Kolkata: Ayushman Bharat, the free health insurance scheme, was launched on September 23, 2018. It offers cover of Rs 5 lakh per family per year for secondary/tertiary care hospitalisation and has been primarily designed to help the poor and vulnerable. However, like all insurance schemes it allows the treatment of some conditions and doesn’t admit some. Let’s have a look at what’s in and what’s out of this scheme.
It is also worthy to note that for those aged above 70, it becomes universal and offers protection to all irrespective of income. Ayushman Bharat is designed to cover big medical expenses, critical conditions requiring hospitalization, intensive care and excludes routine, cosmetic and elective procedures. It is essential to know what’s considered for coverage and what’s not so as to avoid nasty surprises at the last moment, most of which are emergency situations.
Treatment/conditions covered under Ayushman Bharat
The Ministry of Health and Family Welfare has listed out the conditions that are admitted under Ayushman Bharat scheme. These are:
- Burns management
- Cardiology and cardiothoracic surgery
- Emergency room packages (for care under 12 hours)
- General medicine and surgery
- Interventional neuroradiology
- Medical and surgical oncology
- Mental health treatment
- Neonatal care
- Neurosurgery
- Obstetrics and gynaecology
- Ophthalmology
- Oral and maxillofacial surgery
- Orthopaedics
- Otorhinolaryngology
- Paediatric medicine and surgery
- Plastic and reconstructive surgery
- Polytrauma care
- Radiation oncology
- Urology
- Paediatric cancer treatment
Treatments not covered by Ayushman Bharat
The following conditions are not considered for coverage:
- Outpatient treatments (OPD) and conditions that don’t need hospitalisation, doctor consultations, diagnostics, routine medication.
- Hospital stay for assessment: If hospitalisation is only for diagnostics. Also expenditure on tonics, supplements, vitamins (unless these are a part of a proper treatment blueprint)
- Dental treatments: Unless the dental treatment is caused by trauma, tumour, cysts etc that needs bone traetment, all dental procedures such as implants, cavity filling, root canal etc are are excluded.
- Infertility treatments:IVF and assisted reproductive procedures
- Non-essential vaccinations and immunisations
- Cosmetic surgeries
- Circumcision (for children under 2): Unless required for medical treatment of an unrelated condition or accident situations
- Persistent vegetative state cases
Ayushman Bharat scheme offers cover of Rs 5 lakh per family per year for secondary/tertiary care hospitalisation and has been primarily designed to help the poor and vulnerable. However, there is a clear list of what is covered and what is not. Personal Finance Business News – Personal Finance News, Share Market News, BSE/NSE News, Stock Exchange News Today
