Atal Amrit Abhiyan Health Insurance Scheme

What is Atal Amrit Abhiyan?

Atal Amrit Abhiyan is the health assurance scheme of the Health & Family Welfare Department, Government of Assam. Atal Amrit Abhiyan provides insurance coverage of up to Rs 2 lakh per year to each eligible family in the state, used as cashless treatment for a defined list of serious illnesses.

Atal Amrit Abhiyan was launched on 25 December 2016. According to the Assam state portal, the scheme was created "for BPL and APL families besieged with chronic, sudden, or acute health issues", that is, it targets the household that is pushed into debt by one catastrophic hospital admission rather than by routine illness.

The design is deliberately narrow and deep. Atal Amrit Abhiyan does not try to cover every ailment; it covers 437 identified critical diseases and pays for them fully up to the Rs 2 lakh ceiling, at hospitals that have been empanelled in advance.

Key features

• Cashless only. The state portal is explicit that beneficiaries "avail cashless treatment (not reimbursement)".
• Family-level cover of Rs 2 lakh per year, not per person per episode.
• Portable outside Assam. Cashless treatment is available at government and empanelled private hospitals inside and outside the state.
• Benefits are triggered at the hospital, on the basis of the insurance cover, rather than through any claim form filed by the family afterwards.

Which diseases does Atal Amrit Abhiyan cover?

The Assam state portal records that a total of 437 diseases are covered, segregated into six groups:

The portal summarises the same list as covering "cancer, cardiovascular diseases, kidney diseases, neonatal diseases, brain and heart-related ailments and burn injuries". Conditions outside these six groups are not covered by Atal Amrit Abhiyan, which is the single most important thing for a family to check before relying on the card.

Who is eligible for Atal Amrit Abhiyan, and who is not eligible?

Eligibility is decided purely by annual family income, with one hard occupational exclusion.

Who can enrol

• BPL families with an annual income of less than Rs 1.2 lakh. The state portal states that all such families in Assam get free health care under the scheme.
• APL families with an annual income between Rs 1.2 lakh and Rs 5 lakh. They are covered on payment of a nominal premium of Rs 100 per year per member.

Who cannot apply or is not eligible

• All employees working in, or retired from, the service of the Central and State Governments are not eligible for this scheme. Assam runs a separate health scheme: Mukhya Mantri Lok Sevak Arogya Yojana (MMLSAY), for state government employees, contractual staff and pensioners, and government employees should look there instead.
• Families with annual income above Rs 5 lakh fall outside both the BPL and APL slabs the scheme defines.
• Anyone whose documents do not establish the BPL or APL category claimed. The portal notes that all documents of each enrolment are checked properly to confirm whether the family belongs to the BPL or the APL category.

What documents are required for Atal Amrit Abhiyan?

Because the whole scheme turns on the income slab, the income certificate is the document worth getting right first. An income certificate can be applied for online through Assam's Sewa Setu platform, which lists "Application for Income Certificate" among its Revenue & Disaster Management services.

How to apply for Atal Amrit Abhiyan

Atal Amrit Abhiyan enrolment is an offline, in-person process at a designated enrolment centre. There is no self-service online registration for a citizen.

1. Find your nearest Atal Amrit Abhiyan enrolment centre. The Assam state portal states that "the enrolments for the scheme are open and one can reach out to the enrolment center to get themselves registered under the scheme". Ask at your district health office, the office of the Joint Director of Health Services, or your nearest government hospital for the current centre.
2. Get an income certificate first if you do not already hold one, because the certificate is what places your family in the free BPL slab or the paid APL slab.
3. Carry the document set — Voter ID, EPIC (or original birth certificate for minors), the income certificate, your NFSA ration card if you have one, and a doctor-attested photograph.
4. Complete the enrolment form at the centre for the whole family, since the Rs 2 lakh cover is a family-level cover.
5. Pay the premium if you are in the APL slab; Rs 100 per year per member. BPL families pay nothing.
6. Collect the Atal Amrit Abhiyan card and keep it with the family's identity documents. The card is what triggers cashless admission at the hospital.

How do you actually use the Atal Amrit Abhiyan benefit?

1. Confirm the hospital is empanelled before admission. Treatment is available only at government-aided and CGHS-empanelled hospitals and at empanelled private hospitals; a non-empanelled hospital cannot give you the benefit and the bill cannot be reimbursed later.
2. Present the Atal Amrit Abhiyan card at the hospital help desk at the time of admission. The state portal states that eligible beneficiaries get the benefits "at the time of treatment in the hospital on the basis of insurance cover".
3. Check that the condition falls in one of the six disease groups. A condition outside cardiovascular, cancer, kidney, neo-natal, neurological and burns is not covered.
4. Track the Rs 2 lakh annual family limit. The ceiling is per family per year, so an earlier admission in the same year reduces what is left for a later one.

How large is the scheme?

The Assam state portal records enrolment and utilisation figures up to 23 March 2020: 2,45,491 APL enrolments, 1,58,89,339 BPL enrolments, and 85,717 treatments under Atal Amrit Abhiyan. The portal also notes that the state government would bear an additional burden of Rs 200 crore to implement the scheme, and that the government has been working to empanel more hospitals so that residents can access treatment without difficulty.

Why do Atal Amrit Abhiyan claims fail?

• The hospital is not empanelled. This is the most common and the most expensive mistake, because Atal Amrit Abhiyan does not reimburse.
• The condition is outside the 437-disease list or outside the six covered groups.
• The Rs 2 lakh annual family limit is already exhausted by an earlier admission in the same year.
• The card or enrolment record does not match the identity documents produced at admission.
• The family falls in the excluded category. A serving or retired central or state government employee in the family unit.
• APL premium not paid for the year, leaving the cover lapsed.

Where do you get help with Atal Amrit Abhiyan?

• The Health & Family Welfare Department, Government of Assam (hfw.assam.gov.in) is the administering department and publishes the state's health scheme information.
• Your district health authority and the Atal Amrit Abhiyan enrolment centre handle enrolment, card issue and card correction.
• The help desk at the empanelled hospital is the point of contact for a live admission that is being refused cashless treatment.

A note on verification. The dedicated Atal Amrit Abhiyan portal (atalamritabhiyaan.assam.gov.in) did not resolve at the time this guide was fact-checked, so every figure above is taken from the Government of Assam's own state portal scheme page for Atal Amrit Abhiyan, last updated by the department on 16 June 2023. Assam has since expanded its health coverage through Ayushman Bharat and the state's Ayushman Asom initiative, so confirm at your district health office which card applies to your family before you rely on the Atal Amrit Abhiyan cover.