Health insurance has become a crucial component of everyone’s life. With the rising costs of healthcare, a medical emergency can quickly drain your finances, leading to stress, anxiety, and even debt. To address this issue, the Indian government has launched two major healthcare schemes, the ABHA card and Ayushman Bharat card. However, with so many options available, it can be challenging to choose the right card. In this blog post, we will explore the differences between ABHA and Ayushman Bharat and help you pick the best card to suit your healthcare needs.
What is ABHA?
ABHA stands for Aam Aadmi Bima Yojana. It is a social security scheme introduced by the Ministry of Labour and Employment to provide insurance coverage to the poor in the unorganised sector. The scheme offers life and disability cover along with financial aid in case of hospitalisation.
What is Ayushman Bharat?
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a government-funded scheme initiated by the Ministry of Health and Family Welfare. The scheme aims to provide health insurance coverage to the economically weaker sections (EWS) and vulnerable populations of the country.
ABHA: All Indian citizens aged between 18 and 59 years, working as unskilled or semi-skilled labourers, are eligible for ABHA. The annual income limit under this scheme is INR 1,00,000 for all states except Jammu and Kashmir, where the limit is INR 75,000.
Ayushman Bharat: The eligibility criteria for Ayushman Bharat is based on the criteria given under the Socio-Economic Caste Census (SECC) 2011. Individuals belonging to EWS (including homeless and beggars), Scheduled Tribes (STs), and Scheduled Castes (SCs), are automatically considered eligible. In addition, people living in rural areas and those who belong to low-income urban families are classified as eligible.
ABHA: ABHA provides a range of benefits to its cardholders, including life and disability insurance cover, maternity benefits, and hospitalisation expenses. In case of the death of the primary breadwinner, the family receives a lump sum amount of INR 30,000.
Ayushman Bharat: Ayushman Bharat provides a health cover of up to INR 5 lakhs per family per year for secondary and tertiary healthcare. The scheme covers all pre-existing illnesses, and the beneficiaries can avail of cashless treatment at any of the empanelled hospitals.
Scope of Coverage
ABHA: ABHA covers hospitalisation expenses, including room charges, doctor’s fees, operation theatre charges, ICU charges, and other related expenses.
Ayushman Bharat: Ayushman Bharat covers 1,350 medical procedures, including cancer treatment, coronary bypass surgery, joint replacement, and kidney and liver transplant.
ABHA: ABHA is tied up with various hospitals and medical centres across the country. The cardholders can avail of medical treatment at any of these affiliated centres.
Ayushman Bharat: Ayushman Bharat has a network of over 20,000 hospitals across the country, including public and private hospitals.
ABHA: To enrol in ABHA, a cardholder needs to visit the nearest Common Service Centre (CSC) or designated nationalised bank branch. The card can be obtained by paying a premium of INR 200 per annum.
Ayushman Bharat: Ayushman Bharat automatically enrols beneficiaries based on the SECC database. However, if you think that you are eligible but not enrolled, you can visit the nearest Ayushman Bharat empanelled hospital and get yourself registered.
Claim Settlement Process
ABHA: To claim ABHA benefits, the cardholder needs to submit the claim form along with the relevant documents to the designated nationalised bank. The claim settlement process takes around 15-30 days.
Ayushman Bharat: Ayushman Bharat offers cashless treatment at all empanelled hospitals. However, if you incur any expenses, you need to submit the claim form along with the relevant documents to the insurer. The claim settlement process usually takes around 15 days.
ABHA: ABHA needs to be renewed annually by paying the premium amount. If the cardholder fails to renew the card within the stipulated time, the card becomes invalid.
Ayushman Bharat: Ayushman Bharat does not require any renewal. The beneficiaries can avail of the benefits for the entire year.
ABHA: ABHA charges an annual premium of INR 200.
Ayushman Bharat: Ayushman Bharat is a government-funded scheme and does not require any premium to be paid by the beneficiaries.
Both ABHA and Ayushman Bharat have their own sets of advantages and disadvantages. While ABHA offers a range of benefits to the unorganised sector, Ayushman Bharat provides comprehensive healthcare coverage to the economically weaker sections. Ultimately, the choice of card depends on your medical needs and financial status. Evaluate your requirements carefully and choose the card that suits you the most.
1. Are ABHA and Ayushman Bharat the same?
No, ABHA and Ayushman Bharat are two separate schemes launched by the Indian government to provide health insurance coverage to different sections of the society.
2. Who is eligible for ABHA?
All Indian citizens aged between 18 and 59 years, working as unskilled or semi-skilled labourers, are eligible for ABHA.
3. Can Ayushman Bharat beneficiaries avail of cashless treatment?
Yes, Ayushman Bharat beneficiaries can avail of cashless treatment at any of the empanelled hospitals across the country.
4. How much premium is to be paid to enrol in ABHA?
The annual premium for ABHA is INR 200.
5. Is there any limit on the number of family members covered under Ayushman Bharat?
No, there is no limit on the number of family members covered under Ayushman Bharat. The scheme covers all the members of the beneficiary’s family.