Modicare is a flagship healthcare program launched by the Government of India on 23 September 2018. The scheme is designed to provide affordable healthcare to over 100 million poor and vulnerable families in India which covers a population of over 500 million people.
This scheme is also known as Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). It aims to provide health insurance coverage to the poor and vulnerable sections of society who are often unable to access quality healthcare services due to financial constraints.
Modicare is one of the largest public health insurance programs in the world with an estimated budget of $1.6 billion (Rs 10000 crore) in the first year of implementation. The program is funded by the central government and the premium is subsidized by the government for eligible beneficiaries.
- The program has two components:
- Health and Wellness Centers (HWCs)
- Pradhan Mantri Jan Arogya Yojana (PMJAY)
- Health and Wellness Centers (HWCs):
Under this component the government aims to set up 150000 Health and Wellness Centers (HWCs) across the country by 2022. HWCs are meant to provide comprehensive primary health services including preventive promotive and curative services. The HWCs will be equipped with diagnostic facilities and will have a team of health professionals including doctors nurses and community health workers.
The HWCs will provide services for non-communicable diseases such as diabetes hypertension and cancer. They will also provide maternal and child health services communicable disease control programs and mental health services.
Pradhan Mantri Jan Arogya Yojana (PMJAY)
PMJAY is the insurance component of the Modicare programme. It aims to provide health insurance coverage to over 100 million families in India. Under the scheme the eligible beneficiaries will be provided with a health insurance cover of up to Rs. 5 lakh per year per family.
The plan covers hospitalization expenses related to medical and surgical treatment as well as pre- and post-hospitalization expenses. The scheme is cashless which means that eligible beneficiaries can access health services without paying anything at the time of treatment.
The scheme covers both government and private hospitals. The scheme is based on an online platform which enables eligible beneficiaries to access health services across the country. The scheme provides portability of services which means that eligible beneficiaries can access health services across the country.
Eligibility Criteria for PMJAY
The eligibility criteria for PMJAY are as follows:
Socio-Economic Caste Census (SECC) Database: The beneficiaries of the scheme will be identified on the basis of SECC database. SECC is a database of socio-economic status of households in India which was conducted in 2011 by the government.
Deprivation Criteria: Beneficiaries will be selected on the basis of certain deprivation criteria like primitive tribal group without shelter house destitute scavengers and households without adult member.
Urban and Rural Areas: The scheme covers both urban and rural areas.
Family Size: The plan covers families of up to five members. However in case of certain diseases such as cancer and heart disease the scheme covers families with more than five members.
Benefits of Modicare
Officially known as Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) the Modicare program provides several benefits to the citizens of India. Some of the key benefits of Modicare are as follows:
Access to Quality Health Services
Modicare aims to provide access to quality healthcare services to the poor and vulnerable sections of the society who are often unable to access healthcare services due to financial constraints. The program covers both government and private hospitals and enables eligible beneficiaries to access healthcare services across the country.
Financial Security
Modicare provides financial protection for high health care costs to eligible beneficiaries. The program provides health insurance cover of up to Rs. 5 lakh per family per year for pre- and post-hospitalization expenses along with hospitalization expenses related to medical and surgical treatment. The scheme is cashless which means that eligible beneficiaries can access health services without paying anything at the time of treatment.
Reduction in Out of Pocket Expenses
The high cost of healthcare often places a significant financial burden on families especially the poor and vulnerable. Modicare aims to reduce the cost of healthcare and provide financial security to eligible beneficiaries.
Better Health Outcomes
Modicare aims to improve health outcomes for eligible beneficiaries by providing access to quality healthcare services. The program focuses on providing preventive promotive and curative services including maternal and child health services communicable disease control programs and mental health services.
Employment Opportunities
The establishment of Health and Wellness Centers (HWCs) under Modicare has created employment opportunities for health professionals including doctors nurses and community health workers. This has not only helped in bridging the shortage of health professionals in the country but has also contributed to the overall economic development of the country.
