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Sarbat Sehat Bima Yojana (AB-SSBY): Benefits, Eligibility, Diseases Covered & How To Enrol

TeamAckoDec 9, 2024

For many in India, healthcare costs are very difficult to afford. Many families are pushed into poverty because of medical treatment. In such situations, having reasonable Insurance coverage can protect weak and poor families.

Keeping in mind this aspect, the Punjab government started the Ayushman Bharat - Sarbat Sehat Bima Yojna (AB-SSBY) for vulnerable people. Now, economically weak people can also afford medical treatment. In this blog, we will cover all the crucial details regarding this scheme and how it benefits the common people.

Sarbat Sehat Bima Yojana

Contents

Sarbat Sehat Bima Yojana
Benefits of Sarbat Sehat Bima Yojana
Diseases Covered Under Sarbat Sehat Bima Yojana
- Number Of Beneficiaries Covered Under Sarbat Sehat Bima Yojana
Who Is Eligible For Sarbat Sehat Bima Yojana?
How To Enrol For Sarbat Sehat Bima Yojana?
Documents Required For AB-SSBY Enrollment
- Which Hospitals Are Empanelled Under Sarbat Sehat Bima Yojana?
Fees For Sarbat Sehat Bima Yojana Card
Coverage Under Sarbat Sehat Bima Yojana
Claim Process Steps
Reimbursement Process
Benefits of an Insurance Coverage
Frequently Asked Questions (FAQs)

Sarbat Sehat Bima Yojana

The Punjab government launched the Sarbat Sehat Bima Yojna on 20 August 2019. It ensures health insurance coverage of up to Rs. 5 lakh per family per year for secondary and tertiary care hospitalisation (in-patient services).

It extends medical coverage to 65% of the population of Punjab. This means coverage of 39.66 lakh families. Private as well as public hospitals are empanelled under the scheme.

Benefits of Sarbat Sehat Bima Yojana

The benefits of the Sarbat Sehat Bima are as follows:

It provides coverage of up to Rs. 5 lakh per year per family.
It offers 1,579 secondary and tertiary medical care packages.
Coverage of pre-existing diseases from the very beginning of the scheme.
Some of the poorest families in Punjab are covered by this scheme.
Pre-hospitalisation coverage of up to three days and post-hospitalisation coverage of up to 15 days.
Daycare surgeries are included.
Medical expenses for newborn babies are covered.

Diseases Covered Under Sarbat Sehat Bima Yojana

Some of the diseases covered by the Sarbat Sehat Bima Yojana Card are listed below.

Cardiology
Mental disorder
General surgery
Orthopaedics
Paediatric surgery
Plastic surgery
Eye surgery
General medicine
Neurosurgery
Polytrauma
Radiation oncology
COVID-19
Cancer
Other severe diseases
MRI and CT scan

Number Of Beneficiaries Covered Under Sarbat Sehat Bima Yojana

Below, we have listed the number of beneficiaries covered under different categories.

Category	Number
NFSA ration card	18.49 lakh
SECC beneficiaries	16.65 lakh
Construction workers	3.12 lakh
Small traders	0.33 lakh
Journalists	3220

Who Is Eligible For Sarbat Sehat Bima Yojana?

As per the official website, 39.66 lakh families are currently covered by the Ayushman Bharat - Sarbat Sehat Bima Yojna (AB-SSBY). It includes the following categories.

Families covered as per data from SECC 2011.
Smart ration card holder families.
J-form holder farmers.
Small traders registered with the Excise & Taxation Department.
Small and marginal farmers.
Accredited journalists with yellow card.
Construction workers registered with Punjab Building and Other Construction Workers Welfare Board.

How To Enrol For Sarbat Sehat Bima Yojana?

As per the official website, there is no separate enrolment process for the Sarbat Sehat Bima Yojana. It is an entitlement-oriented scheme.

The data for enrollment in the scheme is prepared as per information provided by the following entities.

Food and Civil Supply Department for Smart ration card holders
Excise & Taxation Department for traders
Punjab Mandi Board for J-form holder farmers, Small and Marginal Farmers
PUNMEDIA for Accredited and Yellow Card Journalists
Construction Workers Welfare Board for construction workers.

You can do the SHA Punjab eligibility check online and check if you have been enrolled for the Sehat Bima card.

Documents Required For AB-SSBY Enrollment

To enroll in the scheme, here is a list of documents required for the registration process:

1. Identity Proof

Documents to establish the applicant's identity:

Aadhaar Card
Voter ID
PAN Card
Passport
Driving License

2. Address Proof

Documents that confirm the applicant's residential address:

Aadhaar Card (if not already used as identity proof)
Electricity Bill
Ration Card
Bank Passbook with Address
Lease Agreement/Property Tax Receipt (if applicable)

3. Eligibility Proof

Documents confirming eligibility for AB-SSBY based on socio-economic status:

Ration Card (indicating family category under the scheme)
SECC Data Certificate (Socio-Economic Caste Census)
BPL (Below Poverty Line) Card (if applicable)
Income Certificate (if required by the state)

4. Family Composition Proof

Documents for listing family members under the scheme:

Ration Card (showing family details)
Joint Family Certificate (if applicable)
Marriage Certificate (in cases where spousal relationship needs validation)

5. Bank Account Details

For linking insurance claims and payments:

Bank Passbook (with account holder's name and IFSC code)
Cancelled Cheque

6. Photographs

Passport-Size Photographs (as specified by the enrollment center, usually 2-4)

Which Hospitals Are Empanelled Under Sarbat Sehat Bima Yojana?

