Andaman & Nicobar Health Insurance Scheme: ANISHI Guide

For residents of the Andaman and Nicobar Islands, accessing specialized medical treatment may require traveling to the mainland. This can raise questions about how treatment costs, referrals, and travel expenses are covered.

The Andaman & Nicobar Islands Scheme for Health Insurance (ANISHI) was introduced to provide health insurance support to eligible residents. However, ANISHI is no longer a standalone health insurance scheme. It was discontinued on June 30, 2020, and merged with Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

This guide explains how ANISHI worked, who was eligible, what benefits it provided, and how its merger with AB-PMJAY affects beneficiaries today, including access to mainland treatment and travel reimbursement.

What Is the Andaman and Nicobar Islands Scheme for Health Insurance (ANISHI)?

The Andaman & Nicobar Islands Scheme for Health Insurance (ANISHI) was a government health insurance scheme for eligible residents of the Andaman and Nicobar Islands. It provided cashless treatment at empaneled hospitals, including hospitals on the mainland, for beneficiaries who needed medical treatment outside the Islands.

Under the scheme, eligible beneficiaries could receive cashless treatment for medical care. It also reimbursed eligible transport costs for beneficiaries referred to empaneled mainland hospitals for treatment. 

ANISHI was discontinued on June 30, 2020, and subsequently merged with AB-PMJAY on August 15, 2020. Following the merger, eligible beneficiaries are covered under the current AB-PMJAY framework. 

Eligibility Criteria for Andaman and Nicobar Islands Scheme for Health Insurance

When ANISHI was active, it covered eligible residents of the Andaman and Nicobar Islands who met the scheme's prescribed criteria. These included:

• Families with an annual income below ₹3 lakh.
• Eligible Below Poverty Line (BPL) families.
• Eligible Priority Household (PHH) and Antyodaya Anna Yojana (AAY) families.
• Pensioners of the Andaman and Nicobar Administration who had settled in the Islands, along with their eligible dependents.

Today, eligible beneficiaries are covered under the applicable AB-PMJAY framework rather than a separate ANISHI policy. These include:

• SECC beneficiaries identified under the scheme.
• National Food Security Act (NFSA), Priority Household (PHH), and Antyodaya Anna Yojana (AAY) ration-card holders.
• Former ANISHI beneficiaries, who are classified as Non-SECC beneficiaries under the current framework.
• ASHA workers, Anganwadi workers and helpers, and Building & Other Construction Workers (BoCW) covered under the applicable AB-PMJAY expansion.
• Senior citizens aged 70 years and above, regardless of income, through the Ayushman Vay Vandana Card.

Benefits and Coverage Under ANISHI: Cashless Treatment and Travel Reimbursement

ANISHI provided eligible beneficiaries with cashless treatment and financial support when they needed medical care on the mainland. 

ANISHI and AB-PMJAY: How Coverage Has Expanded for Island Residents

The merger of ANISHI with AB-PMJAY expanded the hospital network available to eligible Island residents, but it also changed how the coverage works. The key differences include:

• Coverage Limit: Under ANISHI, eligible beneficiaries could receive up to ₹5 lakh per patient per illness. Under AB-PMJAY, the coverage is ₹5 lakh per family per year, so the available amount is shared among eligible family members.
• Hospital Network: AB-PMJAY gives eligible beneficiaries access to a broader network of empaneled hospitals, including hospitals outside the Islands, which can be important when specialized treatment is unavailable locally.
• Outpatient Department (OPD) Coverage: ANISHI also covered eligible outpatient department treatment. AB-PMJAY primarily covers hospitalization and specified procedures rather than routine OPD treatment.
• Pre- and Post-Hospitalization Expenses: Under AB-PMJAY, eligible hospitalization packages include expenses incurred for up to 3 days before hospitalization and up to 15 days after discharge, where applicable.

This means the merger expanded access to empaneled hospitals but changed the coverage structure. For households with multiple members or recurring medical needs, the ₹5 lakh family-level limit is shared across eligible treatments during the year.

How to Apply for ANISHI and Documents Required

To access cashless treatment, eligible beneficiaries need to complete AB-PMJAY registration under the scheme's current framework. The AB-PMJAY card, also known as the Ayushman Card, can be generated through the following channels:

• Ayushman App: Use the official Ayushman App to generate the card.
• Common Service Centre (CSC): Visit a nearby CSC for assistance with card generation.
• Government Health Institution: Approach the nearest government health facility for assistance.
• AB-PMJAY Help Desk: Visit the AB-PMJAY Help Desk at G.B. Pant Hospital, Sri Vijaya Puram for assistance.

