Ayushman Bharat Health Accounts (ABHA): Important Things to Know!

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB - PMJAY) is a public health insurance scheme. It was launched by the Government of India in September 2018 [1]. It aims at providing free and easy access to health insurance coverage for citizens with low income. The program provides access to free secondary healthcare for those who need specialist treatment or require hospitalization. Ayushman Bharat Yojana is a part of the National Health Policy with a national health mission of achieving Universal Health Coverage (UHC).

Ayushman Bharat health insurance is jointly financed by union and state governments that cover above 50 crore Indians, making it the largest government-funded health scheme. With the announcement of Ayushman Bharat Health Accounts (ABHA), the government hopes to increase participation in Ayushman Bharat Digital Mission. Read to know more about digital health card or the Ayushman bharat health accounts.

What is ABHA?

ABHA stands for Ayushman Bharat Health Accounts. It promotes safe digital healthcare that allows you to access and share your health records digitally with healthcare providers and payers. It gives you the means to interact with medical companies and receive lab reports, prescriptions, and diagnoses with ease. ABHA was previously known as the ABHA Address (Health ID)or ABHA Card.

The government had launched Ayushman Bharat Digital Mission (ABDM) in August 2020 to create an integrated health infrastructure. As part of the national health mission, you will receive a 14-digital identification number. However, ABHA is a voluntary program that allows you to create your digital health cards by using an Aadhaar card, driving license or mobile number.

What is the history behind the idea of a government health policy?

In 2017, a study reported major risk factors and diseases affecting all states in India from 1990 and 2016 [2]. This raised interest and led to the formation of a new government health policy as major challenges needed to be addressed. A report was also published in 2018 that revealed more than 6 crore Indians were going bankrupt annually due to medical expenses [3]. 

Although there were national and regional healthcare programs in India, much more needed to be done. Therefore, the GoI in February 2018 announced Ayushman bharat yojana as a universal healthcare plan.

What is the implementation and reach of Ayushman Bharat Yojana?

The states and UTs in India have the right to choose to avail the Ayushman Bharat Yojana. Around 20 states had committed to be a part of the program when it was launched. But soon after, some UTs and states stepped back. States like Tamil Nadu and Maharashtra initially declined as they already had healthcare programs. Similarly, Kerala joined the national health mission in November 2019. West Bengal and Telangana initially participated in the program but then opted out to support their regional health programs. Odisha joined the program in January 2020 while Delhi announced its interest in March 2020.

The Prime Minister in May 2020 said that Ayushman Bharat Yojana had benefitted more than 1 crore citizens [4]. By that time, the scheme had provided treatments totalling Rs.13,412 crore in cost. There were 24,432 empanelled private and public hospitals. In November 2019, the program also started collaborating with the Employees’ State Insurance program.

What are the features and benefits of a digital health card?

Here are some features and benefits of digital health card: [5]

• It provides maximum coverage of Rs.5 lakh per family per year
• It covers over 10.74 crore poor families
• It is the largest health insurance scheme by the government
• It gives access to cashless healthcare services
• It covers all pre-existing conditions from day one
• Its benefits are portable across the country
• The reimbursement at public hospitals is at par with private hospitals
• Its services include approximately 1,393 procedures
• It does not have any restriction on the family size, age, or gender
• It covers up to 3 days of pre-hospitalization and 15 days of post-hospitalization expenses

Digital health card covers the following:

• Medical treatment and consultation
• Cost of medicines
• Diagnostics and lab tests
• Non-intensive and intensive care services
• Implantation
• Food services
• Pre-hospitalization
• Post-hospitalization
• Complications during treatments

What are illnesses covered under ayushman bharat yojana?

What were the challenges in implementing Ayushman Bharat Yojana?

An important challenge for Ayushman bharat yojana is the need for infrastructure that contributes to the modern healthcare system.  Ayushman Bharat - PMJAY aims at providing excellent healthcare. However, India still suffers from problems like shortage of doctors, growing infectious diseases, and a low national budget in healthcare. Another challenge is that not many private hospitals have participated in the initiative as they can’t afford to offer services at government prices. Also, there has been reports of some private hospitals misusing the scheme.

What are the eligibility criteria for Ayushman Bharat Yojana?

• The following qualify for the Ayushman Bharat Yojana among rural families
• Destitute families relying on alms
• Households with no proper shelter
• Families of bonded labour
• Primitive and vulnerable tribal groups
• Families of manual scavengers
• Families with no earning adult between 16 and 59 years of age
• Households with one room made of makeshift walls and a roof
• Households from the categories of Scheduled Tribes and Scheduled Castes
• Households with differently-abled members and no support
• Manual labourers with landless households
• Households headed by female members with no adult male members aged between 16 and 59 years
• The following qualify for the Ayushman Bharat Yojana among urban families
• Street vendors or domestic workers
• Hawkers and cobblers
• Rag pickers and beggars
• Plumbers, painters, and welders
• Construction site workers
• Security guards, sweepers, and sanitation workers
• Gardeners, coolies, washermen, and watchmen
• Conductors, drivers, and cart pullers
• Home-based workers, artisans, and handicraft workers
• Tailors, peons, shop workers, and helpers
• Delivery assistants and attendants
• Electricians and mechanics
• Assemblers and repair workers

How to enrol for Ayushman Bharat health accounts? 

To check your eligibility under PMJAY, visit the portal and click on ‘Am I Eligible’. Enter your mobile number the CAPTCHA code. Then, click on ‘Generate OTP’. Select your state and search by name, HHD number, ration card number, or mobile number. Check the results to verify if your family is covered under PMJAY. You can also contact any of the empanelled hospitals or call the helpline number.

What is the medical package and hospitalization process under Ayushman Bharat Yojana?

Individuals and families get an insurance cover of Rs.5 lakh under PMJAY. It covers medical and surgical treatments across 25 specialties. Once you are identified as a beneficiary and get a health card under PMJAY, you can get hospitalized at network hospitals and access the benefits of the scheme.

How to contact the ABHA help center?

As a beneficiary, you can contact the toll-free helpline number 14555 or reach out to the Ayushman Mitra in the hospital you are getting treated.

You too can apply for the Ayushman Bharat Health Accounts (ABHA) and avail of digital healthcare services. Apart from this, remember that a health insurance plan in today’s times is a must. If you are not eligible for the Ayushman Bharat Health insurance scheme, you can check out the affordable health plans under Aarogya Care offered by Bajaj Finserv Health.

These plans cover your entire family and offer benefits like preventive health check-ups, consultation reimbursements, network discounts, and more. Make sure you prioritize your health for a happy and stress-free life.

You can use the Bajaj Health Card to turn your medical expenditures into simple EMIs if you are not eligible for an ABHA card.