Understand Ayushman Card benefits and maximise its usage - Oneassure

Healthcare is one of the most crucial aspects of our lives. With rising medical costs, having access to affordable healthcare has become a necessity. The Indian government has launched several initiatives to make healthcare accessible to all, one of them being the Ayushman Bharat Yojana. This blog will help you understand Ayushman card benefits and how it can be a game-changer for millions of Indians.

What is the Ayushman Card?

The Ayushman Card is a health card issued to eligible beneficiaries under the Ayushman Bharat Yojana. It allows cardholders to avail themselves of cashless treatment in empaneled hospitals across the country. This card is a gateway to a range of healthcare services without the burden of hefty medical bills.

How to Get an Ayushman Card

To obtain an Ayushman Card, eligible individuals can apply online or visit the nearest Common Service Centre (CSC). After verifying eligibility, the card is issued, which can be used to access healthcare services under the scheme. To get a step-by-step guide Click here.

List of Critical Diseases Covered Under Ayushman Bharat Health Scheme: 

Some of the Critical illnesses that the policy covers are as follows:  

> Double valve replacement

> Prostate cancer

> Coronary ABG

> Carotid angioplasty with stent

> Anterior spine fixation

> Pulmonary valve replacement

> Skull base surgery

> Laryngopharyngectomy

> Tissue expander for disfigurement in case of burns

Key Features of Ayushman Bharat Yojana

> Wide Coverage: Ayushman Bharat Yojana covers over 10 crore families, benefiting around 50 crore people, making it the world's largest government-funded healthcare scheme.

> Cashless Treatment: Ayushman Card holders can avail themselves of cashless treatment across all empaneled hospitals in India.

> Comprehensive Health Package: The scheme covers nearly 1,400 procedures, including surgery, medical, and daycare treatments.

> No Premium: Unlike private insurance, there is no premium or enrollment fee for beneficiaries.

> High Financial Cover: Each family is covered up to ₹5 lakh per year, sufficient for most medical emergencies.

> Portable Across India: The scheme is portable across India, meaning you can avail of services in any state regardless of your domicile.

> Focus on Secondary and Tertiary Care: The scheme focuses on providing coverage for secondary and tertiary healthcare services and not on primary care coverage.

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> Pre-existing Diseases Covered: Pre-existing diseases are covered from day one, eliminating the typical waiting period found in private insurance.

> Support for Rural and Urban Poor: The scheme primarily targets the economically vulnerable sections of society, both in rural and urban areas.

> Simple Claim Process: The process to claim benefits under the Ayushman Bharat Yojana is straightforward, paperless, and fast, ensuring timely medical care.

Ayushman Card Benefits

> Comprehensive Coverage: This scheme provides health insurance coverage of ₹5 lakhs per family each year. It also covers 3 days of pre-hospitalization and up to 15 days of post-hospitalization expenses, along with both intensive and non-intensive healthcare services.

> Wide Reach: The Ayushman Bharat Yojana aims to provide health protection to around 10 crore families across India, covering about 8 crore families in rural areas and 2 crore in urban areas. It primarily helps poor and lower-middle-class families.

> Eligibility: The scheme is entitlement-based, meaning families listed in the Socio-Economic Caste Census (SECC) and meeting the required criteria automatically qualify for coverage. There's no limit on age or family size, ensuring all members, including women, girls, and the elderly, are protected.

> Free Treatment: Beneficiaries can receive free, paperless, and cashless treatment at government hospitals and selected private hospitals.

> Priority Coverage: The scheme gives special priority to covering girl children, women, and elderly family members.

> Comprehensive Hospitalisation: The scheme covers major secondary and tertiary care hospitalizations, offering almost 1350 medical packages that include day-care treatments, surgeries, medicines, diagnostic tests, transportation, food, and accommodation.

> Pre-Existing Illnesses Covered: All pre-existing conditions are covered from day one, and hospitals cannot deny treatment under this policy.

> No Out-of-Pocket Expenses: Beneficiaries do not need to pay for any hospitalization costs. Hospitals are also prohibited from charging for treatments covered under the scheme.

> Nationwide Availability: With health centers set up nationwide and partnerships with private hospitals, beneficiaries can access services across India.

> 24/7 Helpline: A round-the-clock helpline (14555) is available for any assistance or to resolve complaints related to the scheme.

