Evaluating the Reliability of Government Health Insurance for Senior Citizens
The Union government has recently expanded the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to include individuals above 70 years of age. The proposed healthcare plan offers to cover medical expenses for seniors without charge, but the lack of established private hospitals for treatment and certain exclusions from the program have led experts to advise against relying solely on it. Here are the key points of the new additions:
- Coverage and Benefits: The scheme offers Rs 5 lakh annual cover for inpatient hospitalization. If a family has two members above 70 years, they share the policy cover of Rs 5 lakh. Existing diseases or conditions are covered from the moment of enrollment, with no waiting period.
- Limitations: The scheme does not cover outpatient department (OPD) expenses, dental treatments, or vaccinations. Treatment is only available in general wards of empaneled hospitals, and private or semi-private rooms are not covered. Additionally, the scheme only offers cashless treatment, which can be a limitation if the preferred hospital is not part of the network.
- Hospital Network: While the scheme includes around 30,000 hospitals, only about 3,000 are actively providing services under AB-PMJAY. Not all empaneled hospitals offer all treatments, and private hospitals often refuse admission under the scheme due to non-availability of beds or delayed payments from the government.
We are of the opinion that while the scheme is beneficial, it should not be solely relied upon. It is recommended to check the quality of empaneled hospitals in one’s area and consider private health insurance plans or senior citizen-specific health plans for better coverage and services.
Senior citizens can enroll in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) through the following steps:
- Eligibility Check: Ensure you are eligible. The scheme is open to all senior citizens aged 70 and above.
- Documents Required: Gather necessary documents such as Aadhaar card, ration card, voter ID card, PAN card, income certificate (if applicable), and age proof.
- Online Application: Visit the official AB-PMJAY website - Click on the “Apply Now” button - Fill in the application form with personal details and upload the required documents.
- Offline Application: Visit the nearest Common Service Centre (CSC) or designated enrollment center. Fill in the application form and submit the required documents. After submitting the application, you will receive a confirmation message with a unique application ID.
To find empaneled hospitals near you under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), you can go to the official PMJAY website and search for empaneled hospitals by location.
