Health Insurance vs Ayushman Bharat PVC Card: Understanding the Differences

In today’s world, healthcare costs are rising, and ensuring access to quality medical services has become a priority for individuals and governments alike. In India, the government has taken steps to address this issue by introducing initiatives such as Ayushman Bharat and encouraging citizens to opt for health insurance plans. This article aims to provide a detailed comparison between health insurance and the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) PVC card, highlighting their differences and helping readers make informed decisions.

• Understanding Health Insurance:

Health insurance is a contractual agreement between an individual and an insurance provider, wherein the insurer agrees to bear the insured person’s medical expenses, subject to the terms and conditions of the policy. Here are some key aspects of health insurance:

a. Coverage:

Health insurance policies offer coverage for various medical expenses, including hospitalization, doctor consultations, diagnostic tests, surgeries, and medication, among others. The coverage depends on the specific policy and the premium paid.

b. Premiums and Deductibles:

Policyholders pay regular premiums to the insurance company to maintain coverage. Additionally, some policies may require individuals to pay a deductible amount before the insurance coverage kicks in.

c. Network of Hospitals:

Insurance providers often have tie-ups with a network of hospitals, clinics, and healthcare providers. These tie-ups ensure cashless treatment for policyholders at the network facilities, making healthcare more accessible and affordable.

d. Customization:

Health insurance policies offer flexibility, allowing individuals to choose the coverage that suits their needs. One can opt for individual plans, family floater plans, or critical illness plans, among others, depending on their requirements.

• Introduction to Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY):

Ayushman Bharat PMJAY, also known as the National Health Protection Scheme, is a government-sponsored health insurance scheme launched in 2018. Here are the key aspects of the AB-PMJAY PVC card:

a. Eligibility:

AB-PMJAY aims to provide health insurance coverage to economically disadvantaged families in India. The eligibility is based on socio-economic and deprivation criteria defined by the government.

b. Coverage:

AB-PMJAY provides coverage of up to INR 5 lakhs per family per year for secondary and tertiary healthcare. The coverage includes medical expenses related to hospitalization, surgeries, pre- and post-hospitalization care, diagnostics, and medication, among others.

c. Cashless Treat`ment:

AB-PMJAY beneficiaries can avail cashless treatment at any empaneled public or private hospital across the country. The treatment expenses are directly settled by the government to the hospital.

d. No Premium:

Unlike traditional health insurance plans, AB-PMJAY does not require beneficiaries to pay any premium. The scheme is fully funded by the government.

• Key Differences between Health Insurance and AB-PMJAY PVC Card:

a. Coverage and Eligibility:

Health insurance policies are available for individuals and families across income groups. The coverage amount varies based on the premium paid and the policy selected. In contrast, AB-PMJAY targets economically disadvantaged families, providing coverage up to INR 5 lakhs per family per year.

b. Premium and Cost:

Health insurance policies require payment of regular premiums, which can vary based on factors such as age, pre-existing conditions, and coverage. AB-PMJAY, on the other hand, is fully funded by the government, and eligible beneficiaries do not have to pay any premium.

c. Network of Hospitals:

Health insurance policies have tie-ups with specific network hospitals, offering cashless treatment. AB-PMJAY, on the other hand, allows beneficiaries to access treatment at any empaneled public or private hospital across India.

d. Portability:

Health insurance policies offer portability, allowing individuals to switch between insurance providers while retaining their policy benefits. AB-PMJAY is not portable, and beneficiaries can avail treatment only through the empaneled hospitals.

e. Customization and Additional Coverage:

Health insurance policies offer customization options, enabling individuals to choose plans that align with their specific needs. They may also provide coverage for outpatient care, maternity benefits, and critical illness, which are not covered under AB-PMJAY.

Conclusion:

Both health insurance and the Ayushman Bharat PVC card (AB-PMJAY) aim to provide financial protection against medical expenses. Health insurance offers comprehensive coverage and customization options but requires payment of regular premiums. AB-PMJAY, on the other hand, targets economically disadvantaged families, providing cashless treatment without any premium. Understanding the differences between these options can help individuals make an informed decision about the type of coverage that best suits their requirements.