Last week, a retired client, Mr. Raghavan, visited my office with a worried look. At 72, he had recently been diagnosed with a chronic illness that required frequent hospital visits and expensive treatment. Though he had an Independent Insurance cover, the New Illness may demand more than the coverage amount. He understands that he may not be able to increase the coverage now in the current health situation. His question was simple but loaded with concern:
“I’ve heard about the Ayushman Vaya Vandana Yojana, which provides FREE Health insurance for Senior citizens like me. As the Government of India is offering it, should I rely on this and increase the health coverage through this policy? And to save on the high premium costs is it advisable to let go of my existing health insurance?
As a financial planner, I understood that for many retirees, healthcare expenses are a major concern. We sat down and discussed the scheme in detail. I shared how it provides ₹5 lakh of annual coverage per family, cashless treatment at empaneled hospitals, and additional preexisting coverage benefits for seniors. However, I also cautioned him about the potential limitations, like the lack of choice if his preferred hospital wasn’t empaneled or the absence of outpatient coverage.
This discussion led me to review the product in detail, so I also considered writing a detailed article for my readers.
FREE Health Insurance for Senior citizens – Ayushman vaya vandana
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) has recently expanded its coverage to include senior citizens aged 70 and above. This initiative aims to enhance FREE healthcare access for the elderly, providing them with significant benefits and financial support for medical treatments.
Here are the key features:
- Increased Health Insurance Coverage:
- Senior citizens aged 70 and above are now eligible for a health insurance cover of ₹5 lakh annually, irrespective of income or social status. This expanded coverage ensures access to critical healthcare services without financial burden. (Also Read: SIPs: Why Most Investors Fail to Continue? Common Mistakes to Avoid)
- Top-Up for Existing Beneficiaries:
- For those already enrolled in Ayushman Bharat, an additional ₹5 lakh top-up coverage is available, exclusively for senior citizens. This enhances protection against high medical expenses. (Please do share this information with the concerned people you may know)
- If the household includes two or more eligible senior citizens, each of them may qualify for an additional ₹5 lakh coverage, specifically tailored to their medical needs. This ensures that their medical expenses do not overlap or diminish benefits meant for younger family members. As explained in Case 1 below
- For those not enrolled: Family Coverage: Senior citizens who are not part of an existing AB PM-JAY family coverage will be provided with a cover of up to Rs 5 lakh per year on a family basis. As explained in case 2 below
CASE 1 – For already enrolled families, or those who are eligible for otherwise available Ayushman Bharat Schemes
Family Details:
- The Kumar family consists of:
- Mr. Raj Kumar (72 years old, retired)
- Mrs. Meera Kumari (71 years old, homemaker)
- Their son Rohan Kumar (45 years old) and his family of three.
Existing PM-JAY Coverage:
- The family is already enrolled in Ayushman Bharat PM-JAY, which provides ₹5 lakh annual health insurance coverage for the entire household.
Additional Top-Up for Seniors:
- With the new benefit, both Mr. and Mrs. Kumar receive an additional ₹5 lakh coverage each, specifically for their medical needs.
How It Works in Practice:
- The total coverage for the household is:
- ₹5 lakh for the entire family (shared).
- ₹5 lakh for Mr. Raj Kumar (senior-specific).
- ₹5 lakh for Mrs. Meera Kumar (senior-specific).
This makes the effective annual coverage ₹15 lakh, divided as:
₹10 lakh exclusively for the two seniors.
₹5 lakh for the rest of the family.
Case 2 – For not enrolled families, and not eligible for the Ayushman Bharat scheme
Family Details:
- Mr. Vijay Sharma (72 years old, retired teacher).
- Mrs. Sunita Sharma (71 years old, homemaker).
- They live in a middle-class household with their son, who runs a small business.
Previous Scenario:
- The Sharma family was not previously enrolled in the Ayushman Bharat PM-JAY scheme because they did not meet the criteria (either because of income status or lack of prior eligibility). They were relying on private health insurance.
