Everyone Over 70 To Be Covered Under Health Insurance Scheme | Ayushman Bharat | StudyIQ

UPSC CSE StudyIQ

12 Sept 202412:50

Summary

TLDRThe video script discusses the affordability of health insurance policies, highlighting how younger individuals can obtain coverage at lower premiums. It emphasizes the increased costs for seniors, often facing premiums exceeding 50,000 to 70,000. The government's efforts to provide insurance to as many people as possible are underscored, given the financial burden a family faces when a member falls ill. The script also details the government's initiative to offer free health insurance covering up to 5 lakhs for all citizens aged 70 and above under the Ayushman Bharat scheme. It outlines the scheme's benefits, eligibility criteria, and the process for enrollment and utilization of the insurance. Additionally, it mentions a special offer for UPSC courses with a promise of maximum discount using a provided code.

Takeaways

😊 Health insurance premiums are lower for younger people but increase significantly for individuals over 60.
🏥 Older people, especially those above 70, face higher health risks, leading to higher insurance premiums.
💡 The government aims to expand health insurance coverage, making it affordable for senior citizens and vulnerable populations.
🇮🇳 The Indian government has introduced free health insurance coverage of ₹5 lakh for all individuals aged 70 and above.
👨‍👩‍👧‍👦 Approximately 6 crore senior citizens in India will benefit from this scheme.
📋 The scheme, under the Ayushman Bharat initiative, already covers 12 crore families, making it one of the largest public-funded health insurance programs.
🎯 The primary objective of the initiative is to ensure universal health coverage across India, targeting economically vulnerable sections of society.
🛡️ This program provides cashless healthcare services, covering hospitalization, diagnostics, surgeries, and post-treatment care.
🗂️ Pre-existing conditions are covered under this insurance scheme, with no exclusions for previously diagnosed diseases.
🎓 The government continuously expands this scheme, with hopes of including younger age groups in the future to ensure everyone has health insurance.

Q & A

What is the main reason for the high health insurance premium for individuals aged 60 and above?
-The main reason is that individuals aged 60 and above have a higher likelihood of developing diseases, which leads insurance companies to charge a higher premium due to the increased risk.
What significant change did the government make regarding health insurance for people aged 70 and above?
-The government announced that all individuals aged 70 and above in India will receive health insurance coverage of ₹5 lakh for free under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.
How does the health insurance provided under the Ayushman Bharat scheme help individuals?
-The Ayushman Bharat scheme offers cashless hospitalization, covering hospitalization charges, diagnostic tests, surgeries, and post-treatment care, ensuring that individuals do not need to pay from their own pocket.
What is the objective of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana?
-The main objective of the scheme is to provide affordable healthcare to vulnerable sections of society, ensuring universal health coverage in India.
What are the two components of the Ayushman Bharat scheme?
-The two components are the Health and Wellness Centers (providing primary healthcare services) and the Pradhan Mantri Jan Arogya Yojana (offering health insurance coverage of ₹5 lakh per family annually).
How does the Ayushman Bharat scheme determine eligibility for health insurance coverage?
-Eligibility is based on socioeconomic criteria, including scheduled caste and tribe households, beggars, families with no individuals aged 16 to 59, landless households, and certain primitive tribal communities.
How can families check if they are eligible for the Ayushman Bharat scheme?
-Families can visit the Ayushman Bharat website, enter their mobile number, and verify their details under the 'Am I Eligible' section to check if they qualify for the scheme.
What are the benefits of enrolling in the Ayushman Bharat health insurance scheme?
-The benefits include cashless hospitalization, coverage for pre-existing diseases, hospital charges, and a 15-day post-hospitalization care, ensuring complete financial protection for families.
Is there any family size limit for coverage under the Ayushman Bharat scheme?
-No, there is no limit on family size, age, or gender under the scheme. Every family, regardless of size, is eligible for ₹5 lakh of coverage.
How many people have benefited from the Ayushman Bharat scheme so far?
-As of now, over 7.37 crore hospital admissions have been recorded under the scheme, with nearly ₹50,000 crore in benefits provided to the public.

