Last updated: 17th Mar 2024

Ayushman scheme is NOT applicable if family monthly more than 10K or you even own a landline phone

-- Does not cover Regular Medical visits
-- Does not cover Regular Medicine & Tests

AAP Health Model: UNIVERSAL for ALL, NO documents

-- Free Medicines
-- Free treatement & tests at Mohalla clinics
-- Free Diagnostics Tests (even Private centers)
-- Free Surgeries(even Private Hospitals)
-- FREE Ambulances in 15 mins

¶ Eligibility: excludes most residents

• Rural: those who fall under the 6 deprivation list^[1][2]

• Urban: those who fall under 11 specific occupational categories^[1:1][2:1]
  

¶ Further Exclusion Conditions^[3]

Even if you are part of the list above, you could still be excluded if

• Your family income is more than Rs.10,000/month; or
• you own a two wheeler; or
• you are a Government employee; or
• you have a landline phone; or
• you have a decently built houses; or
• ...full list here^[3:1]

¶ Corruption and Fraud alleged in Ayushman scheme: CAG report^[4]

-- ₹6.96 crore was disbursed for patients who were supposedly deceased^[5]
-- Same patients found in multiple hospitals during the same period^[6]

• CAG identified 1000s of registrations linked to a handful of Aadhar numbers ^[7][5:1]
• Non-existing hospitals found on the list of facilities registered on the scheme^[7:1][8]
• In 78,396 claims of 48,387 patients, date of discharge for an earlier treatment was later than admission date for another treatment^[6:1]
• Several other faults highlighted such as invalid names, duplicate health IDs, invalid entries in gender fields, unrealistic family sizes and unrealistic dates of birth^[6:2]

Further cases of fraud

• Jan 2020: c. 20,000 Ayushman cards issued under PMJAY in Gujarat to ineligible beneficiaries^[9]
• Sep 2023: 160 cases found in UP where pvt hospitals claimed bogus inflated bills^[10]
• Dec 2023: Payment of Rs 113 crore withheld over suspicious claims under Ayushman Bharat^[11]

REFERENCES:

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1. https://www.bajajfinserv.in/insurance/how-to-check-if-you-are-eligible-for-the-pradhan-mantri-jan-arogya-yojana ↩︎ ↩︎

2. https://economictimes.indiatimes.com/wealth/insure/ayushman-bharat-how-to-check-entitlement-and-eligibility/articleshow/65422257.cms?from=mdr ↩︎ ↩︎

3. https://timesofindia.indiatimes.com/business/faqs/insurance-faqs/who-is-eligible-for-pmjay/articleshow/93004759.cms ↩︎ ↩︎

4. https://www.thehindubusinessline.com/data-stories/data-focus/from-fake-accounts-to-payments-to-dead-patients-cag-finds-serious-lapses-in-ayushman-bharat-implementation/article67198748.ece ↩︎

5. https://www.thehindubusinessline.com/data-stories/data-focus/from-fake-accounts-to-payments-to-dead-patients-cag-finds-serious-lapses-in-ayushman-bharat-implementation/article67198748.ece ↩︎ ↩︎

6. https://www.businesstoday.in/latest/policy/story/ayushman-bharat-patients-shown-as-dead-getting-treatment-985-lakh-ab-pmjay-beneficiaries-linked-to-same-mobile-number-says-cag-report-393403-2023-08-09 ↩︎ ↩︎ ↩︎

7. https://www.livemint.com/politics/news/ayushman-bharat-scheme-cag-report-exposes-dummy-numbers-aadhar-irregularities-11691998961683.html ↩︎ ↩︎

8. https://www.thequint.com/fit/key-takeaways-from-cag-report-on-ayushman-bharat-pradhan-mantri-jan-arogya-yojana ↩︎

9. https://www.ndtv.com/india-news/after-fraud-20-000-ayushman-health-insurance-cards-junked-in-gujarat-says-official-2158823 ↩︎

10. https://www.hindustantimes.com/cities/lucknow-news/ayushman-bharat-scheme-bogus-bills-and-fake-admissions-uttar-pradesh-private-hospitals-inject-fraud-get-caught-101695322312381.html ↩︎

11. https://economictimes.indiatimes.com/news/india/payment-of-rs-113-crore-withheld-over-suspicious-claims-under-ayushman-bharat-government-tells-rajya-sabha/articleshow/105762672.cms?from=mdr ↩︎