Ayushman Bharat to cover all above 70 years, says BJP: All you must know

The Bharatiya Janata Party (BJP) has pledged in its manifesto for the upcoming Lok Sabha elections to extend the Ayushman Bharat scheme to include all individuals from the transgender community and senior citizens aged 70 and above.

This was announced during the manifesto's release by Prime Minister Narendra Modi, although the specific age bracket has not been detailed in the manifesto's fine print.

"The biggest concern of the elderlies is how they will afford treatment for their ailments. This concern is even more serious for the middle class. BJP has now taken the 'sankalp' that every individual above 70 years of age will be brought within the purview of Ayushman Bharat Yojana," Modi stated.

"We will expand the Ayushman Bharat Yojana to cover senior citizens and provide them access to free and quality healthcare," the manifesto read.

Originally launched by Arun Jaitley, the then Finance Minister, during the FY19 Union Budget, the Ayushman Bharat scheme—also known as Pradhan Mantri Jan Arogya Yojana (PMJAY)—currently provides a Rs 5 lakh cover to nearly 80 crore people across India, incorporating economically vulnerable families from both rural and urban areas.

The scheme includes hospitalisation costs, supports pre- and post-hospitalisation, medication, and more than 1,929 medical procedures including major surgeries and follow-up treatments.

This initiative operates paperless and cashless at a vast network of public and private hospitals, ensuring broad and accessible coverage.

The Ayushman Bharat Yojana includes nearly 1,929 treatments like skull surgery, knee replacement surgery, etc. Moreover, it covers the cost of follow-up care and treatments to ensure full recovery.

The expansion of the scheme, if implemented as pledged, will widen its scope, bringing essential healthcare services to an even broader segment of India's population.

"Extending coverage under the Ayushman Bharat scheme to senior citizens aged 70 and above is a significant step towards enhancing their access to health insurance," said Siddharth Singhal, Business Head - Health Insurance, Policybazaar.com.

"Given the typically higher premiums they face and the limited options available, this move holds promise in easing their financial burden and ensuring they receive necessary healthcare support," he said.

Key features of PMJAY

Healthcare access: Beneficiaries can avail of cashless healthcare services at public-sector and empanelled private hospitals.

Family floater scheme: Each family enjoys an annual insurance cover, facilitating extensive medical treatments without individual caps.

Comprehensive coverage: Includes daycare, pre-existing conditions from day one, and all associated costs during hospital stays.

Transportation reimbursement: PMJAY reimburses the transportation expenses for pre- and post-hospitalisation visits.

Health and wellness centres: The scheme supports 150,000 centres across India to offer primary healthcare services.

Extensive benefits

PMJAY covers nearly 40% of the Indian population, focusing on the most vulnerable. The scheme is distinctive in its wide reach and comprehensive benefits:

Nationwide availability: Treatments under PMJAY are accessible across India at no cost to the beneficiary.

Speciality treatment coverage: Includes 24 categories of speciality care, such as neurosurgery and cardiology.

Multiple surgeries: If multiple surgeries are necessary, the most critical procedure is fully covered, with subsequent surgeries receiving partial coverage.

Cancer treatment: Costs associated with 50 types of cancer treatments, including chemotherapy, are included.

Here’s what the scheme covers:

Medical services: Costs related to medical examinations, treatments, and consultations.

Hospitalisation expenses: Pre-hospitalisation costs are covered for up to three days, and post-hospitalisation expenses for up to 15 days.

Medications and consumables: All medicines and medical consumables used during the treatment.

Accommodation: Charges for hospital stays are fully covered.

ICU and non-ICU services: Both intensive and non-intensive care services are included.

Diagnostic services: Laboratory and other diagnostic procedures needed during treatment.

Surgical and medical implants: Costs for required medical implantation services.

Treatment of complications: Any complications arising during the medical treatment are covered.

Food services: Meals provided during the hospital stay.

Exclusions in coverage

Certain groups of people are not eligible for Ayushman Bharat Yojana, including:

Vehicle owners: Those who own two-wheelers, three-wheelers, or cars.

Government employees and those working in government-run non-agricultural enterprises.

Higher-income bracket: Individuals with a monthly income exceeding Rs 10,000.

Property and equipment owners: Those owning farming machinery, motorised fishing boats, or more than five acres of agricultural land.

Homeowners: Individuals living in well-built houses.

Cardholders: Those possessing a kisan card.

Appliance owners: Households with refrigerators and landline phones.

Eligibility criteria for rural and urban households

To be eligible for PMJAY, households must be listed in the Socio Economic and Caste Census-2011 (SECC) and hold an active Rashtriya Swasthya Bima Yojana (RSBY) card.

Rural households

Families with no adult between the ages of 16-59.

Those living in one-room houses with kucha walls and roof.

Households without a healthy adult or with disabled members.

Landless families deriving major income from manual casual labour.

Scheduled Caste/Scheduled Tribe (SC/ST) households.

Urban households

Individuals in informal employment such as domestic workers, ragpickers, beggars, street vendors, construction workers, and many others typically involved in physically demanding jobs.

How to register for PMJAY Online

Registration for the Ayushman Bharat Yojana can be easily done online:

1. Visit the official website

2. Provide necessary details as prompted to check your eligibility and register.

3. Follow the steps to complete the registration process and receive your Ayushman Bharat Card if eligible.

Critical diseases covered

PMJAY offers coverage for 1,929 medical procedures, including treatment for critical illnesses such as:

Heart and vascular surgeries: Procedures like carotid angioplasty with stent and coronary artery bypass grafting.

Cancer treatments: Including prostate cancer therapies.

Complex surgeries: Such as skull base surgery, pulmonary valve surgery, and double valve replacement surgery.

Other medical procedures: Including anterior spine fixation and tissue expanders for burn-related disfigurements.

These provisions ensure that PMJAY addresses a wide spectrum of healthcare needs, offering comprehensive coverage to those who need it most.