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Thursday, August 16, 2018

What is Ayushman Bharat 5.00 lakhs medical scheme? No Fees, Charges or Premiums

Ayushman Bharat National Health Protection Mission is a defined annual benefit cover of Rs. 5.00 lakh per family to over 10 crores of  poor, deprived rural families and identified  occupational categories of urban workers’ families as per the latest Socio  Economic Caste Census (SECC) data, both rural and urban and existing RSBY Beneficiary Families. The benefit cover will be able to take care of almost all secondary care and most of tertiary care procedure. The launch of AB-NHPM, the existing Rashtriya Swasthya BimaYojana (RSBY) and Senior Citizen Health Insurance Scheme (SCHIS) being implemented by States will be subsumed in Ayushman Bharat. The States / Uts no needs to charge any Beneficiary Family Unit or any of the Beneficiaries as any separate fees, charges, commission or premium, by whatever name called, for providing the benefits under AB-NHPM. However, the aforesaid provision shall not be applicable, if in case, the beneficiary is required to take treatment above the amount of benefit cover of Rs.5.00 Lakhs respectively. The AB-NHPM will cover medical and hospitalization expenses for almost all secondary care and most of tertiary care procedures. AB-NHPM has defined 1,350 medical packages covering surgery, medical and day care treatments including medicines, diagnostics and transport. To ensure that nobody is left out (especially girl child, women, children and elderly), there will be no cap on family size and age in the Mission. The scheme will be cashless & paperless at public hospitals and empanelled private hospitals. The beneficiaries will not be required to pay any charges for the hospitalization expenses. The benefit also includes pre and post-hospitalization expenses. The scheme is an entitlement based, the beneficiary is decided on the basis of family being figured in SECC database. When fully implemented, the AB-NHPM will become the world’s largest government funded health protection mission.

Ayushman Bharat National Health Protection Mission Operational Guidelines
  • Guidelines on Release of Premium and Escrow account
  • Guidelines for Ayushman Mitra
  • Guidelines for Portability of Services
  • Guidelines on Claim Settlement
  • Guidelines on Process of Beneficiary Identification
  • Guidelines on Processes for Empanelment of Hospitals
  • Guidelines on Processes for Hospital Transaction
  • Guidelines on Formation of State Health Agency and District Implementation Unit
  • Guidelines for Grievance Redressal
  • Guidelines for Claim Amount Utilisation by Public Hospitals
  • Guidelines for Partnership with Resource Organisations for
  • Guidelines for Partnership with Resource Organisations for Augmenting Capacity for the National Health Protection Mission (Samvardhan)
Guidelines for Recruitment of Volunteers
  • NHA Volunteer Guidelines
  • Volunteer Application Form
Guidelines for Young Professional Program
For More details : https://www.abnhpm.gov.in/

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