What is SEHAT Health Insurance Scheme?

Prime Minister Narendra Modi launched SEHAT (Social, Endeavour for Health and Telemedicine) Health Insurance Scheme on December 26, 2020. This plan serves as an extension to the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and will provide free healthcare coverage to all residents of Jammu and Kashmir Union Territory.

PMJAY is the world’s largest health insurance scheme that is fully financed by the government under which SEHAT will offer individuals a cover of INR 5 lakh per family per year for secondary and tertiary care hospitalization. One of the best things about this plan is that eligible individuals can get this coverage across all public and private empanelled hospitals in India. Around 21 lakh families of the UT of J&K will get free-of-cost insurance cover under the SEHAT scheme.

Here, we will talk about different aspects related to the SEHAT Health Insurance Scheme to give you a better idea about the same. Let’s start.

Key Features of SEHAT Health Insurance Scheme in Detail

SEHAT Health Insurance Scheme provides cashless health cover to the beneficiaries under the scheme. We have discussed the key features of this plan below. Please check.

1. All residents of the Jammu and Kashmir Union Territory will not only get coverage under the AB-PMJAY SEHAT Health Insurance Scheme but also AB-PMJAY.
2. Under this plan from the Government of India, individuals will get a coverage of INR 5 lakh per family on a floater sum insured basis. It means that the sum insured will float among all the family members in a medical emergency.
3. Individuals will also get an additional extension cover up to INR 15 lakh under ABPM-JAY.
4. There is no capping on the family size or age of the eligible individuals under the plan. It means you can cover all your family members under the scheme without any maximum age limit to contend with.
5. The benefits under the scheme will be portable across the country. In case of a medical emergency, you are not bound to get treatment only in J&K but also across India.
6. Beneficiaries can receive free and cashless treatment at more than 23,000 public and private hospitals across the country up to the sum insured.

What Does SEHAT Health Insurance Scheme Cover?

Eligible individuals will get coverage for the following conditions under the scheme from the Central Government of India.

1. Different medical procedures, including Oncology, Cardiology, Nephrology, etc.
2. Three days of Pre-hospitalization Cover
3. 15-days of Post-hospitalization Cover
4. Diagnostic Tests and Procedures
5. Medicines Costs

How to Apply for SEHAT Health Insurance Scheme?

We have discussed the steps to avail care under SEHAT Health Insurance Scheme below. Please check.

1. Residents of J&K UT who want to apply for the SEHAT Insurance Scheme will need to visit any of the nearest empanelled hospitals under ABPM-JAY or Common Service Center (CSC).
2. Here, you will need to obtain a SEHAT application form from the authorities.
3. Fill in your details on the application form and attach the list of required documents with the same.
4. You will need to submit the duly-filled SEHAT form to the concerned department at the empanelled hospital or CSC Kendra.
5. The authorized people will identify the deserving candidates through Aadhar Card, Voter ID Card or J&K Ration Card.
6. Once all the details are validated successfully, you will get a Golden Card.
7. Arogya Mitra or Common Service Centre will inform the beneficiary about the identified empanelled hospitals to get the due treatment.

What is the Golden Card under SEHAT Health Insurance Scheme?

As mentioned in the previous section, eligible individuals will get a Golden Card after the approval of their applications. This card is issued for registration purposes under the scheme and serves as proof that an individual is eligible to get the benefits under the scheme.

The Golden Card has a unique registration number – SEHAT Registration ID. At the time of treatment of an illness or disease, it is mandatory to show your SEHAT Golden Card at the hospital. The hospital will not provide the coverage amount in case an individual fails to present the card.

Eligibility Criteria and Documents Required for SEHAT Health Insurance Scheme

To be eligible for the SEHAT Health Insurance Scheme, applicants should be permanent citizens of Jammu and Kashmir. You will need the following details to apply for this scheme.

1. Age Proof (Driving Licence, Passport, etc.)
2. ID Proof (Aadhar Card, PAN Card, etc. )
3. J&K Ration Card
4. Residence Proof
5. Recent Passport-sized Photograph
6. Mobile Number

How to Contact SEHAT Health Insurance SchemeHelpline Number?

In case you have any problems or queries related to the SEHAT scheme, you can contact customer care by calling any of the following numbers.

1. 1800 233 5554
2. 1800 111 565
3. 14555
4. 0194 290923
5. 0191 2478585