All About Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is Rs.5 lakh senior citizen health insurance scheme of central government. Let us see features and eligibility.

The Union Cabinet, led by Prime Minister Shri Narendra Modi, has granted approval for health coverage to all senior citizens aged 70 and above, regardless of their income, under the prominent scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).

Features and Eligibility of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

Let us now look into the features and eligibility of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.

# All senior citizens 70 years and above are eligible for this scheme.

# There is no income restriction under this scheme. Hence, irrespective of your income if you are a senior citizen, then you can opt for this.

# The eligible senior citizens would be issued a new distinct card under AB PM-JAY

# The senior citizens aged 70 years and above belonging to families already covered under the Ayushman Bharat Scheme (Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY)) will get an additional top-up cover up to 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).

# All other senior citizens of the age 70 years and above will get a cover up to Rs.5 lakh per year on a family basis.

# Senior citizens of the age 70 years and above who are already availing benefits of other public health insurance schemes such as Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), Ayushman Central Armed Police Force (CAPF)  may either choose their existing scheme or opt for AB PMJAY. 

# Even the senior citizens of 70 years and above who are under private health insurance policies or  Employees’ State Insurance scheme will be eligible to avail benefits under AB PM-JAY.

Check it out my latest post on how to apply for this scheme – Senior Citizens Ayushman Bharat Health Insurance – How to apply?

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana – Should you rely on this?

This initiative by the government is commendable and provides significant assistance to senior citizens who face challenges in obtaining health insurance from insurance providers due to existing health issues or who find the high premiums unaffordable.

The limit of Rs. 5 lakh per family for senior citizens is, in essence, a minimal provision. Regardless of whether one resides in urban, suburban, or rural areas, the expenses associated with hospitalization are substantial and are rising significantly each year. In this context, depending solely on this Rs. 5 lakh coverage could lead to dire consequences.

Therefore, I highly recommend that you consider enrolling in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. However, it is important not to depend solely on this scheme for your hospitalization needs. This caution arises from uncertainties regarding the claims process, the list of hospitals that are included, and whether the specific hospital you choose for admission will honor the claims made under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.

Given that this is a government initiative, numerous private hospitals may be reluctant to process your bills through this scheme. The reimbursement process from the government can often be quite complex and time-consuming. Consequently, some hospitals might unofficially refuse to accept this payment method. What if you present this option to hospitals and they decline your admission due to concerns regarding payment? However, we can remain optimistic that the government will collaborate with all hospitals to ensure a smooth billing process.

Furthermore, as previously stated, it is advisable to not solely depend on this singular health coverage. It is prudent to secure your own health insurance and establish a health emergency fund. In the event of an emergency where you cannot access this benefit, having a contingency plan is essential.

However, it serves as a significant advantage for individuals who are unable to obtain health insurance from providers due to existing health issues, as well as for those who find the high premiums of health insurance unaffordable.