Indian Health
West Bengal set to join Ayushman Bharat PM-JAY tomorrow. Who is eligible?
West Bengal is set to join the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), the Centre's flagship publicly funded health assurance scheme, on Monday.
A Memorandum of Understanding (MoU) for the implementation of the scheme in the state will be signed between the National Health Authority (NHA), under the Ministry of Health and Family Welfare, Government of India, and the Department of Health and Family Welfare, Government of West Bengal, at Vigyan Bhawan in New Delhi.
With the signing of the MoU, West Bengal will become the 36th State/Union Territory in the country to implement AB PM-JAY.
Key Benefits of Ayushman Bharat PM-JAY
Ayushman Bharat PM-JAY provides health insurance coverage of up to ₹5 lakh per family per year for secondary and tertiary hospitalisation to eligible beneficiaries.
Financial Health Coverage
Cashless hospitalisation coverage of up to ₹5 lakh per family annually.
Coverage of consultation fees, medicines, diagnostic tests, surgeries, ICU charges, implants, accommodation and food expenses.
Coverage for pre-hospitalisation expenses for up to three days and post-hospitalisation expenses for up to 15 days.
Coverage for complications arising during treatment.
Additional Features
Coverage of all pre-existing diseases from day one.
No cap on family size, age or gender.
Nationwide portability, allowing beneficiaries to avail treatment at empanelled hospitals across India.
Coverage for approximately 1,929 medical procedures.
Eligibility Criteria
Rural Beneficiaries
Families falling under at least one of the following deprivation categories are eligible:
Only one room with kutcha walls and a kutcha roof.
No adult member between 16 and 59 years of age.
No adult male member between 16 and 59 years of age.
Presence of a disabled member with no able-bodied adult in the household.
Scheduled Caste (SC) or Scheduled Tribe (ST) households.
Landless households dependent primarily on manual casual labour.
The following categories are automatically included:
Homeless households.
Destitute persons or those living on alms.
Manual scavenger families.
Primitive tribal groups.
Legally released bonded labourers.
Urban Beneficiaries
The scheme covers workers belonging to the following occupational categories:
Ragpickers.
Beggars.
Domestic workers.
Street vendors, cobblers, hawkers and other street-based service providers.
Construction workers, plumbers, masons, labourers, painters, welders, security guards, coolies and other head-load workers.
Sweepers, sanitation workers and gardeners.
Home-based workers, artisans, handicraft workers and tailors.
Transport workers, drivers, conductors, helpers, cart pullers and rickshaw pullers.
Shop workers, assistants, peons, helpers, delivery assistants, attendants and waiters in small establishments.
Electricians, mechanics, assemblers and repair workers.
Washermen and chowkidars.
Exclusion Criteria
The following categories are not eligible under the scheme:
Households owning a two-wheeler, three-wheeler, four-wheeler or a motorised fishing boat.
Owners of mechanised farming equipment.
Holders of Kisan Credit Cards with a credit limit of ₹50,000 or more.
Government employees.
Employees of government-managed non-agricultural enterprises.
Individuals earning more than ₹10,000 per month.
Households owning refrigerators and landline telephones.
Families living in well-constructed pucca houses.
Households owning five acres or more of agricultural land.
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