What you get
- Coverage of up to ₹5,00,000 per family per year. | - Cashless treatments during hospitalization. | - Pre-existing diseases are inclusively covered. | - The scheme encompasses expenses for pre-hospitalization for up to 3 days. | - Post-hospitalization expenses for up to 10 days are covered. | - Hospitalization expenses include: | - Registration Charges, Bed Charges (General Ward), Nursing and Boarding Charges, Surgeons, Anaesthetists, Medical Practitioners, Consultants Fees, etc.. | - Anaesthesia, Blood Transfusion, Oxygen, Operating Theatre (OT) Charges, Cost of Surgical Appliances, etc., Medicines and Drugs, Cost of Prosthetic Devices, Implants, etc., Pathology and Radiology Tests: Radiology to Include but Not Be Limited to X-ray, Magnetic Resonance Imaging (MRI), Computed Tomography (CT) Scan, etc., Diagnosis and Tests, etc., Food for the Patient. | - Pre and Post-hospitalization expenses encompass costs incurred for consultation, diagnostic tests, and medicines before the patient's admission to the hospital. Additionally, it covers the cost of diagnostic tests and medicines up to 10 days post-discharge for the same ailment/surgery. | - All other expenses related to the patient's treatment within the hospital are also covered. | NOTE: In the case the applicant has employment with the state government, the insurance program’s benefits are also available to their dependents.
Who can apply
Required Paperwork
- Aadhaar Card
- PAN Card
- Income Certificate
- Residence Proof (Domicile)
Common Questions
Are drugs and alcohol-induced illnesses covered?
No, illnesses induced by drugs and alcohol are excluded from the policy coverage.
How much coverage is provided per family per year for hospitalization and surgical procedures?
The scheme offers coverage up to [?]5 Lacs per family per year, with [?]1 Lac for secondary ailments and [?]4 Lacs for high-cost tertiary ailments.
Can pre-existing conditions be covered under the Risk Cover?
Yes, pre-existing conditions/diseases are covered under the Risk Cover, including hospitalization and follow-up care benefits.
What expenses are included in the hospitalization expense benefits package?
The package covers registration charges, bed charges (General Ward), nursing and boarding charges, surgeons' fees, and other associated costs.
Is there coverage for diagnostic tests like X-ray, MRI, and CT Scan?
Yes, radiology tests, including X-ray, MRI, CT Scan, etc., are covered under the pathology and radiology tests package.
What is the duration of cashless services for the beneficiary?
Cashless services are available to the beneficiary from reporting to up to 10 days after discharge from the hospital.
Can medical and surgical packages be taken together for the same patient in the same hospitalization episode?
No, medical and surgical packages cannot be taken together for the same patient in the same episode of hospitalization.
What is the significance of complications in the context of the procedures?
Complications are considered a part of the procedure, and they are covered under the policy.
What are the exclusions under the policy regarding hospitalization purposes?
Conditions not requiring hospitalization, hospitalization primarily for evaluation/diagnostic purposes, and dental treatments for cosmetic or aesthetic procedures are excluded.
Is fertility-related procedures covered under the policy?
No, fertility-related procedures are excluded from the policy coverage.
Is there coverage for mental disorders under the medical packages?
Yes, mental disorders are covered under the Medical Packages, including Emergency Room Packages for care requiring less than 12 hrs stay.
How is the unit of enrollment determined?
A family is the unit of enrollment, and the head of the family can be either the husband or wife, based on the defined SECC Database.
What is the specific coverage for high-cost tertiary ailments per family per year?
The coverage for high-cost tertiary ailments is [?]4 Lacs per family per year under the Ayushman Bharat-National Health Protection Mission.
Can beneficiaries claim benefits for pre and post-hospitalization expenses?
Yes, beneficiaries can claim benefits for pre and post-hospitalization expenses, including consultation, diagnostic tests, and medicines.
How are family units determined for enrollment?
A family unit for enrollment is based on the SECC Database, and every family in the database is entitled to claim benefits under the mission.
What is the duration covered for pre-hospitalization and post-hospitalization expenses?
Pre-hospitalization expenses up to 3 days and post-hospitalization expenses up to 10 days are covered for all medicines and diagnostic tests for the same ailment/surgery.
Are there specific specialties covered under the approved list of procedures?
Yes, there is an approved list of procedures in 23 specialties, including Cardiology, Orthopedics, Urology, and Mental Disorders, among others.