Ayushman Bharat health insurance for senior citizens: Who are eligible for ₹5 lakh coverage?

Rs 5 Lakh Health Insurance Under Ayushman Bharat for Senior Citizens Above 70 Years: Eligibility, Benefits, and How to Apply

The Indian government has taken a significant step towards ensuring the health security of its elderly population by extending health insurance benefits to senior citizens above the age of 70 under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). This announcement came in a Press Information Bureau (PIB) release on September 12, 2024, which declared that every senior citizen aged 70 and above will now be eligible for health insurance under this scheme, regardless of their income or socio-economic status.

The government’s decision is part of the ongoing efforts to provide access to healthcare for the elderly, especially those who are more vulnerable to illnesses and health complications. This initiative will benefit millions of senior citizens across the country, offering them financial protection against medical emergencies.

What Is Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)?

Ayushman Bharat PM-JAY is one of the largest government-sponsored health insurance schemes in the world, designed to provide free healthcare to vulnerable and low-income families. Initially launched in 2018, the scheme aimed to cover 10.74 crore families—approximately 40% of India’s population. Over time, the scheme has undergone expansions, and by 2024, it covers more than 12 crore families.

The key offering of the scheme is health coverage up to Rs 5 lakh per family per year for secondary and tertiary care hospitalization. This is meant to cover both the poor and vulnerable sections of society, ensuring that healthcare expenses do not become a financial burden.

In September 2024, the scheme was further expanded to include all individuals aged 70 and above, irrespective of their income or pre-existing health conditions, under the new guidelines.

Key Benefits of Ayushman Bharat for Senior Citizens Above 70

The new policy offers the following major benefits to senior citizens:

1. Rs 5 Lakh Coverage

Each senior citizen above the age of 70 years will receive health coverage of up to Rs 5 lakh per year. This includes hospitalization, surgeries, pre- and post-hospitalization expenses, ICU services, and more.

2. No Income or Socio-Economic Criteria

Unlike the earlier version of the PM-JAY scheme, this extension removes all income barriers. Any citizen aged 70 years or above is eligible, whether they are from an economically disadvantaged background or not.

3. Top-Up Cover for Pre-Enrolled Beneficiaries

For families already enrolled in AB PM-JAY, senior citizens (aged 70 and above) will get a separate top-up cover of Rs 5 lakh, which will be exclusive to them. This means they do not have to share their coverage with other family members under 70.

4. Free Healthcare at Public and Empanelled Private Hospitals

Eligible senior citizens can avail of treatment at any public hospital or private hospitals empanelled under PM-JAY. The scheme covers a vast array of secondary and tertiary care treatments, including surgeries, cancer treatment, and more.

5. Comprehensive Medical Coverage

The scheme provides a wide range of coverage including:

• Medical examinations and consultations.
• Pre-hospitalization care for up to three days.
• Medicines and medical consumables.
• Non-ICU and ICU care services.
• Diagnostic and laboratory tests.
• Medical implants if required.
• Food and accommodation during hospitalization.
• Post-hospitalization care for up to 15 days.

Who Is Eligible?

Under the new guidelines, the following categories of individuals are eligible for the Rs 5 lakh health insurance under Ayushman Bharat for senior citizens aged 70 and above:

1. All Senior Citizens Aged 70 and Above

Every citizen who is 70 years old or older is automatically eligible for this scheme, irrespective of their income, employment status, or socio-economic standing.

2. Already Enrolled PM-JAY Beneficiaries

Senior citizens who are already part of PM-JAY will receive an additional top-up cover of Rs 5 lakh specifically for themselves. This cover is distinct and will not affect the existing family coverage.

3. Senior Citizens Under Other Government Schemes

Individuals currently availing benefits under Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), or Ayushman Bharat CAPF (Central Armed Police Forces) are also eligible. However, they have the option to either continue with their existing scheme or choose the new Ayushman Bharat scheme.

4. Private Health Insurance Policy Holders

Senior citizens aged 70 and above, who are already covered under private health insurance policies or the Employees’ State Insurance (ESI) scheme, are eligible to benefit from PM-JAY alongside their current policies.

How to Apply for Ayushman Bharat Health Insurance for Senior Citizens

Applying for the Ayushman Bharat PM-JAY scheme is a simple process that involves a few steps. Here’s a detailed guide:

Step 1: Visit the Official PM-JAY Website

Go to the official Ayushman Bharat Digital Mission (ABDM) website at https://abdm.gov.in to check eligibility and get more details about the scheme.

