The Union Cabinet, chaired by Prime Minister, recently approved health coverage to all the senior citizens aged 70 and above irrespective of income under the flagship scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
Coverage expansion for Senior citizens
- ₹5 lakh free health insurance on a family basis for all senior citizens aged 70 and above.
- Senior citizens belonging to families already covered under AB PM-JAY will get an additional top-up cover of ₹5 lakh, exclusive for them (not shared with younger family members).
- Approximately 4.5 crore families and six crore senior citizens benefit.
- New distinct card issued under AB PM-JAY for eligible senior citizens.
- Senior citizens who are part of other public health schemes (CGHS, ECHS, CAPF) can either retain their current schemes or switch to AB PM-JAY.
- Private health insurance holders and those under Employees’ State Insurance (ESI) are also eligible for AB PM-JAY.
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Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) scheme
- The Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) is a Centrally Sponsored Scheme having a central sector component under the Ayushman Bharat Mission anchored in the Ministry of Health and Family Welfare (MoHFW).
- Umbrella Scheme: It is an umbrella of two major health initiatives, namely Health and Wellness Centres and the National Health Protection Scheme.
- Objectives: Ensuring comprehensive coverage for catastrophic illnesses, reducing out-of-pocket expenditure, and improving access to hospitalization care.
- Health and Wellness Centres: Under this 1.5 lakh existing sub-centers will bring the health care system closer to people’s homes in the form of Health and wellness centres.
- These centres will provide comprehensive health care for non-communicable diseases and maternal and child health services.
- Implementation Strategy:
- A National Health Authority (NHA) has been set up at the national level.
- States/ UTs are advised to implement the scheme by a dedicated entity called State Health Agency (SHA).
Benefits Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana
- Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) provides a defined benefit cover of Rs. 5 lakh per family per year. This cover will take care of almost all secondary care and most of tertiary care procedures.
- Eligibility criteria: AB-PMJAY is an entitlement-based scheme with entitlement decided based on deprivation criteria in the SECC database.
- Hospitals Covered: The beneficiaries can benefit from public and empanelled private facilities. All public hospitals in the States implementing AB-PMJAY will be deemed empanelled for the Scheme.
- Includes pre and post-hospitalisation expenses.
- Pre-existing Conditions: Will be covered from day one of the policy.
- Cashless Benefits: Beneficiaries can take cashless benefits across the country.
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September 12, 2024
