Those aged 70 years and above can now benefit from the expansion of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) regardless of income The prime minister on Tuesday the 29.10.024 extended his government’s flagship health insurance scheme Ayushman Bharat 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

Dear Colleague,

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.

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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 and therefore your active participation is requested for its successful implementation.

Yours sincerely,

Sd/

L.S. CHANGSAN (I.A.S.)
Chief Executive Officer NHA

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Those aged 70 years and above can now benefit from the expansion of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) regardless of income

The prime minister on Tuesday extended his government’s flagship health insurance scheme Ayushman Bharat to all senior citizens aged 70 years and above.

However, PM Modi slammed Delhi, Bengal govt for not implementing Ayushman Bharat and said :

 ‘I apologise to all elderly…’

Prime Minister Narendra Modi hit out at Delhi and West Bengal governments on Tuesday for not implementing the Ayushman Bharat health insurance scheme due to “political interests” and said he was pained that the elderly in these places cannot avail free treatment under the expanded programme. The prime minister on Tuesday extended his government’s flagship health insurance scheme Ayushman Bharat to all senior citizens aged 70 years and above.

With these states not implementing the scheme, elderly citizens cannot join or receive the benefits of AB PM-JAY.

Those aged 70 years and above can now benefit from the expansion of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) regardless of income, a major shift in the govt policy. Earlier, only poor and vulnerable families and a few specific categories of workers, like ASHA staff, were eligible for the scheme that offers health cover of Rs 5 lakh per family per year for secondary and tertiary-care hospitalisation.

Beneficiaries can visit any empanelled hospital, present either their Ayushman card or their PMJAY ID to receive treatment. Before visiting, the beneficiary should confirm that the hospital is empanelled to treat the specific condition for which they require assistance.

Nearly all treatments covered by the scheme cost below Rs 2 lakh and, so, the Rs 5 lakh cover is sufficient to meet beneficiaries’ healthcare needs, govt sources said. Further, under the umbrella scheme of Rastriya Arogya Nidhi (RAN), financial assistance up to Rs 15 lakh is provided to patients from poor families — who are eligible for PM-JAY — for availing those treatments that are not covered under PM-JAY. Hence, AB PM-JAY along with other central govt schemes can take care of hospitalisation needs of eligible beneficiaries.

 With these states( Delhi & West Bengal) not implementing the scheme, elderly citizens cannot join or receive the benefits of AB PM-JAY.Inall other States Those aged 70 years and above can now benefit from the expansion of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) regardless of income, a major shift in the govt policy. Earlier, only poor and vulnerable families and a few specific categories of workers, like ASHA staff, were eligible for the scheme that offers health cover of Rs 5 lakh per family per year for secondary and tertiary-care hospitalisation.

Beneficiaries can visit any empanelled hospital, present either their Ayushman card or their PMJAY ID to receive treatment. Before visiting, the beneficiary should confirm that the hospital is empanelled to treat the specific condition for which they require assistance.

Nearly all treatments covered by the scheme cost below Rs 2 lakh and, so, the Rs 5 lakh cover is sufficient to meet beneficiaries’ healthcare needs, govt sources said. Further, under the umbrella scheme of Rashtriya Arogya Nidhi (RAN), financial assistance up to Rs 15 lakh is provided to patients from poor families — who are eligible for PM-JAY — for availing those treatments that are not covered under PM-JAY. Hence, AB PM-JAY along with other central govt schemes can take care of hospitalisation needs of eligible beneficiaries.

 

Here’s a comparative table of Delhi, West Bengal (Bengal) Government healthcare schemes, and the Ayushman Bharat scheme, highlighting their scope, expansion, and eligibility criteria, especially concerning coverage for elderly individuals without income restrictions:

Criteria	Delhi Govt. Healthcare Schemes	Bengal Govt. Healthcare Schemes	Ayushman Bharat (PMJAY)
Scheme Name	Delhi Arogya Kosh, Farishtey Scheme	Swasthya Sathi	Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY)
Target Beneficiaries	Primarily Delhi residents; Focus on all age groups, especially low-income & elderly residents	Primarily West Bengal residents, inclusive of elderly & marginalized sections	Targeted at economically vulnerable across India, based on SECC 2011 criteria
Income Criteria for Eligibility	Typically income-based; few schemes may relax criteria for elderly citizens	Generally no income criteria for Swasthya Sathi scheme	Primarily targeted based on income and social category from SECC data
Elderly Coverage Expansion	Proposed expansion to include elderly citizens without income checks for certain schemes	Currently includes elderly without income-based restrictions under Swasthya Sathi	Limited coverage expansion for elderly; eligibility tied to pre-determined income-based criteria
Financial Coverage	Covers up to ₹5 lakh per family per year for medical treatments under selected schemes	Offers up to ₹5 lakh per family per annum for secondary and tertiary care	Provides ₹5 lakh per family per annum for secondary and tertiary care
Enrollment Process	Requires ID proof, residency verification, potentially age-related criteria relaxation for elderly	Self-enrollment possible; cards provided for residents, including elderly without income restrictions	Automatic enrollment for SECC 2011 database beneficiaries; some states allow voluntary enrollment with verification
Network of Hospitals	Public and some empaneled private hospitals in Delhi	State-run and empaneled private hospitals in West Bengal	Empaneled public and private hospitals across India
Portability	Limited to Delhi; emergency provisions in nearby areas	Limited to West Bengal; may offer cross-state treatment in emergencies	Nationwide portability, allowing treatment across India
Special Consideration for Elderly	Planned elderly-centric expansion with focus on non-income-based access	Inclusive approach covering elderly under general scheme benefits	Limited special provisions for elderly, mainly income-based without targeted elderly schemes

This comparison highlights that Delhi and Bengal schemes are relatively more flexible in expanding to cover elderly without income criteria, with Bengal already operating inclusively through the Swasthya Sathi scheme. Ayushman Bharat is primarily income-based, and elderly-specific expansions are limited.

Inference With the expansion of Ayushman Bharat to include elderly individuals aged 70 and above without income criteria, here’s a revised assessment:

1.     Delhi Government Schemes: With plans to relax income-based restrictions specifically for elderly citizens, Delhi schemes are progressing toward inclusivity for the elderly. However, their geographic limitation (primarily Delhi-based coverage) restricts portability, which may be a drawback for elderly individuals requiring access to treatment outside the region.

2.     Bengal Government Schemes (Swasthya Sathi): The Swasthya Sathi scheme in West Bengal remains highly inclusive, covering the elderly without any income-based criteria. With access to a network of public and private hospitals across the state, it ensures broad accessibility for elderly residents. However, its regional limitations might not suit those who need treatment outside West Bengal.

3.     Ayushman Bharat (PMJAY): With the new expansion to cover all elderly individuals aged 70 and above without income restrictions, Ayushman Bharat now offers broader accessibility for senior citizens. Its nationwide portability is a significant advantage, allowing elderly patients to access healthcare across India. This makes it particularly suitable for elderly individuals who may live away from their families or need flexible treatment options across states.

Revised Inference:

With Ayushman Bharat’s expanded coverage, it now offers the most comprehensive solution for elderly individuals aged 70 and above, thanks to its nationwide reach and lack of income restrictions for seniors. It allows seniors to access healthcare services across India, making it ideal for those who may need treatment outside their home states.

Thus:

·       Most Comprehensive for 70+ Elderly: Ayushman Bharat, due to its portability and income relaxation.

·       Best for Regional Access: West Bengal’s Swasthya Sathi (for those within West Bengal) and Delhi schemes (for those within Delhi) remain solid options, especially if local access is a priority.