West Bengal recently elected a new government under Chief Minister Suvendhu Adhikari, who announced the implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) by the Central government. A new policy expansion has turned health security into a universal right for India’s eldest generation.
What is Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)?
Under the updated guidelines, every senior citizen aged 70 and above is now eligible for Rs 5 lakh in annual, cashless health insurance, a safety net that covers the high costs of secondary and tertiary hospitalisation.
Whether a senior comes from a struggling household or a wealthy background, the policy recognises that health crises at 70+ are a universal challenge, ensuring no family has to drain their life savings to provide quality medical care for their elders.
The scheme was first implemented from September 23, 2018, to January 10, 2019. However, it was later withdrawn. Now, the PMJAY scheme has been re-implemented, and people can avail its benefits.
Included in AB-PMJAY
This scheme coverage spans initial medical consultations, diagnostic laboratory investigations, and necessary medications. It includes both intensive and non-intensive care, surgical implants, and room benefits. Additionally, it offsets expenses for three days pre-hospitalisation and fifteen days of post-hospitalisation follow-up care.
Excluded from AB-PMJAY
Excluded from standard coverage are outpatient department expenses, cosmetic surgeries, and drug rehabilitation programmes. Furthermore, fertility treatments and individual diagnostics are generally not reimbursed, as these are considered elective or specialised services.
Eligibility Criteria:
Senior citizens above the age of 70 are eligible under this scheme; the income level of the individuals and their current health insurance are not taken into consideration yet.
It also includes senior citizens from urban and rural areas. Individuals under private health insurance plans or covered by the Employees’ State Insurance (ESI) scheme are also eligible for the scheme.
The Ex-Servicemen Contributory Health Scheme (ECHS), Central Government Health Scheme (CGHS), or Ayushman CAPF can continue with the current government health insurance scheme or shift to AB PM-JAY.
Urban eligibility encompasses marginalised groups, including ragpickers, street vendors, labourers, and assistants. Rural criteria prioritise families in kutcha houses, households without able-bodied adults or those headed by females/disabled members, and landless labourers. These designations aim to identify and support socially and economically vulnerable individuals across both environments.
Documents to carry for verification
How to apply for the eligibility?
The entire process is online, and documents can be submitted online.
Aadhaar-based e-KYC must be completed and downloaded. The card you retrieve is digital. Proof of income is not required.
You will receive a member ID login for the self-service portal. Check if you are a beneficiary by logging into the portal using your registered mobile number. If you are already a registered beneficiary, you can directly log in using your member ID.
Points to be noted to avoid issues in the process
Offline process:
For people not well-versed in the online process, the government has also enabled an offline option. Visit the Common Service Centre (CSC) or a diagnostic centre. Carry the required documents and an Aadhaar card, and complete the verification process.
Medical expenses covered: