“The Uttar Pradesh government has rolled out enhanced health insurance benefits for seniors under the Ayushman Bharat scheme, offering free coverage up to ₹5 lakh for those aged 70 and above. This move aims to ease healthcare costs for over 6 crore elderly citizens, introducing new cards and top-up coverage options, ensuring accessible medical care regardless of income.”
Uttar Pradesh Enhances Healthcare for Seniors with New Insurance Benefits
The Uttar Pradesh government has introduced significant enhancements to its health insurance framework under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), specifically targeting senior citizens aged 70 and above. Announced on September 11, 2024, by the Union Cabinet, this expansion ensures that approximately 4.5 crore families, including 6 crore elderly individuals, will benefit from free health insurance coverage of up to ₹5 lakh per family annually. This initiative marks a pivotal step in addressing the healthcare needs of India’s aging population, particularly in a state like Uttar Pradesh, where access to affordable medical care remains a critical concern.
A key feature of the updated scheme is the issuance of a distinct card for eligible senior citizens, enabling them to access healthcare services seamlessly across network hospitals. For seniors already covered under AB PM-JAY as part of their families, an additional top-up cover of up to ₹5 lakh per year has been introduced, exclusively for their use. This top-up does not need to be shared with younger family members, ensuring that elderly individuals have dedicated financial support for their medical needs. For those not previously enrolled, the scheme provides coverage of up to ₹5 lakh per year on a family basis, making it inclusive for all seniors irrespective of their socio-economic status.
The initiative also offers flexibility for seniors already enrolled in other public health insurance schemes, such as the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), or Ayushman Central Armed Police Force (CAPF). They can choose to continue with their existing plans or opt for AB PM-JAY, depending on their preferences. Additionally, seniors with private health insurance or coverage under the Employees’ State Insurance (ESI) scheme are also eligible, broadening the scheme’s reach.
This expansion aligns with the Insurance Regulatory and Development Authority of India’s (IRDAI) recent regulations, effective from April 1, 2024, which mandate insurance companies to offer health policies to all age groups, including seniors above 65. The IRDAI has also reduced the waiting period for pre-existing conditions from four to three years, enabling faster access to coverage for chronic ailments common among the elderly. However, industry experts suggest that these changes could lead to a 10-15% hike in premiums, as insurers develop targeted products for seniors to account for higher morbidity risks.
In Uttar Pradesh, where the elderly population is projected to grow significantly by 2050, such measures are timely. The state’s Upper Peninsula Health Plan (UPHP) has also been recognized for its innovative approach to healthcare, winning a national award in 2008 for its drug-management system. The recent enhancements under AB PM-JAY build on this legacy, offering comprehensive coverage for hospitalization, pre- and post-hospitalization expenses, day-care treatments, and AYUSH therapies. The scheme has already facilitated over 7.37 crore hospital admissions nationwide, with 49% of beneficiaries being women, and saved the public over ₹1 lakh crore in healthcare costs.
The move has been lauded for its inclusivity, as it eliminates income-based eligibility criteria for seniors, ensuring that even those with private insurance or higher incomes can benefit. However, challenges remain, including raising awareness among rural seniors and streamlining claim settlements to minimize administrative hurdles. The Uttar Pradesh government is working to integrate these benefits with existing public health resources, such as UPHP’s Connected Communities platform, to help seniors locate additional support services in their areas.
Disclaimer: This article is based on recent news reports, government announcements, and insights from health policy experts. Information is sourced from credible platforms like pmindia.gov.in, careinsurance.com, and businesstoday.in. Readers are advised to verify details with official government or insurance provider sources for the latest updates.