The Pradhan Mantri Health Insurance for senior citizens, also known as the PMVVY scheme, is an important government-sponsored health insurance program in India that provides coverage specifically for senior citizens aged 60 years and above. Implemented by the National Health Authority, this scheme aims to provide health insurance benefits to vulnerable and low-income seniors to help them afford quality healthcare. In this article, we will provide a comprehensive guide to the Pradhan Mantri Health Insurance for senior citizens including its features, eligibility criteria, benefits, coverage amount and more.
Eligibility Criteria
The eligibility criteria for the Pradhan Mantri Health Insurance for senior citizens are straightforward. To qualify for this health insurance scheme, the senior citizen must:
- Be aged 60 years or above at the time of applying. The upper limit for age is 80 years.
- Be a resident of the nation with a valid address proof. Documents like Aadhaar card, voter ID or ration card can be furnished.
- Not be a beneficiary of any other government-sponsored or retirement health insurance schemes. There cannot be any overlap of benefits.
As long as the senior citizen meets these basic criteria, they can apply to become a beneficiary under the Pradhan Mantri Health Insurance scheme.
Benefits and Coverage
The Pradhan Mantri Health Insurance policy for senior citizens provides a coverage amount of Rs. 50,000 per insured person per year. This amount can be utilized to cover expenses incurred towards hospitalization and treatment costs during the policy year. Following are the key benefits offered:
- Cashless hospitalization: All treatments are provided on a cashless basis up to the coverage amount at empaneled hospitals. There is no need to make upfront payments.
- Pre and post-hospitalization coverage: Relevant medical expenses incurred before and after hospitalization are covered for up to 30 days and 60 days respectively.
- Day care procedures: Costs for approved day care procedures like dialysis, chemotherapy and radiotherapy are covered.
- Ambulance charges: Expenses towards ambulance transportation to and from the hospital are covered up to Rs. 2,000.
Therefore, the coverage provides end-to-end support for the senior citizen starting from hospital admission until discharge, to enable affordable and accessible healthcare.
Premiums and Policy Term
One of the biggest advantages of the Pradhan Mantri Health Insurance scheme for senior citizens is that premiums are highly affordable. Policyholders only pay a one-time lump-sum premium at the time of enrollment as follows:
- For age 60 years: Premium of Rs.21,250
- For age 61-65 years: Premium of Rs.34,000
- For age 66-70 years: Premium of Rs. 51,000
- For age 71-75 years: Premium of Rs. 68,000
- For age 76-80 years: Premium of Rs. 1,00,000
The premium is the same for all applicants basis their age bracket. Once enrolled, beneficiaries receive a policy cover for a term up to 5 years or till the time they turn 81 years old, whichever is earlier. The policy can be renewed thereafter. This makes it a beneficial long-term health insurance solution for seniors.
Network Hospitals
The Pradhan Mantri Health Insurance scheme enables cashless treatments for policyholders at thousands of empaneled public and private hospitals across India through its extensive network. Seniors can easily access the network hospitals as per their location and convenience.
You can find the list of network providers on the official National Health Authority portal, and we update it regularly. The network coverage includes top hospital chains like Apollo, Fortis, Manipal, and Medanta, which have a presence across metros as well as Tier 2 and 3 cities.
Enrollment Process
Seniors who meet the eligibility criteria can enroll under the scheme in the following ways:
Online application
You can find the enrollment form on the National Health Authority portal and fill it out online. Remember to upload supporting documents like identity proof, age proof, and address proof. Premium payment also happens via online mode like UPI, cards, net banking etc.
Common Service Center (CSC)
Seniors can visit their nearest CSC center with the required documents and submit the duly filled form. The CSC representative assists with the application formalities and online premium payment.
Hard copy application
Eligible candidates can also opt for offline application by submitting physical copies of the enrollment form at designated offices. Payment is made via Demand Draft (DD).
Upon successfully completing the application process, we dispatch the insurance policy document to the senior citizen’s registered address within 30 days. Start of insurance coverage may take upto 45 days from date of application.
Claims Process
In case the policyholder needs to utilize the health coverage during the policy tenure, they can submit a claim against the Pradhan Mantri Health Insurance policy through the following procedures:
Cashless claims
If hospitalization happens at an empaneled hospital, beneficiaries simply need to present their health card and valid KYC documents to commence treatment. The insurer directly settles payments with the hospital.
Reimbursement claims
Seniors need to initially pay the expenses for treatments at non-network hospitals and later submit the claim documents to get reimbursement up to the sum insured amount.
When submitting reimbursement claims, you must furnish documents like claim form, medical reports, original bills and receipts, discharge summary as proof. The insurer verifies the paperwork and credits the admissible claim amount to the policyholder’s bank account.
FAQs
What is the Pradhan Mantri Health Insurance Scheme for Senior Citizens?
The Pradhan Mantri Health Insurance Scheme for Senior Citizens, also known as PMVVY, is a government-sponsored health insurance scheme that provides coverage for hospitalization expenses of senior citizens aged 60 years and above in India.
What is the coverage amount under this policy?
The policy provides coverage of Rs. 50,000 per insured person per year for hospitalization costs related to treatment of illnesses and injuries.
What are the key benefits of the policy?
The key benefits include cashless hospitalization at network hospitals, coverage for pre and post-hospitalization expenses for 30 and 60 days respectively, expenses towards ambulance service up to Rs. 2,000 and coverage of costs for approved day care procedures.
Conclusion
In summary, the Pradhan Mantri Health Insurance scheme for senior citizens in India extends valuable assistance to low-income and vulnerable sections of elders by making quality healthcare affordable and within reach through insurer-paid hospitalizations. The policy coverage and features are structured around the unique needs and challenges faced by the seniors, from eligibility criteria to enrollment process to claims settlement. With premiums as low as Rs. 21,250, senior citizens can safeguard themselves against financial difficulties arising from medical emergencies and hospitalization costs after retirement. As India’s senior population increases, such government health insurance schemes will continue empowering them with vital financial health protection when they need it the most.
