SENIOR CITIZENS CAN USE HEALTH PLAN FOR TREATMENT COSTS ABOVE Rs 5 LAKH

 

SENIOR CITIZENS CAN USE HEALTH PLAN FOR TREATMENT COSTS ABOVE Rs 5 LAKH

Take pvt cover with Ayushman Bharat

This will expand cover for expensive treatments & also offer flexibility

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

Email: pmgiia26.com Mobile  9868944340