Modi may roll out PMJAY for senior citizens by 23 September, sixth anniversary of health insurance scheme

Prime Minister Narendra Modi is likely to officially launch the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) for people who are 70 years or older by 23 September, the sixth anniversary of the health coverage scheme, according to an official aware of the matter.

The National Health Authority (NHA), the implementing agency of PMJAY, is gearing up to start registering eligible senior citizens on to a specified portal.

On Wednesday, Union minister Ashwini Vaishnaw during a cabinet briefing said the government has approved the health cover for all seniors aged 70 and above irrespective of their income.

This will benefit 45 million families with 60 million senior citizens with free and cashless health cover of up to ₹5 lakh per year. The government has budgeted ₹3,437 crore for this.

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“PM may announce the rollout of the scheme very soon on the occasion of the sixth anniversary of AB-PMJAY. However, the date is still not fixed. NHA is fully prepared to implement the PMJAY for senior citizens 70 years of age and above,” said the official.

“NHA is ready to initiate the registration process of all eligible senior citizens on a specified PMJAY portal.”

Eligible senior citizens would be issued a new card linked to their Aadhaar number on the AB-PMJAY portal, the official said.

Currently, beneficiary families under AB-PMJAY are identified from the socioeconomic caste census of 2011, on the basis of certain deprivation- and occupation-based criteria. While some 107.4 million poor and vulnerable families comprising the bottom 40% of India’s population were covered under the scheme initially, the government widened the base to 120 million families in January 2023, considering the growth of 11.7% over the 2011 population.

In February this year, the scheme was further expanded to cover 3.7 million ASHAs (accredited social health activists), AWWs (anganwadi workers) and AWHs (anganwadi helpers) working across the country and their families.

Opened to senior citizens

Senior citizens aged 70 and above belonging to families already covered under AB-PMJAY will get an additional top-up cover up to ₹5 lakh per year for themselves which they do not have to share with the other members of the family.

Those eligible senior citizens who are already availing benefits of other public health insurance schemes such as the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS) and Ayushman Central Armed Police Force (CAPF) have to choose between their existing scheme and AB-PMJAY.

Those eligible senior citizens under private health insurance policies or the Employees’ State Insurance Scheme will be eligible to avail benefits under the new scheme.

AB-PMJAY is the world’s largest publicly funded health assurance scheme by the number of people covered—550 million.

Industry experts welcomed the move and suggested fair reimbursement and timely payments.

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Probal Ghoshal, chairman, director and co-founder of Ujala Cygnus Healthcare Services, said senior citizens require specialized and consistent medical care and through the PMJAY scheme eligible senior citizens can now access critical treatments with greater ease and support.

He suggested improvements like streamlined reimbursement processes and adjustments in coverage to deliver quality care under the scheme.

“Expanding the beneficiary base significantly may challenge smaller and medium-sized hospitals, which often work with tight budgets. The added demand from senior citizens, who require more care, could strain their resources. To ensure the scheme’s success, it’s crucial to set fair reimbursement rates and ensure timely payments. If not addressed, these issues could overwhelm smaller hospitals, impacting their ability to provide quality care for the elderly,” said Dr Harsh Mahajan, chair of the Ficci Health Services Committee and founder of Mahajan Imaging and Labs.

Queries sent to the prime minister’s office and a health ministry spokesperson remained unanswered.