GS Paper - II

The Union cabinet approved the expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) health cover to all Indians of age 70 years and older irrespective of their income. The registration for the expanded insurance scheme was likely to begin within a week.

What is AB PM-JAY?

• AB PM-JAY is already the world’s largest public health insurance scheme.
• It provides free cover upto Rs 5 lakh annually to all members of eligible families — estimated to comprise the bottom 40% of the population economically — irrespective of age.
• Expansion of the cover to the country’s entire elderly population now the first complete age-cohort to receive coverage under the scheme.

Register for scheme

• Those eligible for the expanded cover will be able to register themselves and get the Ayushman Bharat card as soon as the new module is added to the existing portal.
• Beneficiaries can register either through the government’s Ayushman App or at the Ayushman Bharat counter at any government health facility.
• Anyone who has turned 70 as per their Aadhaar can register for the new health cover.
• There will be no exclusions or waiting period of pre-existing conditions.
• Beneficiaries will be able to utilise their policy as soon as they complete their eKYC.
• The portal will also be face-authorisation-enabled, to ensure that even elderly persons whose fingerprints are difficult to read or have changed over time can avail the benefits.

Cover, beneficiaries

• Everyone of age 70 or more will be entitled to a cover of Rs 5 lakh annually, shared within the family.
• This means if there are two elderly beneficiaries in the household, the cover will be split among them.
• Elderly members (age 70 and more) of families that are already covered in accordance with their economic status will get a top-up cover of Rs 5 lakh — to be used only for the elderly. These elderly beneficiaries will have to re-register to receive the top-up cover.
• The scheme will cover almost 6 crore individuals (from 4.5 crore families), of whom 1.78 crore are already covered by the scheme. For the additional top-up amount, the financial implication is very little.
• The Ayushman Bharat scheme already covers 1,670 procedures across 26 specialities, which includes 25 geriatric packages. More packages for the elderly are in the process of being added.

Those already covered

• Some 80 lakh people are separately covered under various government health schemes — the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme, or cover provided to family members of defence and railway personnel, etc.
• Those who are covered under these government health schemes will have the option of choosing either Ayushman Bharat or continuing with their existing coverage.
• People who are covered under the Employees State Insurance Corporation (ESIC), however, will be eligible to have both their existing cover and Ayushman Bharat.
• This is because premiums for ESIC are paid by the insured and their employer, not the government.
• People who have their own privately purchased insurance cover will be eligible to have the Ayushman Bharat cover as well.

Why scheme matters

• Making health cover universal over the age of 70 is very significant as India’s population ages.
• More Indians are likely to need health facilities in the coming years, and much of the population is currently under-covered by health schemes.
• At the time of the 2011 census, only 8.6% of India’s population was over the age of 60 years.
• This is expected to increase to 19.5% by 2050, according to the government’s Longitudinal Ageing Study in India (LASI).
• In terms of numbers, Indians over the age of 60 are likely to be 319 million in 2050 — up more than three times from the 103 million in 2011.
• Older Indians are much more likely to be hospitalised and to stay in hospitals for longer.
• The rate of admission among the elderly already covered under the scheme has been more than 7% — double the 3-4% admission rate for the younger people covered under the scheme, according to officials.
• The elderly remain largely uncovered by any health scheme. Just over 20% of India’s population above the age of 60 is currently covered by any government, employer-provided, or personal insurance scheme, according to the India Ageing Report 2023.
• Women make up the larger share of the elderly population — a survey by NITI Aayog found that 58% of the elderly are women, and 54% among them are widows.
• This presents a substantial challenge because they may not have healthcare support. This scheme will be of immense help to women, especially those who are widowed.