Change with the New Expansion:
- With the recent expansion of PM-JAY to include seniors aged 70 and above, both Mr. Vijay Sharma and Mrs. Sunita Sharma are now eligible to enroll in the scheme without income restrictions.
Enrollment:
- Mr. and Mrs. Sharma can now enroll online using their Aadhaar cards for e-KYC verification through the PM-JAY portal.
- Once enrolled, they will receive their Ayushman Bharat Health Cards for themselves.
Coverage Details for the Entire Household:
- Total coverage for the entire household is ₹5 lakh annually, which is shared among all members, including Mr. Vijay Sharma and Mrs. Sunita Sharma.
- This means:
- If there are 4 family members (including the senior citizens), the ₹5 lakh coverage is divided across them.
Example of Coverage in Practice:
- If Mr. Vijay Sharma requires hospitalization for a condition that costs ₹6 lakh:
- The ₹5 lakh coverage will be applied to the entire family, including him.
- The remaining ₹1 lakh will be paid out of pocket or through other means.
Key Point:
- Since the additional ₹5 lakh top-up coverage is available only to seniors who are part of families already enrolled in the PM-JAY scheme, the Sharma family in this scenario would not receive the senior-specific top-up. They would only get the ₹5 lakh shared coverage for the entire family. Explore How attractive is Senior Citizen Savings Scheme offering 8.2% Interest.
Other Key Features of Government Health Insurance for Senior Citizens
- Health Cards:
- A dedicated health card called as Ayushman Vaya Vandana card will be issued to eligible seniors, simplifying the process of accessing healthcare services.
- Choice of Insurance Scheme:
- Senior citizens with other public health schemes like the Central Government Health Scheme (CGHS) or Ex-Servicemen Contributory Health Scheme (ECHS) can choose between their existing coverage and Ayushman Bharat
- Budgetary Support:
- The program’s expansion is projected to cost ₹3,437 crore annually, funded jointly by the central and state governments. For northeastern and hilly states, the central government covers 90% of the cost
These enhancements aim to address the unique healthcare challenges faced by the elderly, ensuring better access to medical services and reducing out-of-pocket expenses.
Benefits of the Ayushman Bharat Card
– Cashless Treatment: Beneficiaries can avail themselves of cashless treatment at over 1,500 empaneled hospitals across India. This includes various medical services such as major surgeries and chronic illness treatments.
– Pre-existing diseases are covered from the very first day. This means that any eligible person suffering from any medical condition before being covered by PM-JAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.
– Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
– The cover under the scheme includes all expenses incurred on the following components of the treatment.
- Medical examination, treatment, and consultation
- Pre-hospitalization
- Medicine and medical consumables
- Non-intensive and intensive care services
- Diagnostic and laboratory investigations
- Medical implantation services (where necessary)
- Accommodation benefits
- Food services
- Complications arising during treatment
- Post-hospitalization follow-up care up to 15 days
Discover why your existing health cover might not be sufficient.
Comparison with Other Countries
India’s approach through the Ayushman Bharat scheme is unique in its direct focus on elderly citizens without income restrictions, contrasting with programs in countries like the US where eligibility often hinges on age and disability status. Here is a detailed comparison with other countries:
| Country | Program Name | Coverage Amount | Eligibility Criteria |
|---|---|---|---|
| India | Ayushman Bharat Yojana | ₹5 lakh per family | All seniors aged 70+ |
| United States | Medicare | Varies | Age 65+, specific disability requirements |
| Canada | Canada Health Act | Universal | All citizens, no age limit |
| UK | National Health Service (NHS) | Universal | All residents, no age limit |
The Ayushman Vaya Vandana Yojana is a game-changer in India’s healthcare landscape, especially for elderly citizens. By providing Free Health Insurance for Senior citizens, cashless medical treatment, no income-based restrictions, and additional top-up coverage, it ensures that senior citizens can age gracefully without worrying about medical costs. However, challenges remain. Limited awareness, especially in rural areas, and uneven hospital empanelment in certain regions hinder the scheme’s reach. Critics also highlight the need for better grievance redressal mechanisms and monitoring for fraud prevention, particularly at private hospitals.
