Ayushman Bharat Yojana 2025: Free ₹5 Lakh Health Insurance Guide

Ayushman Bharat Yojana is also referred to as the National Health Protection Mission. It is a health insurance scheme launched by the Indian Government. It was released by Prime Minister Narendra Modi, which provides free health coverage to millions of the economically weaker section of people in the country. This has been launched on September 25, 2018, and has been identified as the largest government-funded healthcare programme in the world.

Major Aim of Ayushman Bharat Yojana

Presently, 70-80% of the people of India do not possess comprehensive health insurance, making India face a massive health bill. The medical exigencies force them to undergo hefty out-of-pocket costs which make it difficult for people with meager incomes to stand this amount of expenditure, mainly bringing long-term debt at stake. The scheme aims to provide cashless and paperless health coverage of up to ₹5 lakh per family per year to more than 10 crore poor and deprived families, thereby benefiting around 50 crore individuals.

Ayushman Bharat Yojana Highlights

1. Comprehensive Health Coverage

• The scheme provides health insurance coverage of up to ₹5 lakh per family annually.
• It covers secondary and tertiary care procedures, including pre- and post-hospitalization expenses.
• Beneficiaries can seek cashless treatments at empanelled public and private hospitals all over India.

2. No Upper Limits of Family Size, Gender, or Age

• No upper limit of family size, gender, or age of the beneficiaries.
• There is coverage for women, children, and elderly members in the family.

3. All Over India

The benefits can be availed anywhere in India. Thus, it ensures portability across states.

4. Paperless and Cashless Claims

Beneficiaries can avail of treatments without any upfront payments or documentation hassles.

5. No Aadhaar Mandate

While Aadhaar is not mandatory, beneficiaries must provide other valid ID proofs to claim the benefits.

Eligibility Criteria for Ayushman Bharat Yojana

The scheme is entitlement-based, and the beneficiaries are identified using the Socio-Economic Caste Census (SECC) database of 2011. The eligibility is categorized separately for rural and urban areas.

Rural Area Beneficiaries:

Eligible families must meet one or more of the following criteria:

• Families living in one-room kuchcha houses.
• Households with no adult member aged 16 to 59.
• Families headed by a lady without any adult male between 16 and 59 years of age.
• Households with no adult member aged 16 to 59.
• Landless households primarily earning through manual casual labor.
• Destitute and other households, such as alms-seekers.
• Families engaged upon manual scavenging, or classified as SC / ST.

Urban Area Beneficiaries:

Eligible families include those engaged in 11 identified occupational categories, among which are:

• Rag-pickers, beggars, domestic workers.
• Street vendors, plumbers, masons, and daily wage laborers.
• Transport workers, shop assistants, electricians, and mechanics.

How to Avail Ayushman Bharat Benefits

Steps to Check Eligibility:

1. Pre-identified Beneficiaries:The beneficiary list is prepared with the help of the SECC database, and there is no need for registration.
2. Verification: A printed eligibility letter from the Prime Minister is sent to all the beneficiaries.
3. Information Access:To check eligibility, the beneficiaries can contact Asha workers or Common Service Centers.
4. Official Website: Visit the Ayushman Bharat portal at www.abnhpm.gov.in for details.

Hospitalization Process:

1. Visit an empanelled hospital and contact the Ayushman Mitra desk.
2. Provide valid ID proof for verification.
3. After verification, a unique QR code is issued, enabling cashless treatment.
4. Treatment details are recorded digitally for seamless access to future benefits

Key Features of the Scheme

1. Wide Coverage of Medical Procedures:
   • Covers over 1,354 medical packages, including procedures like coronary bypass, knee replacements, and stenting.
   • Package rates are set at 15-20% lower than the Central Government Health Scheme (CGHS) rates to ensure affordability.
2. No Waiting Period:
   • Beneficiaries can claim benefits from day one of the scheme.
   • Pre-existing medical conditions are also covered.
3. Funding Structure:
   • The scheme is jointly funded by the central (60%) and state (40%) governments.
   • Participating states have signed MoUs with the National Health Agency (NHA).
4. Cashless Benefits Include:
   • Hospitalization expenses including food, medicines, and transportation.
   • Pre- and post-hospitalization costs.
   • Diagnostic and consultation charges.