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Everything to know about Ayushman Bharat Health Account

The Ayushman Bharat Health Account is a significant initiative under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. It provides financial protection to vulnerable families against devastating healthcare expenses.

Launched in September 2018, ABHA seeks to empower beneficiaries by facilitating cashless access to quality healthcare services and promoting financial inclusion. Here is everything you need to know about Ayushman Bharat Health Account:

Objective

The primary objective of the Ayushman Bharat Health Account is to create a dedicated healthcare fund and provide financial security to economically lower families. By offering cashless treatment for specified medical conditions and procedures, ABHA aims to alleviate the financial burden associated with healthcare expenses and ensure timely access to essential medical services.

Coverages

ABHA covers eligible beneficiaries identified under the Socio-Economic and Caste Census database, which includes vulnerable households based on predefined criteria such as income levels and social deprivation indicators. Beneficiaries are entitled to cashless treatment for a range of secondary and tertiary healthcare services at public and private hospitals across India.

Features

The features of ABHA include:

Cashless treatment

ABHA provides access to cashless treatment for specified medical conditions and procedures covered under the AB PM-JAY scheme.

Portability

Beneficiaries can avail of healthcare services at any network hospitals across India, irrespective of their state of residence.

Family coverages

The scheme extends coverage to all members of eligible families, ensuring comprehensive healthcare protection for households.

Pre-authorisation

Prior authorisation from the designated authorities is required for availing cashless treatment under ABHA, ensuring transparency and accountability in healthcare delivery.

Funding mechanisms

ABHA operates on a co-contribution model, wherein the central and state governments contribute funds to the healthcare account based on predefined sharing ratios. Beneficiaries may also contribute to their health account through voluntary contributions or premiums, thereby fostering a sense of ownership and responsibility for their healthcare needs.

Benefits

The benefits you enjoy under ABHA are:

Financial protection

ABHA offers financial protection against catastrophic healthcare expenses, shielding vulnerable families from the risk of impoverishment due to medical emergencies.

Access to quality healthcare

By enabling cashless access to quality healthcare services, ABHA ensures that beneficiaries receive timely and appropriate medical treatment, thereby improving health outcomes and reducing mortality rates.

Empowerment

ABHA empowers beneficiaries by giving them control over their healthcare expenditures and promoting informed decision-making regarding their health and well-being.

Implementation

ABHA is implemented through a network of state-level agencies, Insurance companies, and healthcare providers under the oversight of the National Health Authorities. Network hospitals need to adhere to predefined treatment protocols and quality standards to ensure the delivery of safe and effective healthcare services to beneficiaries.

Conclusion

As a part of Individual Health Insurance, the Ayushman Bharat Health Account represents a massive step towards achieving universal health coverage and addresses the healthcare needs of vulnerable populations in India. By offering these facilities, ABHA embodies the principles of equity, inclusivity, and social justice in healthcare delivery.

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