to help limit the expensive medical costs in the country and to provide healthcare facilities to over 6 Crore Indians. A health card called Ayushman Card is provided to the insured under the Ayushman Bharat Yojana, which serve as a proof of eligibility of the insured to avail treatment under this scheme.

Under the Ayushman Bharat Yojana, health insurance cover of 5 lakh rupees is presented to every eligible family in the country. This scheme covers over 50 crore Indians from poor families with facilities of secondary and tertiary hospitalization under ayushman bharat card benefits.

The eligibility criteria of Ayushman Bharat Yojana is segregated among families in villages and cities as per their occupation and level of income based on 2011 Census.

Another section under the Ayushman Bharat Scheme is the Pradhan Mantri Jan Arogya Yojana (PM-JAY), which was launched by PM Narendra Modi in Ranchi, Jharkhand on September 23, 2018. The aim of this Yojana was to mitigate the cost of expensive medical facilities, which drive over 6 Crore people of the country towards poverty every year.

Know More : Saral Jeevan Bima – Coverage, Benefits and Eligibility

Features of Pradhan Mantri Ayushman Bharat Yojana (PMABY)

Below are the Ayushman Card Facilities that an insured family can avail:

  • This is a Govt. of India financed medical insurance scheme.
  • The scheme allow coverage to over 1,393 medical procedures
  • Some of the protection available under this scheme are:
    1. Cost of treatment
    2. Room rent charges
    3. Physician fee
    4. OT charges
    5. ICU charges
    6. Diagnostic facilities charges
    7. Surgeon’s costs etc.
  • Pre and post hospitalization cover of 3 days and 15 days respectively is also included under this scheme including the cost of medicines and diagnostics.
  • Cover of up to 5 Lakh Rupees is allowed under this plan.
  • The plan covers both secondary and tertiary hospitalization care.
  • Both private and government hospitals in India can be availed under this plan for treatment.
  • The facility of cashless hospitalization is also available.
  • There is no constraint of age, size of the family, or gender under this scheme.
  • Unlike in other private schemes, the Ayushman Card allows coverage to pre-existing diseases from the first day onwards.
  • This scheme allows PAN India benefits with cashless facility in any private or government hospital listed under the panel of hospitals across the country.

>> Secure Your Family Health with Family Floater Insurance Policy

Benefits of Pradhan Mantri Ayushman Bharat Yojana (PMABY) Health Card

Unlike in other government schemes where the cover limit is less, the Ayushman Health Card offers a higher coverage amount of 5 lakh rupees.  The scheme also offers cashless treatment facilities in private and government hospitals across India that are enlisted under the panel of hospitals of this scheme. The sum insured under this scheme covers both secondary and tertiary care.

You can get compensated for the below medical treatment costs that you incur under the Ayushman Bharat Yojana benefits as mentioned below:

  • Doctor consultation, treatment as well as medical examination fee.
  • Pre-hospitalization charges for 3 days.
  • Charges of Post-hospitalization care for up to 15 days.
  • Charges of diagnostic treatments and lab examinations.
  • Medicine costs covered.
  • Medical consumable costs covered.
  • Both intensive and non-intensive care facilities are covered.
  • Coverage of accommodation assistance is offered.
  • If required, medical implantation services are covered.
  • Covers food services.
  • Covers any complications that result from treatment.

The above are some of the Ayushman Health Card benefits that can be availed by the insured families under the scheme.

Also Read: What is Pradhan Mantri Atmanirbhar Swasth Bharat Yojana (PMASBY) Scheme?

Critical Illness Coverage under the Pradhan Mantri Ayushman Bharat Yojana (PMABY)

The critical illness cover under the Ayushman card benefits allow families to access healthcare facilities:

The following are the various Critical illnesses that are covered under this scheme:

  • Prostate cancer
  • Coronary ABG
  • Double valve replacement
  • Skull base surgery
  • Carotid angioplasty with stent
  • Anterior spine fixation
  • Tissue expander for disfigurement in case of burns
  • Pulmonary valve replacement
  • Laryngopharyngectomy

Exclusions of Ayushman Bharat (PMABY) Health Scheme 

Below are some of the exclusions of the Ayushman Bharat benefits that you cannot avail:

  • Doesn’t cover drug rehabilitation
  • Doesn’t cover OPD expenses
  • Doesn’t cover organ transplantation
  • Doesn’t cover cosmetic procedures
  • Doesn’t cover fertility treatment

To Conclude

The best benefits of Ayushman Card is that it has no capping related to age or number of members insured. The sum insured available under this scheme is 5 lakh rupees that can be availed on a family floater basis under a single plan. The insured families can avail cashless hospitalization cover under this plan. Since, the plan cover pre-existing diseases without any waiting period, so anyone suffering from health issues can avail treatment from the day of enrolment under the scheme.

Found this post informational? Browse PayBima Blogs to read interesting posts related to Health Insurance, Car Insurance, Bike Insurance, Term Life Insurance and Investment section. You can visit PayBima to Buy Insurance Online.

Apr 22, 2022
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