Ayushman Bharat's Rs 5 Lakh Health Insurance for Seniors: Who's Eligible and How to Apply

On September 11, 2024, the Union Cabinet made a landmark decision to expand the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) in a move that will significantly impact the lives of senior citizens across India. This expansion ensures that all senior citizens aged 70 and above will receive health insurance coverage up to Rs 5 lakh per family, regardless of their income. This significant expansion is set to benefit approximately 4.5 crore families, including 6 crore senior citizens.  

Eligibility for Ayushman Bharat Health Insurance for Senior Citizens

• Senior Citizens: All senior citizens aged 70 and above are eligible for the expanded benefits of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). Under this scheme, they receive a health insurance cover of Rs 5 lakh per year on a family basis, ensuring comprehensive protection for medical expenses.

• Distinct New Card for Seniors: As part of this expansion, eligible senior citizens will receive a new, unique card under the AB PM-JAY scheme. This card will facilitate access to the enhanced health coverage and simplify the process of availing benefits.

• Top-Up Coverage for Existing Families: Senior citizens who are part of families already covered by AB PM-JAY will benefit from an additional top-up cover of up to Rs 5 lakh per year. This top-up is designated specifically for them and is separate from the coverage available to other family members under the age of 70.

• Family Coverage for Non-Members: Seniors who do not belong to an existing AB PM-JAY family coverage will receive a coverage of up to Rs 5 lakh per year on a family basis, ensuring comprehensive health protection.

• Options for Existing Scheme Beneficiaries: Those already covered under other public health insurance schemes, such as the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), or Ayushman Central Armed Police Force (CAPF), can either continue with their current scheme or opt for the benefits under AB PM-JAY.

• Eligibility with Private Insurance: Senior citizens covered by private health insurance policies or the Employees’ State Insurance scheme are also eligible to benefit from AB PM-JAY, providing them with additional flexibility and support.

Benefits of AB PM-JAY for Senior Citizens

The AB PM-JAY scheme is renowned for its extensive coverage, and the recent expansion enhances its reach and impact. Here’s what senior citizens can expect:

• Medical Examinations and Consultations: Coverage includes expenses for medical examinations, consultations, and treatments, ensuring that seniors receive comprehensive care.

• Pre-Hospitalisation Care: Costs incurred up to three days before hospitalization are covered, allowing for seamless care coordination.

• Medicines and Consumables: Essential medications and medical consumables are included, reducing out-of-pocket expenses for necessary treatments.

• Intensive Care Services: The scheme covers both non-intensive and intensive care services, including ICU care, addressing critical health needs.

• Diagnostic Investigations: All necessary diagnostic and laboratory tests are covered, aiding in accurate and timely diagnosis.

• Medical Implants: Coverage includes the cost of medical implants, if required, ensuring that seniors receive advanced medical support.

• Accommodation and Food Services: During hospitalisation, expenses for accommodation and food services are provided, contributing to a more comfortable recovery experience.

• Treatment Complications: Any complications arising during treatment are also covered, ensuring comprehensive care.

How to Apply

Applying for the AB PM-JAY scheme is straightforward. Here’s a step-by-step guide:

1. Visit the Official Website: Start by visiting the AB PM-JAY official website to access the application portal and gather relevant information.

2. Verification: At a PMJAY kiosk, have your Aadhaar card or ration card verified. This step is crucial for establishing eligibility.

3. Submit Proofs: Provide necessary family identification proofs to complete the verification process.

4. Obtain e-Card: Once verified, you will receive an e-card with a unique AB-PMJAY ID. This card will be used to access the benefits of the scheme.

The Impact of the Expansion

The AB PM-JAY is already the world’s largest publicly funded health assurance scheme, covering Rs 5 lakh per family per year for secondary and tertiary care hospitalization. The recent expansion to include all senior citizens aged 70 and above reflects the government’s commitment to enhancing healthcare access for the elderly, a vital demographic that requires special attention.

Initially launched to cover the poorest and most vulnerable families, the scheme has progressively expanded its reach. From covering 10.74 crore families, the beneficiary base has grown to 12 crore, with further expansions to include additional groups like ASHAs/AWWs/AWHs and now, senior citizens aged 70 and above.

This expansion underscores a significant step towards inclusive healthcare, ensuring that senior citizens, regardless of their socio-economic status, have access to essential health services. By providing up to Rs 5 lakh coverage, the scheme aims to alleviate the financial burden of medical expenses and improve the overall quality of life for India's elderly population.

For more details on eligibility and to apply, visit the official AB PM-JAY website and take advantage of this critical health coverage opportunity.