The Ayushman Bharat Scheme, also known as Modicare, is a groundbreaking initiative launched by the Government of India. Designed to transform the healthcare sector, this scheme brings forth numerous benefits for both the people and healthcare centers across the nation. With the Health Ministry actively urging public and private hospitals to join forces, the Ayushman Bharat scheme aims to provide cashless insurance coverage of up to ₹5 lakhs to 10.74 crore economically disadvantaged families. As part of the implementation process, the National Health Agency (NHA), the governing body responsible for the scheme, has initiated the formal procedure to empanel hospitals from both the public and private sectors.
What are the key features of Ayushman Bharat Yojana?
Ayushman Bharat is a flagship healthcare scheme launched by the Government of India in 2018. It consists of two components: Pradhan Mantri Jan Arogya Yojana (PM-JAY) and Health and Wellness Centers (HWCs). Here’s a description of each component and the benefits it offers to hospitals and patients:
1. Pradhan Mantri Jan Arogya Yojana (PM-JAY):
PM-JAY aims to provide health insurance coverage to economically vulnerable individuals and families across India. Under this scheme, eligible beneficiaries receive a health insurance cover of up to Rs. 5 lakh per family per year. Some key features and benefits of PM-JAY include:
– Coverage: PM-JAY covers a range of medical services, including hospitalization, surgeries, diagnostics, medicines, and post-hospitalization care.
– Cashless Treatment: Beneficiaries can avail cashless treatment at empaneled public and private hospitals across India.
– Extensive Network: PM-JAY has a wide network of empaneled hospitals, ensuring access to quality healthcare services for beneficiaries.
– Portability: The scheme is portable, allowing beneficiaries to avail treatment at any empaneled hospital in India, regardless of their home state.
– No Cap on Family Size: The scheme covers the entire family, including dependent members, with no restrictions on the family size.
– Pre-existing Conditions: PM-JAY covers pre-existing conditions from the beginning of enrollment, ensuring access to healthcare for individuals with existing ailments.
2. Health and Wellness Centers (HWCs):
HWCs are the primary healthcare facilities established under Ayushman Bharat. These centers focus on delivering comprehensive primary healthcare services and preventive care to the community. Some benefits of HWCs include:
– Essential Services: HWCs offer a range of essential healthcare services, including diagnosis and treatment of common ailments, maternal and child health services, non-communicable disease management, and health promotion activities.
– Health Education: HWCs engage in health education and awareness programs, promoting preventive measures and healthy lifestyles within the community.
– Referral System: HWCs play a crucial role in referring patients to higher-level facilities, including hospitals, for specialized care when needed.
Benefits for Hospitals:
– Increased Patient Footfall: Hospitals empaneled under PM-JAY can expect an increased number of patients, as the scheme provides insurance coverage to a large population.
– Timely Payments: Empaneled hospitals receive timely payments for the services rendered to PM-JAY beneficiaries, reducing financial uncertainties.
– Reduced Financial Burden: PM-JAY helps alleviate the financial burden on hospitals by ensuring payment for the treatment of eligible beneficiaries, thereby improving their financial sustainability.
Benefits for Patients:
– Access to Quality Healthcare: PM-JAY provides access to quality healthcare services at empaneled hospitals, enabling beneficiaries to receive treatment without financial strain.
– Financial Protection: The scheme offers financial protection to vulnerable families by covering their medical expenses, reducing the risk of catastrophic healthcare expenditures.
– Choice of Hospitals: Beneficiaries have the freedom to choose from a wide network of empaneled hospitals, both public and private, as per their preference and convenience.
Overall, Ayushman Bharat aims to improve the accessibility and affordability of healthcare services for the economically vulnerable population while supporting hospitals by ensuring a steady patient flow and timely payments.
The patient has to submit all the insurance documents to the hospital where he/she visits for treatment. After checking and verifying all the documents, the hospital will mention the amount needed for the treatment to the insurance company. Once all the formalities and procedures are completed, the hospital staff will begin the treatment of the patient.
Benefits of Ayushman Bharat Scheme Empanelment
- Empanelment with Ayushman Bharat scheme help in hospital marketing.
- Empanelment leads to Increases the Number of Customers.
- Empanelment to a hospital stimulates continuous improvement.
- Empanelment provides an objective system of empanelment by insurance and other third parties.
- Empanelment with Ayushman Bharat stimulates continuous improvement. It enables hospital in demonstrating commitment to quality care. It raises community confidence in the services provided by the hospital. It also provides opportunity to healthcare unit to benchmark with the best.
- Empanelment provides an objective system of empanelment by insurance and other Third Parties. Accreditation provides access to reliable and certified information on facilities, infrastructure and level of care.
Documents Required for Ayushman Bharat Registration
There are some Important Requirement to get your hospital empaneled with Ayushman Bharat Scheme such as:
- Rohini Registration
- Hospital PAN Card
- Building Plan Approval
- Fire Department Clearance Certificate
- Pollution Control Board Certificate
- Lift License
- Occupancy Certificate
- Opium License
- Hospital Registration Certificate
- State Medical Council/Association Registration
- Morphine License
- PCPNDT Act Registration
- Surgical Spirit License
- Bio-Medical Waste Management
- AERB
- TLD Badge
- Pharmacy License/Tie up/ self – declaration*
- Blood bank license/ tie-up letter/ self-declaration*
- Ambulance Registration Certificate/Tie-up Letter/ self – declaration*