SENIOR CITIZENS CAN USE HEALTH PLAN FOR TREATMENT COSTS ABOVE Rs 5 LAKH
Take pvt cover with Ayushman Bharat
Senior Citizens above 70 years should combine
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) with a private
health insurance plan for a comprehensive cover. They can use the government
cover for primary hospitalization. And for expensive treatments that go beyond
Rs 5 lakh or prolonged hospitalization, make use of a private cover.
The AB-PMJAY provides a base floater cover of
Rs 5 lakh for all senior citizens above 70 years, which is beneficial to cover
primary and tertiary expenses. To supplement the cover, senior citizens should
consider private plans of at least Rs 5 lakh to cover additional expenses such
as outpatient treatments, specific diseases, or higher room categories as
health expenses tend to increase with age. This combination will ensure
comprehensive coverage and address both essential and advanced healthcare
needs.
Moreover, they can look at a top-up which is a
cost-effective strategy to expand coverage for expensive treatments. This can
help them avoid high premiums for comprehensive coverage, while ensuring they
are covered for substantial expenses if need be.
Senior citizens are vulnerable to high-risk
illnesses, treatments for which can be very expensive and may go beyond Rs 5
lakh. To ensure more comprehensive coverage, seniors can combine it with a
private health insurance policy that covers additional healthcare expenses,
including any specialized services for expensive treatments.
Added advantages
Unlike private insurance, there is no waiting
period for any preexisting conditions in AB-PMJAY and the coverage starts
immediately after enrolment. Aadhar is the only document needed for enrolment
in the scheme. It there are two members above 70 years in a family, then the Rs
5 lakh coverage will be shared between them.
Senior citizen will have to generate an
Ayushman Vaya Vandana card to enroll. Separate enrolments are not needed for people
above 70 years in a family. After enrolling the first family member aged 70 or
above, the names of other family members above 70 years can be added under the
scheme using the ‘add member’ feature.
Senior citizen already covered under public health
insurance schemes like the Central Government Health Scheme will have the
option to either continue with their existing scheme or opt for AB-PMJAY. Those
under private health insurance policies or the Employee’s State Insurance
Scheme will also be eligible to avail of the benefits of AB-PMJAY.
Once a senior citizen chooses the AB-PMJAY
scheme and surrenders the existing government health insurance scheme, he
cannot switch back as it is a one-time option and cannot be reversed. However,
residents of Delhi and West Bengal cannot apply for the scheme as the state governments
had not signed up for the scheme.
Limitations of AB-PMJAY
As the treatment is restricted to empaneled
hospitals only, senior citizens may face limitations especially in case of any
emergency. Moreover, there is limited participation of major private hospitals
in the scheme and not all hospitals offer every specialty. These factors can
limit the usage of AB-PMJAY.
It also does not have a reimbursement clause. Most
private health insurance policies include reimbursement clauses, where the
insured can go to non-network hospitals and claim reimbursement of the bills up
to the insured limit. So, combining AB-PMJAY with a private health insurance
plan can provide flexibility in choosing healthcare providers. Under AB-PMJAY,
all admissions will be limited to general wards. In contrast, a private health
cover will have the option of a private room as per the terms and condition of
the policy.
To maximize benefits, senior citizens should understand
the coverage limits and exclusions of both AB-PMJAY and a private cover. The
insured can use the government cover for surgeries and major ailments, while
reserving their private insurance for conditions not fully covered by PMJAY. Keeping
track of claim procedure and ensuring timely renewals of both policies will
enhance benefits.
Benefits of AB-PMJAY
No premium payments
No co-payments
Three days pre and 15 days post-hospitalization
coverage
Cashless
treatment at any empaneled public or private hospital across India
For More Details: Pooja Manoj Gupta, visit www.giia26.com
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