Will the new Ayushman Bharat scheme affect your business?

Government's Ayushman Bharat Health Insurance Scheme

The cost of medicine has become so expensive in modern times that it has become almost impossible for the backward sections of the society to afford decent healthcare facilities. As most of our country’s population belongs to the lower income levels, the Government decided to launch a national healthcare scheme for the poor. This gave birth to the Ayushman Bharat Scheme which is also called PM Jan Arogya Yojana (PMJAY). The scheme came into existence in September 2018 and since then has seen rapid application across India. With the scheme providing free health insurance cover, many of you think whether the scheme would affect your business prospects. Will it? Let’s find out–


What is Ayushmn Bharat Scheme?


Under the Ayushman Bharat scheme, free health insurance coverage is provided to the poor. The scheme covers hospitalization expenses of up to INR 5 lakhs per family for all secondary as well as tertiary treatments taken at the hospital.


Who is covered under the scheme?


The scheme covers only the “poor and vulnerable” citizen of India. The definition of “poor and vulnerable” is given in the Rural Development Ministry’s Socio-Economic Caste Census which was updated in the year 2015. The Government has recognized about 10.74 crore families belonging to the category ‘poor and vulnerable’ and about 50 crore members of such families are the pre-determined beneficiaries of the scheme. All the members of the recognized families would be covered under the scheme on a floater basis.


How does the scheme operate?


The premium for the scheme is paid by the Central and the State Government. The families who were recognized by the scheme were sent a letter containing a unique QR code. In the case of hospitalization, the covered member should visit a hospital having an Arogya Mitra stationed there. The Aarogya Mitra would help the beneficiary with the claim. The letter with the QR code would be matched with the scheme database available with the Aarogya Mitra. The member would also have to provide identity proof. When the authentication of the member is done with the QR code and identity proof, a golden health card would be issued. This health card allows beneficiaries cashless treatments at hospitals. The claim for hospitalization would also be shared between the Central and the State Government in the ratio 60:40.


Does the Ayushman Bharat scheme affect your insurance business?


The Ayushman Bharat scheme is only for the less unfortunate who cannot afford healthcare on their own. It covers named beneficiaries who belong to a specific set of families. As such, it does not provide free health insurance to your set of contacts unless you cater to anyone who falls under such a category. The scheme works at the grass-root levels of the society and in general, does not pose a threat to your insurance business. The demography for which the scheme has been designed has nothing to do with your clients unless you have clients in that segment.


If your clients don’t know the details of the scheme and believe that they would be covered under it, you can enlighten them. With the knowledge shared above now you even know the details about the scheme and how it works.


The Ayushman Bharat scheme is an initiative by our Government to ensure good healthcare for the economically weaker sections of the society. It is important for you to understand the scheme’s benefits so that you can offer it as a benefit to the underprivileged people and protect their interests as well.


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