Ayushman Bharat health insurance: In a significant move to assist 4.5 crore families, the Union Cabinet on Wednesday (September 11) approved health coverage for senior citizens under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
AB PM-JAY is the world’s largest publicly funded health assurance scheme which provides health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to 55 crore individuals corresponding to 12.34 crore families. All members of the eligible families irrespective of age are covered under the scheme. The scheme has covered 7.37 crore hospital admissions including 49 per cent women beneficiaries. The public has benefited to the extent of over Rs 1 lakh crore under the scheme.
Notably, the expansion of cover to senior citizens of the age of 70 years and above was earlier announced by Prime Minister Modi in April 2024.
Who is eligible?
- All senior citizens of the age 70 years and above irrespective of their socio-economic status would be eligible to avail the benefits of AB PM-JAY.
- All senior citizens will get Rs 5 lakh free health insurance cover on a family basis.
- The senior citizens belonging to families already covered under AB PM-JAY will get an additional top-up cover upto Rs 5 lakh per year for themselves (which they do not have to share with the other members of the family who are below the age of 70 years).
- Senior citizens with private health insurance policies or Employees’ State Insurance scheme will be eligible to avail benefits under AB PM-JAY.
- However, senior citizens aged 70 years and above who are already availing benefits of other public health insurance schemes such as the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS) and Ayushman Central Armed Police Force (CAPF) may either choose their existing scheme or opt for AB PMJAY.
- All eligible beneficiaries will be issued a distinct card to avail the scheme.
Benefit cover under PM-JAY
Benefit cover under various government-funded health insurance schemes in India have always been structured on an upper ceiling limit ranging from an annual cover of Rs 30,000 to Rs 3,00,000 per family across various states which created a fragmented system. PM-JAY provides cashless cover of up to Rs 5,00,000 to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment.
- Medical examination, treatment and consultation
- Pre-hospitalization
- Medicine and medical consumables
- Non-intensive and intensive care services
- Diagnostic and laboratory investigations
- Medical implantation services (where necessary)
- Accommodation benefits
- Food services
- Complications arising during treatment
- Post-hospitalization follow-up care up to 15 days
The AB PM-JAY scheme has witnessed continuous expansion of the beneficiary base. Initially, 10.74 crore poor and vulnerable families comprising the bottom 40 per cent of India’s population were covered under the scheme. Later, the Government of India, in January 2022 revised the beneficiary base under AB PM-JAY from 10.74 crore to 12 crore families considering India’s decadal population growth of 11.7 per cent over the 2011 population.
The scheme was further expanded to cover 37 lakh ASHAs/AWWs/AWHs working across the country and their families for free healthcare benefits. Taking the mission ahead, AB PM-JAY would now provide free healthcare coverage of Rs 5 lakh to all citizens of the age group of 70 years and above across the country.
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