Guide to Claiming ABHA Health Insurance

Claiming Insurance with ABHA Health Account

ABHA or Ayushman Bharat Health Account is an insurance account under the Ayushman Bharat Digital Mission (ABDM). Launched on September 27, 2021, this mission aims to strengthen India’s healthcare infrastructure. By inputting all medical details, users can avail safe and single-point access to share these details across various healthcare centres and medical professionals nationwide. This access is subject to users’ consent.

Processes to Claim ABHA Insurance

Since now you are all equipped with the benefits of having an ABHA card, here are 2 processes for claiming this health insurance:

• Claiming Insurance on a Cashless Basis : Ayushman Bharat Health Account offers comprehensive access to cashless treatment at all state and certain empanelled private hospitals. The insured individual must notify the healthcare entity to seek authorisation according to the given process in your policy document. The individual can also get in touch with the medical coordinator at the healthcare unit to avail cashless facilities.
• Claiming Insurance on a Reimbursement Basis : In this case of claiming on a reimbursement basis, the beneficiary first has to pay out-of-pocket to receive healthcare services. Subsequently, the individual must submit a reimbursement form with prescriptions and other invoices on the Pradhan Mantri Jan Arogya Yojana portal. Please note that only the insured individual can raise this claim. Once reviewed, the medical cost will be reimbursed as per the current Central Government Health Scheme rates.

Both cashless and reimbursement options are part of the ABHA card claim process, and beneficiaries can track their claim status online for transparency.

Benefits of Having an ABHA Card 

The ABHA insurance can be beneficial for several reasons, such as:  

• Medical services enlisted under this scheme are free of cost up to ₹5 lakhs at state and private hospitals with an ABHA card. 
• The Government of India covers 3 days of pre-hospitalisation and 15 days of post-hospitalisation costs. 
• In the case of multiple procedures, the cost is covered under the highest package. For the second and third procedures, cost coverage will be 50% and 25%, respectively. 
• The insurance coverage is also applicable to oncology and chemotherapy costs for 50 types of cancer. 
• It also covers follow-up treatment expenses. 
• Insured individuals and beneficiaries can avail the advantage of cashless facilities along with admission services under this scheme.

Things to Keep in Mind to Claim ABHA Health Insurance 

Since the ABHA card is a digital initiative, no hard copies of it are required while claiming. However, there are certain aspects to consider for a hassle-free claiming process:

• Ensure that you keep all the medical bills close to you at the time of discharge. A single missing bill or invoice can disrupt the claiming process. 
• Please bring photocopies of your Aadhar Card, PAN card and Voter ID card while claiming.
• For future reference, keep track of all the submitted medical bills and duly filled forms. This will help you to raise a complaint in case of inconvenience.

The Government of India aspires to build a fool-proof healthcare ecosystem with the Ayushman Bharat Health Account Card. Get in touch with your nearest ABHA enrolment centre immediately or dial the toll-free customer care number 1800-11-4477 if you encounter any issues.