Widening the social security ambit by bringing all senior citizens aged 70 years and above under the Rs 5 lakh health insurance cover is set to revitalise key healthcare infrastructure in India, as the government’s spending outlay balloons to over Rs 1 lakh crore under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). According to Invest India, FDI in medical infrastructure, both under greenfield and brownfield projects, is estimated to breach the $200 billion mark by the end of 2024.
The health cover, a much-anticipated stimulus shot for the sector, may not only improve public healthcare infrastructure through high government spending but is also likely to place India among the top FDI destinations in the health insurance sector. According to government data, FDI inflow in the health insurance sector swelled to Rs 53,900 crore between 2014 and 2024, a surge witnessed after the Union government raised the FDI cap in the sector to 74% in 2021.
Furthermore, the new health scheme aims to benefit over 4.5 crore families directly, with an estimated 6 crore senior citizens, regardless of their social standing, now receiving access to Rs 5 lakh free health cover per family.
“We are committed to ensuring accessible, affordable, and top-quality healthcare for every Indian. In this context, the Cabinet today has decided to further expand the ambit of Ayushman Bharat PM-JAY to provide health coverage for all citizens above 70 years. This scheme will ensure dignity, care, and security to 6 crore citizens!” Prime Minister Narendra Modi announced this week.
https://x.com/narendramodi/status/1833893310366097605
Additionally, under the new plan, all senior citizens whose families are already covered under AB PM-JAY will receive an additional top-up cover of Rs 5 lakh per year for themselves. “All other senior citizens aged 70 years and above will receive cover up to Rs 5 lakh per year on a family basis,” stated a Union government notification.
The notification added that the new health cover for senior citizens can either be clubbed with already existing public health insurance schemes such as the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), Ayushman Central Armed Police Force (CAPF), or they can opt for AB PM-JAY. Additionally, all senior citizens covered under private health insurance policies or the Employees’ State Insurance scheme will now be eligible to avail themselves of benefits under AB PM-JAY.
Health Protection Cover
The AB PM-JAY is said to be one of the world’s largest publicly funded health assurance schemes. According to government estimates, it provides Rs 5 lakh cover per family per year for secondary and tertiary care hospitalisation to about 55 crore individuals, corresponding to 12.34 crore families.
Under the state-funded scheme, hospital admissions have so far been availed by over 7.37 crore policyholders, including 49% women beneficiaries. The new expansion in cover to all senior citizens aged 70 years and above is part of the announcement made by Prime Minister Narendra Modi in April earlier this year.
With this expansion, the health scheme that covers the 12 crore most poor and vulnerable families, comprising the bottom 40%, will now be open to all senior citizens.
Tech Tracking Transition in Healthcare
New-age technology has emerged as the backbone for the implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), ensuring efficient service delivery and transparency. Among the tech innovations central to the scheme are:
- Health eCards: Beneficiaries are issued a unique AB-PMJAY eCard that provides easy access to healthcare services under the scheme. The eCard is linked to an Aadhaar-based verification system that ensures identification accuracy and prevents fraud.
- Health Information Management System (HIMS): This is a comprehensive IT system that manages and tracks hospital admissions, treatments, and claims in real time. It also facilitates a seamless and cashless transaction process for beneficiaries at empanelled hospitals.
- Transaction Management System (TMS): The platform records and processes claims between hospitals and the government. It also ensures fast and transparent settlements, maintaining accountability.
- Data Analytics and Fraud Detection: Advanced data analytics and AI techniques are used to monitor the system for fraudulent activities. The system flags unusual patterns, such as excessive claims or suspicious treatment patterns.
- Grievance Redressal System: This is a tech-driven grievance redressal mechanism that allows beneficiaries to file complaints and track their status online.
- Mobile Apps: The PM-JAY mobile app provides users with access to scheme-related information, hospital lists, and coverage details. It enhances accessibility and allows users to check their eligibility and locate nearby hospitals.