Private Health Insurance vs Ayushman Bharat Yojana 

Understand the key differences between Private Health Insurance & Ayushman Bharat Yojana can help you make informed decisions about your health coverage 

Challenges and Limitations of the Ayushman Bharat Yojana

The Ayushman Card, while offering significant healthcare benefits, also faces several challenges and limitations in its implementation across India.

a) Limited Awareness and Reach

i) Challenge: Despite the wide reach of the program, many eligible beneficiaries in rural and remote areas are still unaware of their entitlement to free healthcare services under the Ayushman Bharat scheme.

ii) Impact: This results in lower enrollment and underutilization of the scheme, particularly in areas that need it the most.

b) Healthcare Infrastructure Deficiencies

i) Challenge: The scheme relies heavily on the existing healthcare infrastructure, which is often inadequate, particularly in rural areas.

ii) Impact: There is a shortage of hospitals, medical staff, and essential equipment, leading to delays in treatment and poor service delivery.

c) Low Hospital Participation

i) Challenge: Many private hospitals are hesitant to join the scheme due to concerns over the low reimbursement rates and delays in payments from the government.

ii) Impact: This limits the options available to patients and can lead to overcrowding in participating hospitals.

d)  Fraud and Abuse

i) Challenge: There have been instances of fraudulent claims and misuse of the scheme, where services are either overbilled or patients are charged despite being covered under the scheme.

ii) Impact: Such practices can undermine the effectiveness of the program and lead to financial losses for the government.

e) Sustainability and Financial Viability

i) Challenge: The financial sustainability of the Ayushman Bharat Yojana is a concern, given the vast scale of the program and the high cost of healthcare services.

ii) Impact: Ensuring continued funding and managing costs effectively is crucial to maintaining the long-term viability of the scheme.

f) Variation in Implementation Across States

i) Challenge: The implementation of the scheme varies significantly from state to state, leading to disparities in healthcare access and quality.

ii) Impact: Some states have been more successful in integrating the scheme into their healthcare systems, while others lag behind, affecting overall efficacy.

g)  Overburdened Public Hospitals

i) Challenge: Public hospitals, which are already overstretched, have to manage the additional influx of patients seeking treatment under the scheme.

ii) Impact: This can lead to longer waiting times and potentially compromise the quality of care provided.

h) Data Privacy and Management Issues

i) Challenge: The collection and management of vast amounts of patient data under the scheme raise concerns about data privacy and security.

ii) Impact: Ensuring the confidentiality and security of sensitive health information is essential to maintaining trust in the system.

i)  Quality of Care

i) Challenge: Ensuring consistent and high-quality care across all participating hospitals is difficult, especially in poorly equipped or understaffed facilities.

ii) Impact: Variability in the quality of care can lead to suboptimal health outcomes for patients.

Ayushman Bharat Yojana: A Glimpse into the Future of Health Coverage:

Let’s explore some key points on how Ayushman Bharat Yojana will evolve and impact India's healthcare system in the coming years:

> Expansion of Coverage: The program is likely to continue expanding its coverage to include more beneficiaries and health services. This could involve adding new diseases, treatments, and healthcare facilities to the scheme.

> Enhanced Technology Integration: With advancements in technology, the scheme may see greater integration of digital tools and platforms to streamline processes, improve accessibility, and enhance data management.

> Focus on Quality: There may be increased emphasis on ensuring the quality of services provided under ABY. This could involve stricter guidelines for hospitals, better monitoring systems, and enhanced training for healthcare providers.

> Strengthening Network: The network of empaneled hospitals and healthcare providers might be expanded to cover more regions, including rural and underserved areas, ensuring that more people can access the benefits.

> Increased Awareness and Outreach: Efforts to raise awareness about the scheme and educate beneficiaries about their rights and available services will likely continue. This could help in better utilization of the scheme and addressing gaps in coverage.

> Sustainability and Funding: The future of ABY will also depend on its sustainability and funding mechanisms. Ensuring adequate resources and financial stability will be crucial for the scheme's long-term success.

> Integration with Other Health Programs: There might be efforts to integrate ABY with other government health initiatives and schemes to create a more comprehensive healthcare ecosystem.

> Policy and Regulatory Changes: Future developments may include updates to policies and regulations to address emerging healthcare needs, improve efficiency, and adapt to changing demographics.

Overall, Ayushman Bharat Yojana is expected to evolve and adapt to meet the growing healthcare needs of India's population while continuing to improve accessibility and affordability of healthcare services.

Conclusion

The Ayushman Bharat Yojana, through the Ayushman Card, plays a crucial role in providing healthcare to millions of Indians who otherwise might struggle to afford it. It ensures that even the most vulnerable populations have access to necessary medical treatments without the burden of hefty costs. The scheme's extensive coverage, including critical diseases and cashless treatment without copay at empaneled hospital, makes it an invaluable resource for those in need.

Understanding the difference in public vs private health insurance is essential. Both offer financial protection, access to quality healthcare, and peace of mind during medical emergencies. While there are challenges like limited awareness and infrastructure issues, the program's future looks bright. With plans to expand coverage, improve technology, and focus on quality, Ayushman Bharat Yojana is set to continue making a big difference in people's lives by making healthcare more accessible and affordable. 

In summary, having health insurance, whether private or through government schemes, is a vital part of financial planning, ensuring that you and your loved ones are protected against unforeseen medical expenses. To get more information How to get best health insurance read our blog.  Not enough? Get tailored advice specific to your needs from experts at OneAssure here.