Applying for the Ayushman Vaya Vandana card is a straightforward process that can be completed online:
1. Visit the Official Portal: Go to [pmjay.gov.in](http://pmjay.gov.in).
2. Login Process:
– Enter your mobile number and captcha code.
– Authenticate your number using the OTP received.
3. Select Options: Choose relevant options from drop-down menus regarding your scheme and location.
4. Fresh Enrollment:
– If no details are found, select ‘clear here to enroll’ for seniors aged 70+.
– Enter your Aadhaar number and proceed with e-KYC verification.
5. Complete e-KYC: Choose your preferred verification method (Aadhaar OTP, fingerprint, etc.) and submit the necessary details including family information.
6. Submission: After completing all required fields and uploading documents, submit your application.
7. Download Your Card: Once approved, you can download your Ayushman card within approximately 15 minutes[1][4][5].
This initiative represents a significant step towards inclusive healthcare in India, ensuring that senior citizens receive the medical attention they need without financial stress.
There is a very good YouTube playlist prepared by concerned agencies, to know the processes
Conclusion:
This Senior citizen Health insurance scheme offered by the government of India no doubt looks attractive. There are lakhs of senior citizens deprived of any health coverage due to their pre-existing health conditions, or high premium costs in their age. With even private hospitals being covered under this Free Health cover, this becomes a must-have cover for all eligible seniors.
But this does not mean that if you already have health coverage you should discontinue the same to save on cost. This new scheme though looks attractive but we are not sure what challenges this may face with hospitals and otherwise. The Practical difficulties are not yet known. Moreover, the cover for a newly enrolled family is quite less looking at the Rising Medical treatment cost.
However, you may think of buying a super top-up policy along with this cover to reduce the overall Health Insurance premium cost. But before that, we need to be sure of the practical working and the claim experiences of the people. We are not sure if Reimbursement will be provided or if this is only cash-less treatment. Also read: Health Insurance for Parents -where to get comprehensive cover
But still Enrolling may not harm you.
“Wondering how secure your financial health is? Check it now with our Financial Health Calculators.”
Frequently asked questions (FAQs) regarding the **Ayushman Vaya Vandana Yojana**, a FREE health insurance scheme launched for senior citizens aged 70 and above in India:
– All Indian citizens aged 70 years or older are eligible, regardless of their economic status
– The scheme offers free health coverage of up to ₹5 lakh annually for each eligible senior citizen , but some conditions apply
– No, there is no income limit; any citizen aged 70 or above can enroll, irrespective of their income level
– Applications can be made online through the official website (beneficiary.nha.gov.in) or via the Ayushman app. Alternatively, applications can be submitted at PM-JAY empaneled hospitals or common service centers
– The primary document required is the Aadhaar card, which is mandatory for e-KYC verification. Other helpful documents include a mobile number and proof of age.
– Yes, Aadhaar-based e-KYC is mandatory for enrolling and obtaining the Ayushman card.
– The coverage includes costs related to consultations, diagnostics, treatments, pre-hospitalization expenses (up to 3 days), in-hospital medications, ICU care, and follow-up care post-discharge
– No, there is no waiting period; beneficiaries can access treatment immediately after enrollment
– Yes, beneficiaries can avail treatment at both public and private empaneled hospitals across India
– Yes, they can enroll in the Ayushman Vaya Vandana Yojana even if they have existing private health insurance
– Each eligible senior citizen will receive coverage of ₹5 lakh, but this amount is shared on a family basis if they are part of the same family unit.
– Once the application is approved, beneficiaries can download their card shortly after completion of the process, typically within 15 minutes
What are your views on this FREE Health Insurance for senior citizens as launched by the government of India? Do you see any benefits? Do share your views ion the comments section
