The Centre’s New Health Insurance Scheme: Eligibility, Benefits, and Application Process

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is a flagship insurance scheme designed to benefit approximately 4.5 crore families and provide a Rs 5 lakh health insurance cover on a family basis for 6 crore senior citizens. This makes it the world’s largest publicly funded health assurance scheme, aiming to provide comprehensive healthcare coverage to senior citizens, regardless of their socio-economic status. Eligible senior citizens will receive a distinct card under AB PM-JAY, enabling them to avail the benefits of the scheme.

Aiming to target over 12 crore poor and vulnerable families, it is expected to cover approximately 55 crore beneficiaries, which represents about 40% of the Indian population. This scheme addresses healthcare from primary to tertiary levels, offering preventative, promotive, and curative services and also provides essential medicines and diagnostic services free of charge. The Pradhan Mantri Jan Arogya Yojana provides health insurance coverage of up to Rs 5 lakh per family annually for secondary and tertiary care hospitalization, offering cashless services across public and private hospitals and reducing out-of-pocket expenses for beneficiaries.

Unlike previous health schemes, there is no cap on the family size, age, or gender of the beneficiaries. The scheme covers pre-hospitalization and post-hospitalization expenses, including diagnostics and medicines, and beneficiaries can avail services in any empaneled hospital across India. From the first day of enrollment, all pre-existing diseases are covered under the scheme, which helps mitigate the financial burden caused by serious illnesses and hospitalization, thus preventing families from being pushed into poverty.

The scheme covers almost 1,929 procedures, including costs for physician fees, room charges, diagnostics, ICU care, and medical implants. It also includes pre-hospitalization care, medicines, non-intensive and intensive care services, diagnostic and laboratory investigations, medical implants, accommodation and food services during hospitalization, complications arising during treatment, and post-hospitalization follow-up care.