Ayushman Bharat Yojana - PM Health Insurance Scheme

Ayushman Bharat Health Insurance for Senior Citizens

In 2024, the Union Cabinet approved the expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) for senior citizens. Under this initiative, all senior citizens aged 70 and above will be eligible for health coverage, irrespective of their economic background and income. With this new development in the scheme, all the senior citizens aged 70 and above will get a new, separate card and will be provided with a cover of up to Rs. 5 lakh per year on a family basis. Senior citizens in families already enrolled under AB PM-JAY will receive an additional top-up coverage of up to Rs. 5 lakh per year. This exclusive top-up is specifically for them and does not need to be shared with family members below the age of 70.

Eligibility criteria for Ayushman Bharat Health Insurance for Senior Citizens

The eligibility criteria for Ayushman Bharat Health Insurance scheme for senior citizens are as listed below:

1. Senior citizens aged 70 years and above are eligible for the scheme.

1. Individuals eligible for this scheme will receive health coverage of Rs.5 lakh per family.

1. Senior citizens from families already covered under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana get an additional Rs.5 lakh health insurance top-up exclusively for themselves, without sharing it with family members.

1. Individuals having private health insurance can also benefit from this scheme.

1. Senior citizens covered under public health insurance schemes like the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), or Ayushman Central Armed Police Force (CAPF) must choose between their current insurance and the Ayushman Bharat scheme.

1. All eligible beneficiaries will receive a unique card to access the scheme benefits.

What is Covered under Ayushman Bharat Yojana (PMJAY)?

Ayushman Bharat Scheme has extensive coverage for pre- and post-treatment, consultation, and medical examination including approximately 1,393 procedures:

1. The scheme takes care of accommodation and food charges in case of hospitalization

1. Under this policy, the beneficiary can avail of treatments under the Intensive care unit (ICU) as well as non-intensive care services
2. The scheme covers diagnostic procedures and medical implants
3. Medicine and related consumables are covered by this policy
4. Expenses incurred post-hospitalization up to 15 days
5. The policy also covers the cost of pre-hospitalization expenses (3 days)

1. Any expenses incurred due to complications arising during the medical care
2. COVID-19 (Coronavirus) treatment.

Features of Ayushman Bharat Yojana (PMJAY)

Some of the salient features of 'Modicare' are mentioned below:

1. PMJAY invariably provides Rs.5 lakh coverage per family every year to more than 10 crore families spread across India.
2. The scheme's benefits are portable all throughout India and all beneficiaries who have signed up for Ayushman Bharat will be able to avail cashless treatments from any empanelled hospital - be it a private entity or a public hospital.
3. Both private as well as public hospitals have been empanelled to carry out procedures in Ayushman Bharat.
4. To promote cost control, each beneficiary's treatment will be paid for based on a certain package rate which the Government of India will predetermine.
5. Ayushman Bharat has adopted the principles of thorough flexibility and cooperative federalism across all states and union territories of India.
6. Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) will be established at the apex level in order to foster effective communication and coordination between the States and the Centre. This body will be governed by the Union Health and Family Welfare Minister.
7. State Health Agencies (SHA) are a prerequisite for Indian states to implement the scheme.
8. An escrow account will be made use of in order to conduct successful transaction of funds to the State Health Agencies (SHAs).

How to Download Ayushman Bharat Yojana Card Online?

The Ayushman Bharat Yojana offers a paperless and cashless health insurance scheme, providing beneficiaries with the "Ayushman Bharat Golden Card" for seamless healthcare transactions. This card is valid at all network hospitals participating in the scheme. To download the card online, follow these steps:

Step 1: Visit the official website for the Ayushman Bharat Yojana scheme 

Step 2: Log in with your registered mobile number.

Step 3: Enter the ‘Captcha Code’ given to generate the OTP.

Step 4: Choose the HHD code and provide it to the Common Service Centre (CSC). The HHD code and other information will be verified by the CSC.

Step 5: The remaining process will be done by 'Ayushman Mitra' (CSC representatives).

Step 6: To obtain your Ayushman Bharat card, pay a fee of Rs.30.

Eligibility Criteria for Ayushman Bharat Yojana

For Rural Beneficiaries:

For beneficiaries from rural areas, the families must fall into at least one of the following categories to avail of the benefits of the scheme:

1. Family with no earning member between the ages of 16 years to 59 years
2. Households with no adults or members in the age group of16-59 years
3. Families with no healthy adults
4. Families with one or more disabled members
5. Households with members who work as manual scavengers

1. Households with no male member within the age group of 16-59 years
2. Families that live in one room or houses with kuccha walls and roof
3. Families who earn from doing manual labor and do not own any land.

For Urban Beneficiaries:

For beneficiaries from urban areas, the following 11 occupational categories of workers are eligible for this scheme:

1. Ragpickers
2. Sweepers, gardeners, and sanitation workers
3. Transport workers, drivers, conductors, helpers to drivers and conductors, cart pullers, and rickshaw pullers
4. Beggars

1. Street vendors, and hawkers, cobblers, and other service providers working on the streets
2. Home-based workers, artisans, handicrafts workers, and tailors
3. Domestic workers
4. Washer-men and chowkidars
5. Shop workers, helpers, assistants, waiters, delivery assistants, attendants, and peons in small establishments

1. Electricians, repair workers, assemblers, and mechanics
2. Construction workers, welders, plumbers, masons, laborer's, painters, coolies, security guards, and other head-load workers

How to Check Eligibility for Ayushman Bharat Yojana Online

Beneficiaries who are eligible do not require a separate enrolment process. You can check your eligibility by following the steps given below:

Step 1: Visit the official website for the Ayushman Bharat Scheme or PMJAY (https://pmjay.gov.in/ )

Step 2: Click on the ‘Am I Eligible’ icon.

Step 3: Fill in your contact details.

Step 4: Click on ‘Generate OTP’.

Step 5: Select your state

Step 6: Search by your name, ration card number, HHD number, or mobile number.

Step 7: You can view if you are eligible for the scheme.

Documents Required

1. Proof of Age (PAN Card or Aadhaar Card)

1. Proof of Identity (Aadhaar Card or PAN Card)
2. Proof of Income (annual income should not exceed Rs.5 lakh p.a.)
3. Details for communication such as mobile number, address for correspondence, and email ID)
4. Caste certificate
5. Document proof of the current status of the family (joint or nuclear)