About Ayushman CAPF
‘Ayushman CAPF’ is a convergence scheme being implemented on Ayushman Bharat PM-JAY IT platform.
A joint initiative by the Ministry of Home Affairs and the National Health Authority, which will provide cashless healthcare services to the serving CAPF personnel from all seven forces, viz. Assam Rifles, BSF, CISF, CRPF, ITBP, NSG and SSB, and their dependents through Ayushman Bharat PM-JAY IT platform.
Launched on 23rd January, 2021 in Assam, this ‘Ayushman CAPF' scheme will be implemented across the country in a phased manner.
The convergence between Ayushman Bharat and CAPF is a first of its kind initiative leveraging strengths of existing robust IT framework, access to the network of various private hospital and portability of services across country.
This initiative will help in moving away from any paper-based manual process of availing healthcare benefits by CAPF personnel and their families to a paperless service at NHA's IT platform.
In addition,a 24x7 call centre, online grievance management system, fraud and abuse control system, and real time monitoring dasboards are other key features of the scheme.
Eligibility :
Serving personnel and their dependents from Assam Rifles, Border Security Force (BSF), Sashastra Seema Bal (SSB), Central Reserve Police Force (CRPF), Central Industrial Security Force (CISF), National Security Guard (NSG), and Indo-Tibetan Border Police (ITBP) will be covered under the scheme.
Key features:
- Onboarding all CGHS empaneled Health Care
- Organizations (HCOs) on NHA IT platform
- Transfer of paper-based processes to online workflows
- Paperless verification of beneficiaries
- Referral mechanism
- Claim processing (intimation, submission, scrutiny and approval / rejection of claims)
- Online transfer of payments
- One time e-KYC authentication on Beneficiary Identification System (BIS)
- Seamless access for serving personnel and their dependents to healthcare services
- Cashless & paperless treatment and diagnostics facilities at the empaneled HCOs upon referral from the CAPF / government Hospitals / CGHS wellness centre
- Health Benefit Packages (HBP) offer more than 1853 procedures across 45 specialties
- Less waiting time for availing healthcare services
How to Avail Cashless Benefit under Ayushman CAPF
Get Ayushman CAPF card
- Beneficiaries may collect the Ayushman CAPF e-card by the respective forces. The card may be activated at empaneled private hospital, post authentication using copy of Force ID and Aadhaar or Government approved photo ID.
- Alternatively, Ayushman CAPF e-card can be obtained from Pradhan Mantri Aarogya Mitra (PMAM) stationed at PM-JAY empaneled private hospital upon presenting the above mentioned documents.
Availing Cashless Medical Treatment
- The beneficiary may avail medical treatment at CAPF or Government-owned facilities free of cost, as per the existing guidelines.
- CAPF or Government-owned facilities may refer the beneficiary to the CGHS & PM-JAY empaneled private hospital wherein beneficiary may avail cashless OPD/ IPD treatment, including diagnostics at CGHS or CAPF empaneled private hospitals. Additionally, beneficiaries may available cashless IPD treatment at other PM-JAY empaneled private hospitals. The beneficiary would be required to register at the hospital using the activated Ayushman CAPF card/ ID.
figure 1.1
| # | HCO Type | Referral required? | Services (As available) |
Mode | Guidelines/ Rates |
|---|---|---|---|---|---|
| 1 | Public HCOs, including MHA and CAPF owned facilities | No | OPD / IPD | Free services | - |
| Other | Self-paid(later claim ‘Reimbursement’) | CGHS | |||
| 2 | Private HCOs empanelled under CGHS | Yes* | OPD/IPD/ Diagnostics | Cashless | CGHS |
| Other | Self-paid(later claim ‘Reimbursement’) | CGHS | |||
| 3 | Private HCOs NOT empanelled under CGHS or under AB PM-JAY | Only in Emergency Cases | All | Self-paid(later claim ‘Reimbursement’) | CGHS |
*In Emergency cases, referral is NOT mandatory for private HCOs (empaneled or non-empaneled).
Reimbursement for Self-Paid Medical Treatment
- The beneficiary may get reimbursement in following scenarios:
Self-paid services availed at CAPF or Government owned facilities (diagnostics, implants, medicines etc.)
Self-paid services availed at non-empaneled hospitals, in case of emergency
- To raise a request for reimbursement of claims, the beneficiary can login to the website (https://tms.pmjay.gov.in/) using Ayushman CAPF ID. Beneficiary will be required to provide requisite details and upload relevant documents such as prescription, referral, invoices etc. Upon approval, payment would be made to serving CAPF personnel’s bank account through UPI, as per applicable rates.