Step 2: Verify Identity

Eligible senior citizens need to visit a PMJAY kiosk to get their Aadhaar card or ration card verified. The Aadhaar card is the preferred identification document as it links to the digital health records maintained by the government.

Step 3: Submit Family Identification Documents

Along with identity verification, you will need to submit proof of family identification. This can be a ration card, family ID, or other acceptable documents.

Step 4: Get Your E-Card

Once verified, you will receive a unique PM-JAY e-card. This card will have your unique AB-PMJAY ID and will be essential for accessing services at hospitals and healthcare facilities. Keep it handy at all times.

Step 5: Avail Healthcare Services

With your PM-JAY e-card, you can now avail of cashless healthcare services at empanelled hospitals. Simply present the card at the hospital, and your treatment costs will be covered under the scheme up to Rs 5 lakh per year.

Additional Features of the Scheme

1. Coverage of Pre-Existing Conditions

The PM-JAY scheme also covers pre-existing medical conditions. For senior citizens who are often burdened with long-term ailments such as diabetes, hypertension, or heart conditions, this is a valuable benefit.

2. Easy Accessibility

With over 24,000 empanelled hospitals across India, the Ayushman Bharat scheme provides easy access to both public and private healthcare facilities. Additionally, beneficiaries can get treatment from any empanelled hospital in any state across the country.

3. Nationwide Reach

PM-JAY is a portable scheme, meaning that eligible individuals can avail of the benefits anywhere in India. Whether you are in your home state or traveling, you will still be covered.

4. Digital Health Records

All beneficiaries’ medical records will be digitally maintained under Ayushman Bharat Digital Mission (ABDM), ensuring seamless healthcare access and eliminating the need to carry physical records.

Frequently Asked Questions (FAQs)

1. Who is eligible for the Rs 5 lakh health insurance under Ayushman Bharat?

All Indian citizens aged 70 and above are eligible for Rs 5 lakh health insurance under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, irrespective of their income or socio-economic status.

2. How can I check my eligibility for the Ayushman Bharat scheme?

You can visit the Ayushman Bharat Digital Mission (ABDM) website or a PMJAY kiosk to check your eligibility and register for the scheme.

3. Can senior citizens with private health insurance also benefit from this scheme?

Yes, senior citizens aged 70 and above who have private health insurance or are covered under the Employees’ State Insurance (ESI) scheme can also benefit from Ayushman Bharat PM-JAY.

4. How much coverage is provided under the scheme?

Eligible individuals are provided with Rs 5 lakh of health insurance coverage per year. This covers hospitalization, surgeries, diagnostic tests, medications, ICU services, and more.

5. What expenses are covered under Ayushman Bharat PM-JAY?

The scheme covers:

• Medical examinations and consultations
• Pre-hospitalization care (up to 3 days)
• Medicines and medical consumables
• ICU and non-ICU services
• Diagnostic and lab tests
• Medical implants
• Food and accommodation during hospitalization
• Post-hospitalization care (up to 15 days)

6. Can beneficiaries avail of treatment outside their home state?

Yes, the scheme is portable, and beneficiaries can avail of treatment at any empanelled hospital across India.

7. Are pre-existing conditions covered?

Yes, the scheme covers pre-existing conditions, meaning that senior citizens with long-term ailments are also eligible for treatment.

8. Is there any premium that needs to be paid?

No, beneficiaries under Ayushman Bharat do not have to pay any premium for the coverage. The scheme is fully funded by the government.

9. How do I get the PM-JAY e-card?

After verifying your Aadhaar card or ration card at a PMJAY kiosk, you will be issued a unique PM-JAY e-card that will allow you to access the health insurance benefits.

Conclusion

The expansion of Ayushman Bharat PM-JAY to senior citizens above the age of 70 is a monumental step toward providing universal healthcare for the elderly in India. By offering Rs 5 lakh health insurance coverage, the scheme ensures that no senior citizen is left without access to vital medical services. With simplified eligibility criteria, easy application processes, and a wide range of medical coverage, Ayushman Bharat is setting a new standard for healthcare support in India.

For more details, visit the official Ayushman Bharat Digital Mission (ABDM) website or visit a PMJAY kiosk to check your eligibility and register.

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