Boost To Healthcare Sector
Modicare has given a boost to the healthcare sector in India. The program has created a demand for healthcare services which has led to the expansion of the healthcare sector. The program has also encouraged the development of new healthcare facilities and technologies that have helped in improving the overall quality of healthcare services in the country.
Increase In Healthcare Coverage
Modicare aims to provide universal healthcare to over 100 million families in India. By providing healthcare coverage to a large segment of the population the program has helped improve the overall health and well-being of the citizens of India. It has also helped address the issue of health disparities in the country.
In conclusion Modicare is an important program which aims to provide quality healthcare services and financial security to the poor and vulnerable sections of the society in India. The program has many benefits including improved health outcomes reduction in out-of-pocket expenditure employment opportunities and boost to the healthcare sector.
What is Modicare Product
Modicare is a direct selling company offering a wide range of products across categories like Personal Care Wellness Home Care Food & Beverages and Auto Care. The products are designed to meet the needs and preferences of the modern Indian consumer and are available through a network of independent consultants.
Here are some of the popular product categories offered by Modicare:
Personal Care
Modicare offers a range of personal care products such as skin care hair care oral care and beauty products. The products are formulated with natural ingredients and designed to meet the diverse needs of the Indian consumer.
Welfare
Modicare offers a variety of wellness products such as dietary supplements health drinks and Ayurvedic products. The products are designed to support overall health and well-being and are formulated with natural ingredients.
Home Care
Modicare offers a range of home care products such as detergents cleaning agents and air fresheners. The products are designed to provide effective cleaning solutions while remaining safe and gentle on the environment.
Food and Beverages
Modicare offers a wide variety of food and beverage products like health drinks breakfast cereals and snacks. The products are designed to provide convenient and healthy food options for the modern Indian consumer.
Autocare
Modicare also offers a range of auto care products like Car Wash Car Wax and Tire Shine. The products are designed to provide effective cleaning and maintenance solutions for automobiles.
Lastly Modicare offers a diverse range of products across categories such as Personal Care Wellness Home Care Food & Beverages and Auto Care. The products are designed to meet the diverse needs and preferences of Indian consumers and are available through a network of independent advisors.
Modicare is a government-sponsored health insurance scheme in India, officially known as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Here are some frequently asked questions (FAQs) about the scheme:
What is Modicare or AB-PMJAY?
Modicare or AB-PMJAY is a health insurance scheme launched by the Government of India in 2018. It aims to provide free healthcare services to economically weaker sections of the society, covering more than 10 crore households in India.
Who is eligible for Modicare?
Families listed in the Socio-Economic Caste Census (SECC) database, with an annual income of less than Rs. 5 lakhs, are eligible for Modicare.
What services are covered under Modicare?
Modicare covers the cost of hospitalization, treatment, and medicines for more than 1,500 medical procedures, including heart surgeries, cancer treatments, and kidney transplants.
How much does Modicare cost?
There is no cost for eligible families to avail the benefits of Modicare. The government pays the premiums for the insurance.
How can I apply for Modicare?
Eligible families are automatically enrolled in the scheme based on their inclusion in the SECC database. However, if you believe you are eligible but have not been enrolled, you can check your eligibility and apply for the scheme through the official website or by visiting a Common Service Centre.
Where can I avail the services under Modicare?
Modicare services can be availed at any empanelled public or private hospital across India.
Is there a limit on the number of times I can avail Modicare services?
No, there is no limit on the number of times you can avail Modicare services. However, the total amount of benefit available is up to Rs. 5 lakhs per family, per year.
Can I avail Modicare services for pre-existing conditions?
Yes, Modicare covers pre-existing conditions as well. However, the treatment for pre-existing conditions is subject to certain terms and conditions, and you should check with the empanelled hospital before availing the services.
How can I check the status of my Modicare claim?
You can check the status of your Modicare claim through the official website, or by contacting the customer care centre.
What should I do if my Modicare claim is rejected?
If your Modicare claim is rejected, you can file an appeal within 30 days of receiving the rejection letter. The appeal will be reviewed by an appellate authority, and the decision will be communicated to you within a specified period.