Why in news?

The Union Cabinet has cleared the expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to provide health coverage to all senior citizens aged 70 years and above irrespective of their income.

What’s in today’s article?

• Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)
• Ayushman Bharat health insurance for senior citizens

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

• About
  • Launched in September 2018, the scheme aimed to offer secondary and tertiary care services to the vulnerable population in the society.
  • It was launched as a second component of the ‘Ayushman Bharat’ scheme.
  • This scheme aimed to offer medical coverage of Rs. 5 lakh per family per year for secondary and tertiary care hospitalisation to poor and vulnerable families.
  • The scheme covers over nearly 40% of the population targeted towards poorest and the vulnerable.
• Eligibility
  • The scheme is targeted to cover 10.74 crore poor, deprived rural families and identified occupational category of urban worker’s families.
  • The beneficiaries as identified by latest Socio-Economic Caste Census (SECC) data.
• Benefits
  • It provides cashless access to health care services for the beneficiary at the point of service, i.e., the hospital.
  • Under the scheme every eligible family will be given Rs 5 lakh Insurance coverage benefit per year.
  • It offers Health Benefit Packages which covers surgery, medical and day care treatments, cost of medicines and diagnostics.
• Role of National Health Authority (NHA)
  • NHA is the apex body responsible for implementing India’s flagship public health insurance/assurance scheme – AB PMJAY.
  • It has been entrusted with the role of:
    • designing strategy, building technological infrastructure and
    • implementation of National Digital Health Mission to create a National Digital Health Eco-system.
    • To implement the scheme at the State level, State Health Agencies (SHAs) in the form of a society/trust have been set up by respective States.
• Performance

Ayushman Bharat health insurance for senior citizens

• About the news
  • The Union Cabinet has expanded the AB PM-JAY to provide health coverage to people aged 70 years and above, regardless of their income level, public healthcare.
  • Currently, the scheme is income-based and provides Rs 5 lakh shared annual coverage to all members of eligible families, irrespective of their age.
    • In its current form, the scheme is estimated to comprise the bottom 40 per cent of the population economically.
• Extension of the scheme
• The extension will now cover all citizens aged 70 years and above, offering Rs 5 lakh annual coverage per family.
• This expansion is expected to benefit an additional 6 crore elderly people from 4.5 crore families.
• Coverage under new plan
  • Senior citizens aged 70 and above, and belonging to families already covered under AB PM-JAY, will get an additional (shared) top-up cover up to Rs 5 lakh per year for themselves.
    • Shared top-up coverage - If there are two senior citizens (70 years+) in a family, then the Rs 5 lakh coverage will be shared between them.
  • Those benefiting from other public health insurance schemes like CGHS, ECHS, or Ayushman CAPF can either continue with their current schemes or opt for AB PM-JAY.
  • Additionally, senior citizens under private health insurance policies or the Employees’ State Insurance Scheme will also be eligible to avail the benefits of AB PM-JAY.
• Other features
  • This is a demand-based scheme; as the demand goes up, the coverage will also be increased.
  • Each beneficiary aged 70 and above will receive a new health card, ensuring streamlined access to healthcare benefits.
• Benefits
  • This expansion is expected to provide substantial relief to a demographic that often struggles with managing disease burdens without a reliable social security net.
  • This move is essential as India witnesses a shift towards nuclear family structures, where the financial burden on elderly individuals is more pronounced.
  • Although the Ayushman Bharat scheme aimed at universal health coverage, this will be the first age group to receive full coverage.