It is well known that the Armed Forces Pensioners who retired from service on or after 1st April 2003 are covered under ECHS compulsorily. A one time contribution was deducted from your Gratuity amount to become a member of the ECHS. Now you and your family are under coverage of ECHS for all kinds of medical expenses.
Meanwhile, the Govt has also introduced many schemes for citizens of India. These are applicable to all citizens in general. However, there are some exceptions which must be noted or you may lose the existing better facility.
Govt of India has launched Ayushman Bharat Pradhan Mantri Jan Arogya Yojana applicable to all. It is a health insurance scheme that provides financial protection for secondary and tertiary healthcare to economically vulnerable families in India.
Points to be noted for ECHS Beneficiaries.
AB PMJAY is a very effective health service scheme for the citizens but ECHS beneficiary can not enrol in the scheme. In the event of enrolment in this scheme, your ECHS medical facility should be surrendered. You must not that, ECHS facility once surrendered, can not be restored. This is irreversible action.
A screen should of the enrolment process is shared here. This reveals that, you should read carefully regarding the provision mentioned in the official web portal of the AB PMJAY.
Some key points of the AB PMJAY Scheme
- PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government. It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India. Over 12 crore poor and vulnerable entitled families (approximately 55 crore beneficiaries) are eligible for these benefits.
- PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
- PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year. It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
- There is no restriction on the family size, age or gender. All pre–existing conditions are covered from day one. Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
- Services include approximately 1,929 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
- Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
Benefit cover under various Government-funded health insurance schemes in India have always been structured on an upper ceiling limit ranging from an annual cover of INR30,000 to INR3,00,000 per family across various States which created a fragmented system. PM-JAY provides cashless cover of up to INR5,00,000 to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment.
- Medical examination, treatment and consultation
- Pre-hospitalization
- Medicine and medical consumables
- Non-intensive and intensive care services
- Diagnostic and laboratory investigations
- Medical implantation services (where necessary)
- Accommodation benefits
- Food services
- Complications arising during treatment
- Post-hospitalization follow-up care up to 15 days
The benefits of INR 5,00,000 are on a family floater basis which means that it can be used by one or all members of the family. The RSBY had a family cap of five members. However, based on learnings from those schemes, PM-JAY has been designed in such a way that there is no cap on family size or age of members. In addition, pre-existing diseases are covered from the very first day. This means that any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.
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