The Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which offers health coverage of Rs 5 lakh on a family floater basis, has several features that many people are still not aware of. In this write-up, we will discuss some of these lesser-known features. However, before we delve deeper into those features, we must first understand the basic objectives of the scheme, its origins, and who it is intended for.
What is AB – Pradhan Mantri Jan Arogya Yojana and which ailments are covered?
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is the central government’s flagship health insurance scheme launched to protect poor and vulnerable families from high medical costs. The scheme offers Rs 5 lakh health insurance cover per family per year for serious illnesses that require secondary or tertiary hospitalisation. Treatment is provided cashless and paperless at thousands of empanelled hospitals across India.
One of the biggest advantages is that all pre-existing diseases are covered from day one, making it a complete protection plan for eligible households. There is no limit on the number of family members, and no age or gender restrictions, which means every member of the eligible family gets covered automatically.
What is the definition of family under PM-JAY?
Under PM-JAY, the term “family” includes the primary beneficiary and all their eligible family members—this covers spouses, children (newborns as well), parents, grandparents, brothers and sisters, in-laws, and any other dependents living in the same household. There is no limit to the number of members, and no age or gender restrictions apply.
As the definition shows, there has never been any limit on the family size or the members covered under PM-JAY. However, the government expanded the scheme last year by introducing an additional Rs 5 lakh cover exclusively for senior citizens above 70. This extra amount is provided separately, over and above the existing Rs 5 lakh family floater limit.
What are the eligibility criteria for senior citizens under this scheme?
The only eligibility criterion is that the individual must be aged 70 years or above, as determined by the age recorded in their Aadhaar card, regardless of economic status, according to a frequently asked question (FAQ).
Is a 70+ family member eligible for the additional top-up?
If your family is already covered under Ayushman Bharat, any member who is above 70 years of age will receive the additional top-up benefit. The only requirement is that they must complete their Aadhaar eKYC again to activate this enhanced coverage.
Key features of PM-JAY for senior citizens
No age limit for coverage:
Unlike many health insurance plans that impose age caps, PM-JAY has no upper age limit. Senior citizens in their 70s, 80s, or even older can fully avail the scheme’s benefits, ensuring complete healthcare inclusion.
Free annual health check-ups:
Through Ayushman Bharat Health and Wellness Centres, senior citizens receive free annual check-ups, preventive care, and regular screenings. This helps in early detection of health issues and better management of chronic diseases.
Secondary and tertiary care coverage:
PM-JAY for senior citizens covers a wide range of treatments—from secondary care like surgeries and specialist consultations to tertiary care, including advanced treatments and organ transplants. This ensures access to high-quality and comprehensive medical care whenever required.