The Union Cabinet has approved the health coverage with Rs 5 Lakh free health insurance cover on a family basis to all the senior citizens aged 70 years and above irrespective of income under the flagship scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
With this approval, all senior citizens of the age 70 years and above irrespective of their socio- economic status would be eligible to avail the benefits of AB PM-JAY. The eligible senior citizens would be issued a new distinct card under AB PM-JAY.
The senior citizens of the age 70 years and above belonging to families already covered under AB PM-JAY will get an additional top-up cover upto 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 upto Rs 5 lakh per year on a family basis.
Ayushman Bharat Yojana Services include approximately 1,929 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
PM-JAY provides cashless cover of up to Rs 5,00,000 to each eligible family per annum for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment.
Medical examination, treatment and consultation
Pre-hospitalization
Medicine and medical consumables
Non-intensive and intensive care services
Diagnostic and laboratory investigations
Medical implantation services (where necessary)
Accommodation benefits
Food services
Complications arising during treatment
Post-hospitalization follow-up care up to 15 days
PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital. All pre–existing conditions are covered from day one. Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment. Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
