The Ayushman Bharat Yojana, popularly known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), is a health insurance scheme launched in 2018 providing Rs 5 lakh coverage per family, including senior citizens belonging to the economically weaker section of society. On Wednesday, Prime Minister Narendra Modi re-launched the scheme with some upgrades to provide the same coverage sum exclusively to every senior aged 70 and above, irrespective of their income status. So, families with seniors aged 70 and older will now get a total coverage of Rs 10 lakh.

About The Scheme

The Ayushman Bharat Yojana was launched in 2018 under the mandate of the National Health Policy 2017 to provide comprehensive health coverage to economically weaker people.

The beneficiaries were selected based on the Socio-Economic Caste Census of 2011. Initially, 10.74 crore families were identified based on the census data. In 2022, the beneficiaries increased as people from other databases and those not included earlier were also enrolled.

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The scheme has two components: Health and Wellness Centres (HWCs), which are also called Ayushman Arogya Mandirs, and Pradhan Mantri Jan Arogya Yojana (PM-JAY).

• HWCs or Ayushman Arogya Mandirs: These centres aim to provide comprehensive healthcare services, including preventive, curative, rehabilitative, and palliative care.

• Pradhan Mantri Jan Arogya Yojana (PM-JAY): It is a health assurance scheme providing coverage of Rs 5 lakh per year per family for secondary and tertiary care hospitalisation.

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Now, the scheme provides exclusive coverage to all seniors aged 70 and above. Those aged 60 and above but less than 70 will share the coverage with other family members. After the recent upgrade, six crore more seniors will benefit besides the 12 crore families already enrolled.

What Does The Scheme Offer?

The scheme provides hospitalisation and tertiary care benefits, including 3-day pre- and 15-day post-hospitalisation, diagnostic services, medicines, and follow-up care. It covers:

• 3-day pre- and 15-day post-hospitalisation care

• Diagnostic services

• Medicine and other healthcare supplies

• Intensive care (ICU) and non-intensive care (non-ICU) services

• Laboratory services for various tests

• Accommodation (Room) services

• Follow-up care

The scheme offers around 1,400 health packages listed under PM-JAY. Hospitals must mandatorily provide them to the beneficiaries. However, states are allowed to add additional package. They can also modify the rates and the list of hospitals depending on their needs.

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The packages include cardiology, mental disorders, oncology, burns management, urology, ophthalmology, pediatric surgery, neurosurgery, ENT, and gynecology, among others.

Who Is Eligible For The Ayushman Bharat Yojana?

Until now, the beneficiaries were determined based on the 2011 census data and the Rashtriya Swasthya Bima Yojana (RSBY) beneficiaries. Now, seniors aged 70 and above will get individual coverage unlike the family plan where seniors less than 70 are also included.

It is also available for central government employees covered under the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), and scheme for Central Armed Police Force (CAPF). However, they are allowed to choose only one scheme.

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How To Avail Of The Services?

The beneficiaries will be issued Ayushman Vaya Vandana cards, which they will need to produce at the government hospitals and empanelled private hospitals to avail of the services.

As of October 30, 2024, 30,661 hospitals were empanelled under the scheme, including 17,079 government hospitals and 13,582 private hospitals, according to the Ayushman Bharat portal.