The Indian Government has expanded the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) to cover all citizens aged 70 and above.

This scheme provides essential health coverage, offering financial protection against high medical expenses for senior citizens.

In this blog, we will discuss the key features, eligibility criteria, and other essential aspects of the scheme.

It’s essential to understand what Ayushman Bharat offers, how to apply, and what this means for senior citizens in India.

What is Ayushman Bharat?

Ayushman Bharat is a government-initiated health insurance scheme that provides coverage for medical expenses.

The program offers annual insurance coverage of up to Rs. 5 lakh per family.

Beneficiaries can use this coverage to access primary, secondary, and tertiary healthcare services across a wide range of medical facilities.

Key features of Ayushman Bharat

• Coverage of up to Rs. 5 lakh per family per year.

• The scheme operates on a family floater basis, meaning the entire family shares the coverage amount.

• It is aimed at providing financial protection against high healthcare costs for underprivileged families.

Here’s an overview of the scheme 👇

Eligibility criteria for Ayushman Bharat

For Rural Areas

Eligibility in rural areas is determined based on specific deprivation criteria. The scheme covers families that meet one or more of the following conditions:

• Families without an earning adult between the ages of 16 and 59

• Households headed by women without any adult male members between 16 and 59 years

• Families living in a single-room house with makeshift walls and roofs

• Families from Scheduled Castes (SC) or Scheduled Tribes (ST)

• Households with disabled members lacking able-bodied support

• Landless households that rely primarily on manual labor for income

For Urban Areas

In urban settings, eligibility is based on occupational categories. The scheme covers families engaged in the following professions:

• Street vendors, cobblers, hawkers

• Domestic workers

• Rag pickers and beggars

• Plumbers, masons, painters, welders, and security guards

• Coolies (porters)

• Sweepers, sanitation workers, and gardeners

• Conductors, drivers, and cart pullers

• Artisans, home-based workers, handicraft workers, and tailors

• Washermen, and watchmen

• Electricians, mechanics, and repair workers

• Peons, helpers, shop workers, delivery assistants, attendants, and waiters

Eligibility for Senior Citizens

The government recently extended Ayushman Bharat to cover senior citizens aged 70 and older. Key aspects include:

• Senior citizens 70 years and older are automatically eligible

• Those in this age group will receive an additional top-up of Rs. 5 lakh in coverage

• It is estimated that 12.3 crore families will benefit from this initiative

Which hospitals are eligible for Ayushman Bharat?

Not all hospitals are eligible to provide services under the Ayushman Bharat scheme. Hospitals must meet the following criteria to participate:

• Registered with state health authorities

• Availability of qualified medical and nursing staff 24/7

• A minimum of 10 in-patient beds

• Comprehensive record-keeping of Ayushman Bharat patients, as required by the government

What does Ayushman Bharat include?

• Hospitalization Expenses: Ayushman Bharat takes care of costs related to hospitalization, such as bed charges, ICU services, and operating room fees.

• Pre- and Post-Hospitalization Costs: The scheme also covers medical expenses for three days prior to admission and 15 days following discharge.

• Serious Illness Treatments: This includes coverage for expensive treatments like cancer care, heart surgeries, and kidney transplants, as long as they fall within the approved procedures.

How does Ayushman Bharat function?

• Cashless Treatment: The program operates on a cashless and paperless model. Eligible patients can receive treatment at empaneled hospitals without needing to pay upfront for covered services.

• E-card: Beneficiaries get an Ayushman Bharat e-card upon registration, which allows them to access cashless treatments at participating hospitals.

How to register for Ayushman Bharat

Eligible individuals can register for Ayushman Bharat by generating a unique number through the official government website. To register:

1. Visit the official Ayushman Bharat website or call the helpline number.
2. Follow the instructions and complete the registration process

Please note that only those who meet the eligibility criteria will be able to complete the registration.

Can Ayushman Bharat replace personal Health Insurance?

While Ayushman Bharat aims to make healthcare more affordable, especially for low-income families, it does not fully replace personal health insurance for those who can afford additional coverage.

For individuals with the means, personal health insurance provides more comprehensive and customizable options, which can complement the coverage provided by Ayushman Bharat.

Conclusion

The Ayushman Bharat scheme is a significant step towards providing healthcare access to underprivileged and senior citizens in India.

With expanded eligibility for those aged 70 and above, the initiative offers essential financial protection against rising healthcare costs.

However, for those who can afford it, having additional health insurance remains a wise decision.

Ensure you understand your eligibility and explore all healthcare options available to you.

*Disclaimer – This is for information purposes only and not investment advice. Data credit to the rightful source.