Approval of the Government of India for extending the benefits of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to all senior citizens aged 70 years and above.National Health Authority L.S. CHANGSAN (I.A.S.) Chief Executive Officer D. O. No. S-12018/395/2022-NHA 20th September, 2024
This is to inform you of
the approval of the Government of India for extending the benefits of the
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to all senior
citizens aged 70 years and above.
2. Salient features of
the approval are as below:
a. The benefits of AB
PM-JAY would now be available to all senior citizens of the age 70 years and
above irrespective of their socio-economic status. These benefits will be
available to senior citizens of 70 years and above in families already covered
under AB PM-JAY (hereinafter referred to as ‘existing families’), as well as in
families which are not covered under the AB PM-JAY, (hereinafter referred to as
‘new families’).
b. The only eligibility
criteria for availing benefits under the scheme would be attainment of age of
70 years or above by the individual. This would be determined on the basis of
age recorded in Aadhaar. As per prevailing practice, Aadhaar would be the only
document required for enrolment. Aadhaar-based e-KYC will be mandatory for
enrolment and issuance of Ayushman cards for eligible senior citizens of both
existing and new families.
c. Beneficiaries with
other central and state government health insurance schemes will be given a
one-time option to choose between their current scheme or the AB PM-JAY scheme
to avoid duplication.
d. Senior citizens of the
age 70 years and above holding active private health insurance policies or
senior citizens of the age 70 years and above who are beneficiaries of the
Employees’ State Insurance scheme would also be eligible to avail benefits
under the extended scheme.
e. An additional shared
top-up cover of up to ₹5 lakh per year will be provided for the senior citizens
aged 70 years and above in families already covered under AB PM-JAY. This
top-up cover up to a total of ₹5 lakh will be provided for treatment of senior
citizens if the other members have utilized full or part of the original family
wallet. Further, if senior citizens (of the age 70 years and above) utilize
full or part of the original family wallet of ₹5 lakh, other members of the
family will be provided a top-up cover up to ₹5 lakh.
f. A shared cover of ₹5
lakh per family per year will be available for senior citizens in families not
currently covered under AB PM-JAY. This cover will be exclusive to senior
citizens aged 70 years and above.
g. The additional cost of
covering senior citizens including administrative expenses will be shared
between the Central and State Governments as per the existing guidelines on
fund release in AB PM-JAY.
h. Registration for all
eligible senior citizens aged 70 years and above will be application-based
only.
i. Enrolment will be a
continuous process, allowing registration throughout the year.
j. A separate module has
been created in the mobile phone application (Ayushman App) and in the web
portal (beneficiary.nha.gov.in) for the enrolment of those senior citizens who
would like to avail the benefits under the scheme. Desirous senior citizens would
have to apply on this portal or app.
k. A distinct Ayushman
card will be issued to all eligible senior citizens with the age 70 years and
above for both existing and new families.
3. Implementation of the
scheme
Implementation of the
scheme would require States and Union Territories to facilitate the enrolment
of all eligible senior citizens of the age 70 years and above. The States/UTs
would have to undertake extensive IEC activities to raise awareness about the
expansion of AB PM-JAY for all senior citizens of the age 70 years and above.
This would include creating and distributing informative materials, conducting
community outreach programs, and using various media channels to ensure broad
dissemination of information. Further, all the relevant stakeholders including
empanelled hospitals, local government bodies, healthcare providers, and
community organizations would have to be engaged for successfully rolling out
the scheme benefits to the eligible senior citizens.
4. The scheme is to be rolled out shortly
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