You can go to the official website to find out which hospitals are empanelled under the scheme.

Fees For Sarbat Sehat Bima Yojana Card

Beneficiaries can go to Common Service Centers (CSC), market committees, and Sewa Kendras to get a printout of the Sehat Bima Card for Rs. 30.

Coverage Under Sarbat Sehat Bima Yojana

The health benefits provided under the SSBY Punjab scheme include coverage for surgeries, newborn care, up to three days of pre-hospitalization expenses, up to 15 days of post-hospitalization costs, and various other hospitalization charges.

Below is a list of common medical conditions and treatments covered under the AB-SSBY scheme:

General Surgery
Cardiology
General Medicine
Eye Surgery
Mental Health Disorders
Plastic Surgery
Paediatric Surgery
Neurosurgery
Cancer
COVID-19 Treatment
Polytrauma
Radiation Oncology
Orthopaedics
CT Scans
MRI Scans
Other Critical Illnesses

Claim Process Steps

1. Locate an Empanelled Hospital: Beneficiaries must first find an empanelled hospital under the AB-SSBY scheme. A list of such hospitals can usually be accessed on the official website of the State Health Agency, Punjab.

2. Submit Required Documents: Once at the hospital, beneficiaries are required to submit their AB-SSBY card and other identification documents, if any (e.g., Aadhaar card, ration card).

3. Cashless Treatment: Once admitted to the hospital, the beneficiaries will receive treatment for their specific medical condition. Post-treatment, the beneficiary has to pay no hospital bills. The hospital will directly settle the claim with the insurance company for the eligible amount.

4. Post-Hospitalization Claims: For expenses incurred post-hospitalization, the beneficiary may be required to provide additional documentation as defined by the hospital or insurance provider for up to 15 days.

Reimbursement Process

In some cases where cashless payment is not available at the hospital administering treatment or any other case, the reimbursement option is given. This is where the beneficiary of the scheme can pay for his medical bills for the time being and get reimbursed under the scheme terms later on. Following are the steps of this reimbursement process:

1. Treatment Details: Maintain the entire medical history, including diagnosis and treatment bills, prescriptions, and discharge summaries.

2. Submission of Application: Reimbursement Claim Form: Collect and fill out the reimbursement claim form. This form can usually be obtained from the hospital or downloaded from the official website of the State Health Agency, Punjab. Submit the completed claim form along with all collected documents to the designated authority or insurance provider.

3. Claim Review and Approval: The reimbursement is done based on the terms and coverage limits of the scheme. Upon successful processing of the claim, the beneficiaries will get reimbursed for eligible expenses directly to their bank account.

Benefits of an Insurance Coverage

We would recommend that you buy insurance coverage to protect yourself against medical and financial hazards. Throughout India, many families are facing financial distress due to medical costs. In this section, we will cover some of the features of an insurance cover.

Financial Security

Many families fall into poverty because of healthcare expenses. It is impossible to predict when a disaster will strike. Thus, insurance can cover a significant amount of the treatment that a patient would need. Thus it can save your health as well as wealth.

Premium Linked To Risk Value

One of the key factors in deciding the premium for insurance coverage is the risk potential of the applicant. So a healthy applicant will have to pay a lower premium for insurance coverage.

Tax Benefits

Many of the insurance coverage packages are tax-free or come with tax incentives. So you can pick and choose your insurance coverage as per your needs.

Peace of Mind For Family

In case of untimely death of the head of the family, the family will stay protected from financial dangers if there is enrollment for insurance coverage. Thus, it guarantees peace of mind.

Key Takeaway

Sarbat Sehat Bima Yojna (SSBY) is a scheme for uplifting economically vulnerable families in Punjab. By offering extensive healthcare coverage, this scheme ensures access to essential medical services without the burden of financial distress. This initiative is a step towards providing equitable healthcare and safeguarding the well-being of countless families in Punjab.

Frequently Asked Questions (FAQs)

Here are some commonly asked questions about the Sarbat Sehat Bima Yojana.

1. What is the Sarbat Sehat Bima Yojana?

It is a health insurance scheme started by the Punjab government to protect economically vulnerable people. It provides coverage of up to Rs. 5 lakh per family per year.

2. How to enrol for Sarbat Sehat Bima Yojana?

The government hasn’t prescribed any separate procedure for enrollment. They have prepared a list of beneficiaries on the basis of the data they already have.

3. How much fees has to be paid for Sarbat Sehat Bima Yojana?

A fee of Rs. 30 has to be paid to get a printout of the Sehat Bima card.

4. Which diseases are covered by the Sarbat Sehat Bima Yojana?

Some of the diseases covered under Sarbat Sehat Bima Yojana Card are as follows.

Cardiology
Mental disorder
General surgery
Orthopaedics
Paediatric surgery
Plastic surgery
Eye surgery
General medicine
Neurosurgery
Polytrauma
Radiation oncology
COVID-19
Cancer
Other severe diseases
MRI and CT scan

5. Am I eligible for Sarbat Sehat Bima Yojana?

You can find out from the official website by entering your details.

6. What are the benefits of Sarbat Sehat Bima Yojana?

The benefits of Sarbat Sehat Bima are as follows.

Coverage of up to Rs. 5 lakh per year per family.
1579 secondary and tertiary medical care packages.
Coverage of pre-existing diseases.
Pre-hospitalisation coverage of up to three days and post-hospitalisation coverage of up to 15 days.
Daycare surgeries included.
Medical expenses for newborn babies are covered.