• Prime Minister Narendra Modi launched the expansion of government’s flagship health insurance scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) to all senior citizens aged 70 years and above. 

• Every elderly person above 70 years of age in the country will get free treatment in hospital by showing an Ayushman Vaya Vandana Card. 

• The PM also launched other projects related to the health sector with an aggregate cost of Rs 12,850 crore.

• The major push in the health sector was unveiled on the occasion of the ninth Ayurveda Day and the birth anniversary of Dhanvantari, the Hindu god of medicine.

Benefits of this expansion:

• The Rs 5 lakh free health insurance cover would benefit approximately six crore senior citizens of around 4.5 crore families. 

• All senior citizens of the age 70 years and above irrespective of their socio-economic status would be eligible to avail the benefits of AB-PMJAY.

• Senior citizens of the age 70 years and above belonging to families already covered under AB-PMJAY will get an additional top-up cover up to Rs 5 lakh per year for themselves (which they do not have to share with the other members of the family who are below the age of 70 years).

• Senior citizens of 70 years and above who are under private health insurance policies or Employees’ State Insurance scheme will be eligible to avail benefits under the AB-PMJAY.

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

• Over the past few decades there has been improvement in various health indicators of India. However, the out-of-pocket expenditure, which pushes millions of people into poverty every year. 

• In order to address this and provide health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to poor and vulnerable section of the population, Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was launched, subsuming the erstwhile Rashtriya Swasthya Bima Yojana, on September 23, 2018. 

• It is the largest publicly funded health assurance scheme in the world.

• AB-PMJAY scheme has witnessed continuous expansion of the beneficiary base.

• Initially, 10.74 crore poor and vulnerable families comprising the bottom 40 per cent of India's population were covered under the scheme.

• In January 2022, the Union government revised the beneficiary base from 10.74 crore to 12 crore families considering India's decadal population growth of 11.7 per cent over the 2011 population.

• The scheme was further expanded to cover 37 lakh ASHAs/AWWs/AWHs working across the country and their families for free healthcare benefits.

• Currently, 55 crore individuals corresponding to 12.34 crore families are covered under the scheme. Further, many states have expanded beneficiary base on their own.

• The scheme is implemented in 33 states/UTs except the NCT of Delhi, West Bengal and Odisha.

• All members of the eligible families irrespective of age are covered under the scheme.

• The funding of the scheme is shared between central and state governments. The ratio of central share to state share for all states except northeast states and Himalayan states and Union Territories with legislature, is 60:40. For northeast states and Himalayan states, the ratio is 90:10. In the case of Union Territories without legislatures, the central contribution of premium is 100 per cent.

• The AB-PMJAY scheme is completely cashless and paperless and without the concept of reimbursement. Beneficiaries can avail treatment under defined packages. 

• It is an entitlement-based scheme. Eligible beneficiaries can directly visit any empanelled public or private hospital to avail cashless treatment. Ayushman cards are issued to the beneficiaries to create awareness about the scheme. 

• As of June 30, 2024, more than 34.7 crore Ayushman cards have been created under the scheme in the country.

• The Empanelled Healthcare Providers are paid based on specified health benefit packages with standardised rates.

• The scheme has covered 7.37 crore hospital admissions, including 49 per cent women beneficiaries. The public has benefited to the extent of over Rs 1 lakh crore under the scheme, the government said.

Manorama Yearbook app is now available on Google Play Store and iOS App Store