Ayushman Bharat Yojana: Insurance Coverage to Increase to ₹10 Lakh – Beneficiaries to Triple in Three Years
The Ayushman Bharat Yojana, also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY), is set for a significant enhancement in its insurance coverage. Currently, the scheme provides health coverage of ₹5 lakh per family annually, benefiting approximately 12 crore families. The government is now planning to double this coverage to ₹10 lakh, aiming to triple the number of beneficiaries within the next three years.
Current Scope and Future Expansion
At present, the Ayushman Bharat scheme covers around 70 crore individuals under various central and state government plans, with over 25 crore people possessing an Ayushman Bharat card. As part of the upcoming budget, the government is considering increasing the annual insurance coverage from ₹5 lakh to ₹10 lakh for each family under the PMJAY.
Focus on the Elderly Population
One of the key proposals under consideration is to include individuals aged 70 and above within the ambit of this enhanced coverage. This initiative was highlighted in the President’s address to the joint session of Parliament. The government aims to double the number of beneficiaries in the next three years, which could lead to an additional annual expenditure of ₹12,076 crore, as estimated by the National Health Authority. This expansion would cover over two-thirds of India’s population, significantly reducing the financial burden of healthcare on Indian families.
Policy Recommendations by NITI Aayog
The NITI Aayog, in its October 2021 report titled “Health Insurance for India’s Missing Middle,” recommended expanding the Ayushman Bharat scheme to include those over 70 years old. This expansion would potentially add 5 crore beneficiaries to the scheme. The report highlighted that around 30% of India’s population lacks health insurance coverage, with a significant gap in insurance among the economically weaker sections. Currently, 20% of the population is covered by group insurance and private voluntary health insurance, primarily catering to higher-income groups.
Demand for Increased Tax Exemptions on Health Insurance
Insurance companies have urged the government to increase the tax exemptions on health insurance premiums. Presently, individuals can claim a deduction of up to ₹25,000 under Section 80D of the Income Tax Act, with the industry demanding this limit be raised to ₹50,000. For senior citizens, there is a call to increase the deduction limit from ₹50,000 to ₹75,000, considering the recent rise in insurance premiums. Higher tax exemptions would encourage more people, especially the elderly, to opt for adequate coverage.
Reduction in GST on Health Insurance Products
Non-life insurance companies have reiterated their demand to reduce the GST on health insurance products from 18% to 5%. Lowering the GST rate would make health insurance more affordable for the general public. Additionally, the insurance industry is seeking changes in the new tax regime to allow tax exemptions under Section 80D for life insurance products.
Ayushman Bharat Card: Eligibility and Application Process
The PMJAY scheme, launched on September 23, 2018, provides health coverage to about 50 crore Indian citizens, primarily targeting the economically weaker sections. The scheme covers most medical treatment costs, including medications, diagnostics, and pre-hospitalisation expenses, offering cashless hospitalisation services through the Ayushman health card at empanelled hospitals nationwide.
Eligibility Criteria for Rural and Urban Areas
To qualify for the Ayushman Bharat Yojana, applicants must belong to specific categories such as SC/ST, lower-income groups, or economically weaker sections (EWS). The eligibility can be checked using the “Am I Eligible” feature on the official PMJAY website.
- Rural Eligibility: Includes families living in scheduled caste and tribe households, beggars, those surviving on alms, families with no individuals aged 16 to 59, households with at least one physically challenged member, landless households dependent on casual manual labor, and those living in makeshift houses.
- Urban Eligibility: Covers workers such as washermen, rag pickers, mechanics, domestic help, sanitation workers, artisans, cobblers, hawkers, transport workers, and others listed in the Socio-Economic Caste Census 2011.
Comprehensive Coverage Under PMJAY
The Ayushman Bharat scheme provides a wide range of coverage, including medical examination, consultation, treatment, pre-hospitalisation services, non-intensive and intensive care, medication, diagnostics, accommodation, medical implants, food services, treatment-related complications, and post-hospitalisation expenses for up to 15 days.
Critical Diseases Covered
PMJAY covers over 1,350 medical packages, including critical treatments such as prostate cancer, coronary artery bypass grafting, double valve replacement, carotid angioplasty with stent, pulmonary valve replacement, skull base surgery, and anterior spine fixation.
Exclusions Under PMJAY
Certain procedures are not covered under the scheme, such as outpatient department (OPD) expenses, drug rehabilitation, cosmetic surgeries, fertility treatments, individual diagnostics, and organ transplants.
Affordable Insurance and Subscription Plans
Bajaj Finance offers various affordable insurance and subscription plans to cater to different needs, providing coverage for medical emergencies, vehicle damages, credit card fraud, and more. These plans can be easily purchased online with minimal paperwork.
Conclusion
The planned expansion of the Ayushman Bharat Yojana to provide ₹10 lakh coverage per family annually represents a significant step towards improving healthcare access for economically disadvantaged sections of society. By including senior citizens and increasing the number of beneficiaries, the scheme aims to reduce the financial burden of healthcare and enhance the overall well-being of Indian families.
