How to Apply for Senior Citizen Health Insurance Under Ayushman Bharat Scheme

The Ayushman Bharat scheme, also known as Pradhan Mantri Jan Arogya Yojana (PM-JAY), is a government initiative designed to provide health insurance coverage to low-income families across India, including senior citizens. With rising healthcare costs, senior citizens often face significant financial burdens, making health insurance essential. This guide will explain how to apply for senior citizen health insurance under the Ayushman Bharat scheme, the eligibility criteria, and how to maximize its benefits.

What is Ayushman Bharat’s senior citizen health insurance?

Ayushman Bharat offers comprehensive senior citizen health insurance, covering medical treatments, surgeries, hospitalisations, and more. The scheme provides coverage of up to Rs. 5 lakh per family annually for secondary and tertiary healthcare services. This coverage ensures that senior citizens have access to essential medical care without the stress of financial strain.

Eligibility criteria for Ayushman Bharat

The Ayushman Bharat scheme is targeted at the economically vulnerable population. Here are the key eligibility criteria for senior citizens under the scheme:

1. Socio-Economic Caste Census (SECC) 2011 data: Families listed in the SECC 2011 database are eligible for the scheme. This database identifies families based on deprivation and occupational criteria, ensuring that the most vulnerable sections of society are covered.
2. No specific age limit: The scheme does not impose any age restrictions. This means senior citizens, along with their families, can avail themselves of the benefits provided they meet the overall family eligibility criteria.
3. Rural and urban coverage: Both rural and urban households that meet the deprivation criteria are eligible for the scheme, ensuring wide coverage across all regions.

How to check eligibility for Ayushman Bharat

Before applying for senior citizen health insurance under Ayushman Bharat, it is essential to confirm your eligibility. Here’s how you can check:

1. Visit the official website: Go to the official website at www.pmjay.gov.in.
2. Use the ‘Am I Eligible’ feature: On the homepage, select the ‘Am I Eligible’ option.
3. Enter your details: Enter your mobile number and the OTP you receive for verification.
4. Check your eligibility: Once verified, the website will inform you whether your family is listed in the SECC 2011 database and is eligible for the scheme.

How to apply for senior citizen health insurance under Ayushman Bharat

If you are eligible, follow these steps to apply for senior citizen health insurance under the Ayushman Bharat scheme:

1. Get the Ayushman Bharat e-card: The first step is obtaining the Ayushman Bharat e-card. You can do this by visiting an empanelled hospital or a Common Service Centre (CSC). The e-card is proof of enrolment in the scheme and is necessary to avail the cashless treatment benefits.
2. Submit required documents: When applying, you will need to provide necessary identification documents. These typically include:
   • Aadhaar card
   • Ration card
   • SECC-based identification (if applicable)
3.  Complete the enrolment process: The staff at the empanelled hospital or CSC will assist you in completing the application process. Once your details are verified, the e-card will be issued to you. This card is what you will use to access healthcare services under the scheme.

Benefits of senior citizen health insurance under Ayushman Bharat

The Ayushman Bharat scheme offers several benefits for senior citizens, making it one of the most accessible and comprehensive health insurance policies in India. Some of the key benefits include:

• Cashless treatment: With the Ayushman Bharat e-card, senior citizens can receive cashless treatment at over 24,000 empanelled hospitals across India. This includes both government and private healthcare facilities, providing a wide network of accessible hospitals.
• Coverage for a wide range of treatments: The scheme covers over 1,500 medical procedures, including surgeries, hospitalisation, diagnostics, and follow-up care. This ensures comprehensive care for senior citizens.
• Pre-existing conditions covered: Unlike many private health insurance policies, Ayushman Bharat covers pre-existing conditions from the start. This is particularly important for senior citizens who may have ongoing health issues.
• No age or family size limit: There are no restrictions on the number of family members or their ages. Senior citizens and their families can benefit without any limitations, ensuring maximum coverage for those who need it most.

Using the Ayushman Bharat e-card for treatment

Once you have your Ayushman Bharat e-card, you can begin using it to access healthcare services under the scheme. Here’s how:

1. Visit an empanelled hospital: Locate a hospital that is part of the Ayushman Bharat network. You can find this information on the scheme’s official website or by contacting the helpline.
2. Present your e-card: Show your Ayushman Bharat e-card at the hospital’s helpdesk. The hospital staff will verify your details and guide you through the admission and treatment process.
3. Receive cashless treatment: Once your e-card is verified, you will be eligible for cashless treatment. The costs of the treatment will be directly covered under the Ayushman Bharat scheme, so you do not have to worry about paying out of pocket.

Tips for a smooth application and claim process

To make the application and claims process as smooth as possible, here are a few tips to keep in mind:

• Keep your documents handy: Always ensure you have your Aadhaar card, ration card, and other necessary identification documents ready when applying or seeking treatment.
• Understand the coverage: Familiarise yourself with the medical treatments and services covered under the scheme to ensure you are fully informed when accessing healthcare services.
• Opt for empanelled hospitals: To take full advantage of the cashless treatment benefit, always choose a hospital within the Ayushman Bharat network.

Conclusion

The Ayushman Bharat scheme provides essential senior citizen health insurance, ensuring that the elderly population has access to necessary healthcare services without facing financial difficulties. By understanding the eligibility criteria and application process, families can make the most of this health insurance policy and secure the well-being of their elderly members. With its wide network of hospitals, cashless treatment, and coverage for pre-existing conditions, Ayushman Bharat is a valuable safety net for senior citizens across India.