The newly implemented Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has expanded healthcare access for India’s elderly, making every citizen aged 70 and above eligible for annual cashless medical coverage worth Rs 5 lakh, regardless of income status.

The move comes as the new government in West Bengal, under Chief Minister Suvendu Adhikari, announced the rollout of the Centre’s flagship health insurance scheme in the state once again.

Originally launched between September 23, 2018, and January 10, 2019, the scheme was later withdrawn in the state. With its return, lakhs of residents, especially senior citizens, are expected to benefit from cashless hospital treatment across empanelled hospitals.

 

What is AB-PMJAY?

The scheme provides up to Rs 5 lakh per year per family for secondary and tertiary hospitalisation.

Under the latest expansion, all senior citizens aged 70 years and above are automatically eligible, even if they already have private insurance or are covered under other government health schemes.

The initiative aims to ease the growing financial burden of healthcare among elderly citizens, many of whom face expensive long-term treatment and hospitalisation costs.

 

What expenses are covered?

The scheme includes:

  • Medical consultations
  • Diagnostic tests and laboratory investigations
  • Medicines and medical consumables
  • ICU and non-ICU treatment
  • Surgical procedures and implants
  • Accommodation and food during hospital stay
  • Pre-hospitalisation expenses for three days
  • Post-hospitalisation follow-up care for 15 days
  • Treatment-related complications

What is not covered?

Certain categories remain outside standard coverage, including:

  • Outpatient department (OPD) expenses
  • Cosmetic surgeries
  • Drug rehabilitation programmes
  • Fertility treatments
  • Standalone specialised diagnostics

Who is eligible?

  • All citizens aged 70 and above are eligible under the updated guidelines. Income level is no longer a criterion for senior citizens.

The scheme also covers:

  • Rural and urban residents
  • People already under private insurance
  • Beneficiaries of ESI schemes
  • Senior citizens covered under ECHS, CGHS, or Ayushman CAPF, who may either continue with their current scheme or switch to PM-JAY

Urban eligibility includes vulnerable workers such as ragpickers, street vendors, labourers, and domestic assistants. In rural areas, preference is given to landless labourers, households without able-bodied adults, and families living in kutcha houses.

 

Documents required

Applicants may need:

  • Aadhaar card or PAN card
  • Address proof
  • Income certificate
  • Caste certificate
  • Mobile number and e-mail ID
  • How to apply online

Applicants can apply digitally through the official PM-JAY portal or the Ayushman mobile application.

 

Steps include:

  1. Open the portal or app
  2. Select “I am eligible”
  3. Enter mobile number, captcha, and OTP
  4. Choose state, district, and PMJAY under “Sub Scheme”
  5. Complete Aadhaar-based e-KYC
  6. Upload documents in the prescribed format
  7. Submit verification request
  8. Download the digital Ayushman card after approval

Officials say beneficiaries should ensure their Aadhaar details match their application information to avoid delays.

 

Offline option also available

People unfamiliar with digital applications can visit nearby Common Service Centres (CSC) or diagnostic centres with required documents and Aadhaar cards for offline verification and enrolment.

The government has said the expanded health coverage is intended to provide elderly citizens with financial security during medical emergencies and reduce the risk of families exhausting savings on treatment costs.