Documents Required for Travel Reimbursement

If you are formally referred to the mainland for treatment and want to claim travel reimbursement, you need:

• AB-PMJAY e-Card.
• Aadhaar copies of the patient and one attendant.
• Patient's bank account details.
• Referral letter issued by the Director of Health Services.
• Original ship or air tickets and boarding passes for the patient and one attendant.
• Discharge summary or outpatient department slip.
• Ambulance or cab receipts, if applicable.

The reimbursement claim must be submitted to the AB-PMJAY Nodal Cell after returning to Port Blair, within 60 days of the return journey.

Empaneled Hospitals and Mainland Referrals Under ANISHI

Eligible beneficiaries can receive cashless treatment at empaneled AB-PMJAY hospitals, including hospitals on the mainland. For treatment that requires travel outside the Islands, beneficiaries should follow the prescribed referral process.

The referral is initiated by the concerned specialist at G.B. Pant Hospital, Sri Vijaya Puram. After the referral is approved, the Director of Health Services issues the referral letter for treatment at an empaneled mainland hospital. The referring specialist also recommends the appropriate mode of travel based on the patient's medical condition.

How to Find an Empaneled Hospital?

Beneficiaries can check the latest list of hospitals in the PM-JAY network through the official PM-JAY hospital search facility. The portal allows users to search for hospitals by location and other available filters.

Beneficiaries can also contact the AB-PMJAY Help Desk at G.B. Pant Hospital, Sri Vijaya Puram, for assistance with mainland referrals and empaneled hospitals.

If a beneficiary travels to the mainland without a formal referral, they can still receive cashless treatment at an empaneled AB-PMJAY hospital. However, travel expenses will not be reimbursed in such cases.

ANISHI vs. Private Health Insurance: Do You Still Need Cover?

Eligible former ANISHI beneficiaries have access to cashless treatment under the AB-PMJAY framework. However, private health insurance can still be useful as an additional layer of financial protection.

• Additional Financial Protection: A private health insurance policy can provide a higher sum insured, which may be useful for expensive treatments or multiple hospitalizations.
• Mainland Hospital Access: Private health insurance provides access to the insurer's cashless hospital network, which may offer additional hospital choices beyond the PM-JAY network.
• Coverage and Policy Features: AB-PMJAY treatment is provided according to the scheme's defined health-benefit packages and conditions. Private health insurance may offer features such as restoration of the sum insured, bonus, coverage for a wider range of medical expenses including consumables, and additional coverage options for maternity and OPD, depending on the policy.
• Mainland Travel: Private health insurance generally does not provide this specific mainland travel benefit, although individual policies may include their own road and air transportation benefits.
• Medical Inflation and Cover Adequacy: The ₹5 lakh family-level cover may become less adequate as healthcare costs rise. Medical inflation can increase the cost of hospitalization and major procedures over time, making a higher private health insurance sum insured useful for long-term financial protection.

Therefore, private health insurance can complement the coverage available under AB-PMJAY. It may be worth considering if you want higher financial protection, additional hospital choices, or coverage features beyond the government scheme.

Why Choose Ditto for Health Insurance?

At Ditto, we’ve assisted over 12,00,000 customers choose the right insurance policy. Why customers like Pallavi love us:

• 100% Free Consultation
• No Spam. No Sales Pressure.
• Rated 4.9/5 on Google Reviews by 30,000+ Happy Customers
• Backed by Zerodha
• Dedicated Claim Support Team
• Compare Plans and Premiums with a Trusted Insurance Advisor

Confused about the right insurance? Speak to Ditto’s certified advisors for free, unbiased guidance. Book your call now or chat with us on WhatsApp. Slots fill up fast!

Conclusion

The Andaman & Nicobar Islands Scheme for Health Insurance (ANISHI) provided eligible residents with cashless treatment and support for accessing specialized care on the mainland. Although the scheme is now part of the AB-PMJAY framework, beneficiaries should understand the current coverage limit, eligibility requirements, Ayushman Card process, mainland referral procedure, empaneled hospital network, and travel reimbursement rules before relying on the coverage.

If you want additional financial protection, greater flexibility in choosing hospitals, or coverage beyond what AB-PMJAY provides, it is worth comparing some of the best health insurance plans in India to find a policy that complements the government scheme and fits your healthcare needs.