Assam Atal Amrit Abhiyan Application Form PDF

This is the application form for the Assam Atal Amrit Abhiyan, a Statewide Health Assurance Scheme by the Health & Family Welfare Government of Assam. This scheme aims to provide healthcare support for all Below Poverty Line (BPL) and Above Poverty Line (APL) families in the state with an annual income of up to Rs. 5 lakh. You can easily download the PDF application form from the link provided below. After completing the application form, make sure to submit it either by hand or via post to the Office of the Joint Director of Health Services in your district.

Essential Details to Include in the Atal Amrit Abhiyan Application Form

• Patients Details
• Annual Income
• Address
• Disease for which Treatment is required
• Name of Hospital where the treatment is received
• Total cost incurred in the treatment
• Any other Information

Documents Required for Application

• Photograph of the Patient (Attested by Doctor)
• Annual Income Certificate issued by Circle Officer (An attested copy of the certificate must be enclosed with the application)
• Attested copy of the Voter ID or Voter ID of Parent
• Attested copy of the Referral Certificate/Discharge certificate & Prescription from the hospital
• Original copy of the Bills attested by the treating hospital (Only from empanelled hospitals under Assam Arogya Nidhi)

Salient Features of the Assam Atal Amrit Abhiyan Scheme

1. The Scheme is being implemented with the help of an Implementation Support Agency (ISA) called Medi Assist Insurance TPA Pvt. Ltd., which has been selected for this important task.
2. This Scheme is available for all BPL and APL families in the state, having an annual household income of up to Rs. 5 lakh. Families of government employees, however, are not eligible to apply.
3. Every adult member of a qualifying family will be enrolled through the ISA and will receive a laminated ID card with a unique identification number, enabling cashless treatment at empanelled hospitals. Children under 18 years will be registered under the head of the family.
4. The Scheme is entirely free for BPL families, while APL families will need to pay a nominal annual enrolment fee of just Rs. 100/- for each member.
5. This scheme offers inpatient treatment facilities at both private and public empanelled hospitals, covering a maximum limit of Rs. 2.00 lakh per individual member, per annum. It includes 438 procedures for various diseases, such as:
   • Cardiovascular diseases
   • Cancer
   • Renal (Kidney) diseases
   • Neonatal diseases
   • Neurological conditions
   • Burns