Introduction: From Having a Card to Getting Treatment
So, you have successfully applied for and downloaded your Ayushman Card. Congratulations! You now hold the key to a ₹5 lakh annual health cover. But how do you actually use it when you need it the most? Navigating the hospital process can be daunting, but the Ayushman Bharat scheme is designed to be simple and beneficiary-friendly. The entire system is cashless, paperless, and portable.
This detailed guide will walk you through the complete step-by-step process of using your Ayushman Card at any empanelled hospital in India, ensuring you are well-prepared and can avail the benefits without any hassle.
Before You Go to the Hospital: Preparation is Key
A little preparation can make your hospital visit much smoother. Before you leave, make sure you have the following:
- Confirm the Hospital is Empanelled: The scheme is only valid at empanelled hospitals. You can check the list on your state's hospital page, for example, the Uttar Pradesh Hospital List, or the official NHA portal.
- Patient's Ayushman Card: Carry a physical copy or a digital version of the patient's Ayushman Card (Golden Card) on your mobile.
- Patient's Aadhaar Card: This is mandatory for biometric verification at the hospital.
- Doctor's Prescription (if any): If you have been referred by a doctor for admission, carry that prescription.
First, ensure you know how to check your name in the Ayushman list to confirm your eligibility beforehand.
The Process at the Hospital: A Step-by-Step Walkthrough
Once you arrive at the empanelled hospital, the process is handled by a dedicated professional to ensure you don't face any issues.
- Step 1: Contact the Ayushman Mitra
Every empanelled hospital has a dedicated Ayushman Mitra helpdesk, usually near the reception or main entrance. The Ayushman Mitra is a trained professional whose job is to guide beneficiaries. Approach them and inform them that the patient is an Ayushman Card holder.
- Step 2: Verification of Beneficiary
The Ayushman Mitra will ask for your Ayushman Card number and Aadhaar Card. They will use a biometric device (fingerprint scanner) to verify the patient's identity against the Aadhaar database. This is a quick and secure process.
- Step 3: Pre-Authorization Request
After successful verification, the hospital's medical team will assess the patient's condition. The Ayushman Mitra and the hospital staff will then digitally submit a "pre-authorization request" to the insurance company or the state health agency. This request includes the patient's diagnosis and the planned treatment package. This entire process is online and usually gets approved within a few hours. For emergencies, this is done on a high-priority basis.
- Step 4: Cashless Admission and Treatment
Once the pre-authorization is approved, the patient is admitted, and the treatment begins. From this point onwards, the entire process is completely cashless for you. This includes:
- Doctor's consultation and surgery fees.
- All required medicines and consumables.
- All diagnostic tests like blood tests, X-rays, MRI/CT scans.
- Bed charges and food for the patient.
- ICU and OT charges.
- Step 5: Discharge Process
At the time of discharge, the hospital will submit the final bills and treatment records to the portal for the final claim settlement. You will not be asked to pay any money. You will be provided with a discharge summary and all necessary reports. The scheme also covers post-hospitalization expenses for up to 15 days, for which the hospital will provide the required medicines.
What If You Haven't Applied for the Card Yet?
If you are eligible but haven't made your card, you can do it directly at the hospital. The Ayushman Mitra can check your eligibility using your Aadhaar or ration card and complete the e-KYC process on the spot. If you're unsure how to start, you can read our guide on how to apply for an Ayushman Card online.
Frequently Asked Questions (FAQs)
Q. Can I get treatment in a different state with my Ayushman Card?
Yes. Ayushman Bharat offers national portability. This means you can use your card, issued in any state, to get cashless treatment at any empanelled hospital across India.
Q. What is not covered under the scheme during hospitalization?
While the scheme covers almost all aspects of treatment, it typically does not cover expenses for personal comfort items, special diets not prescribed by the doctor, or the cost of stay for family members.
Q. Does the hospital decide which treatment package to use?
The government has defined specific treatment packages for over 1,900 procedures. The hospital's medical team selects the appropriate package based on your diagnosis. This ensures standardized and transparent billing.