How Senior Citizens Can Use Private Insurance, Ayushman Bharat To Build Comprehensive Coverage

Senior citizens aged 70 years and above have a new benefit coming their way, as the government has included them for the coverage under the Ayushman Bharat Scheme, without any regard to income limits.

This means that any senior citizen across the country who meets the age criteria can get the benefit of coverage up to Rs 5 lakh of various expenses related to healthcare including consultations, pre hospitalisation care, medicines, diagnostics, non intensive and intensive care service and post hospitalisation expenses.

There are several details that are present in the fine print and these need to be understood for the correct implications for the senior citizens, so that they are able to get a comprehensive and adequate cover for themselves.

Here are several factors that will determine this aspect. 

One of the first things to understand is the structure of the Rs 5-lakh limit for coverage that the scheme provides. This limit is calculated on a family basis and is applicable for senior citizens also. This means that if there are two members in the family who are senior citizens, then the Rs 5-lakh limit would have to be shared between them. A couple who falls into the specific age category of 70 years plus would, thus, have to ensure that they know that the limit is not an individual one, but a joint one. This has to be factored into their planning for the total cover that they need to maintain. Also, for the coverage to be applicable, all the senior citizens would need to get registered and get a unique card.  

Since the limit is a family limit, the next question for people would be that if their existing family members are already covered by the scheme, then would they have to share the limit with them too? This is a valid question, since the term family is used, but the good part is that the senior citizens are not affected because they will be getting a separate Rs 5 lakh cover for themselves. This is over and above the Rs 5 lakh cover that the other members of the family might be enjoying. In that sense, this is an extra cover that is available and hence it will not affect other members of the family. 

There is likely to be a situation where several senior citizens above the age of 70 years would be having their own private health insurance policies. Though such policies are very expensive, there are many who still pay the high premium and try and ensure some coverage for themselves for protection against high medical expenses. The good part here is that those having such cover are not prohibited from using the Ayushman Bharat cover benefit. This means that the new additional cover would be an extra cover over and above their existing policies and this will ensure proper planning by them too.

It is essential to continue with the private cover that one has already bought. The additional cover acts as a further backup for them and the best part is that this is coming without the huge premium cost that is normally associated with the health cover. Using both these areas can be a way to ensure that there is a larger cover available to senior citizens giving them peace of mind. 

One of the benefits of the scheme is that there is a wide coverage of places where the person can get treatment and take the benefit of the scheme. Unlike many other health schemes, where the benefit can be taken only in government hospitals, when it comes to Ayushman Bharat, the coverage includes selected government as well as private hospitals. Hence, for those people who might be thinking about where they can use this card and cover, they can check which hospitals are covered in their area. For amounts that are beyond the Rs 5-lakh limit, as well as treatments in other hospitals, the private cover would come in use.  

Arnav Pandya is founder Moneyeduschool.