Ayushman Bharat health insurance scheme: States, UTs asked to facilitate enrolment of eligible senior citizens

New Delhi: The Union Health Ministry has asked all states and Union Territories to facilitate the enrolment of all eligible senior citizens aged 70 years and above to enable them to avail the benefits of the Ayushman Bharat health insurance scheme.

In a letter sent to the states and UTs, Union Health Ministry Additional Secretary L S Changsan said that a separate module has been created in mobile phone application (Ayushman App) and in web portal (beneficiary.nha.gov.in) for 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. 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," she said in a recent letter.

The registration for all eligible senior citizens aged 70 years and above will be application-based only and that enrolment will be a continuous process, allowing registration throughout the year.

"The scheme is to be rolled out shortly," Changsan said.

The benefits of AB-PMJAY would now be available to all senior citizens of the age 70 years and above irrespective of their socio-economic status, Changsan said.

These benefits will be available to the senior citizens of 70 years and above in families already covered under AB PM-JAY as well as in families which are not covered under the scheme.

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 the 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, she stated.

The 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 PMJAY scheme to avoid duplication.

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, the additional secretary informed.

"An additional shared top-up cover of up to 25 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 Rs 5 lakh," she said.

"A shared cover of Rs 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," the letter said.

The additional cost of covering senior citizens, including administrative expenses, will be shared between the central and state governments as per the existing guidelines of fund release in AB PM-JAY.

The letter emphasized that the implementation of the scheme would require the states and Union Territories to facilitate the enrolment of all eligible senior citizens of the age 70 years and above.

The states and UTs were asked 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 successful rolling out the scheme benefits to the eligible senior citizens, the letter said.

Three states Odisha, Delhi and West Bengal have not yet implemented Ayushman Bharat Pradhan Mantri - Jan Arogya Yojana.