Outlines

00:00

💡 Health Insurance Premiums and Government Initiatives

The paragraph discusses the correlation between age and health insurance premiums. It highlights that younger individuals tend to pay lower premiums due to lower health risks, but as age increases, so does the premium, sometimes exceeding 50,000 to 70,000. The speaker emphasizes the importance of health insurance, especially for those above 60 years old, as the likelihood of diseases increases with age. The government's effort to provide insurance to as many people as possible is mentioned, along with a recent government initiative to provide free health insurance covering up to 5 lakhs for all citizens above 70 years old under the Ayushman Bharat Pradhan Mantri Health Care Scheme. The paragraph also mentions a promotional offer for UPSC courses and encourages viewers to take advantage of it.

05:03

📚 Details of Ayushman Bharat Pradhan Mantri Health Care Scheme

This paragraph provides an in-depth explanation of the Ayushman Bharat Pradhan Mantri Health Care Scheme, which aims to provide affordable health care to vulnerable sections of society. It covers primary health care from small local clinics to major surgeries in large hospitals. The scheme has two main components: Health and Wellness Centers, which offer free primary health care services, and insurance-based coverage up to 5 lakhs for selected families. The paragraph outlines eligibility criteria for the scheme, including rural areas, scheduled castes and tribes, homeless, landless, and those with no individual between 16 to 59 years in the family. It also explains the process of enrollment and the benefits covered, such as hospitalization charges, treatment, diagnostic medicine, surgery, and post-treatment care. The paragraph emphasizes the cashless nature of the services and the comprehensive coverage without any caps based on family size or gender.

10:04

👴 Additional Benefits for Senior Citizens and Scheme Impact

The final paragraph focuses on the additional benefits provided by the government for senior citizens aged 70 and above, expanding the existing Ayushman Bharat scheme. It clarifies that those who are already enrolled in the scheme will also receive the additional benefits, not just new enrollees. The paragraph provides statistics on the number of hospital admissions and the amount of benefits availed through the insurance scheme, highlighting the significant financial assistance it has provided to the public. It also mentions the government's commitment to continuously expand and improve the scheme, with plans to potentially extend it to those aged 60 and above in the future. The paragraph concludes with a question about anemia, asking viewers to identify the correct statement from three provided, and encourages engagement on the speaker's Instagram account.

Mindmap

Keywords

💡Health Insurance

Health insurance is a type of insurance coverage that helps policyholders pay for medical expenses. In the context of the video, it is discussed how the cost of health insurance premiums is often lower for younger individuals and increases with age, particularly after 60 or 70 years old, due to higher chances of health issues. The video also mentions the government's efforts to provide insurance to as many people as possible to mitigate the financial burden on families in case of health emergencies.

💡Premium

A premium in the context of insurance refers to the amount policyholders pay periodically to keep their insurance coverage active. The script explains that as age increases, especially beyond 60 or 70 years, the premium amount for health insurance tends to be significantly higher because older individuals are more likely to claim benefits, which insurance companies anticipate and factor into the cost.

💡Senior Citizens

Senior citizens are individuals who are of retirement age, typically 60 or older. The video discusses a government initiative to provide health insurance coverage to all senior citizens aged 70 and above for free, highlighting the importance of health insurance for this demographic due to their increased vulnerability to diseases and health issues.

💡Ayushman Bharat

Ayushman Bharat is a health insurance scheme launched by the Government of India, aimed at providing a large number of underprivileged families with health coverage up to 5 lakh rupees for secondary and tertiary care hospitalization. The video explains that this scheme is being expanded to include all citizens aged 70 and above, offering them free health insurance coverage.

💡Insurance Policy

An insurance policy is a contract between an individual or entity and an insurance company, outlining the terms and conditions of the coverage provided. The script mentions that understanding the details of a health insurance policy is crucial for policyholders to know what is covered and what benefits they are entitled to, especially in the context of government schemes like Ayushman Bharat.

💡Eligibility Criteria

Eligibility criteria are the specific conditions or qualifications that must be met to be able to apply for or receive a particular benefit or service. In the video, eligibility criteria for the Ayushman Bharat scheme are discussed, such as belonging to a rural area, being from a scheduled caste or tribe, or being a homeless or landless household, among others.

💡Pre-existing Conditions

Pre-existing conditions are medical conditions that an individual has prior to applying for health insurance. The video script indicates that the new health insurance initiative for senior citizens covers pre-existing conditions, which is a significant benefit as it includes any medical issues the policyholder already has, such as diabetes.

💡Cashless Services

Cashless services in health insurance refer to the direct settlement of medical expenses between the insurance company and the healthcare provider, without the policyholder having to pay upfront. The script emphasizes that the Ayushman Bharat scheme offers cashless services, which means policyholders can receive treatment without having to pay the hospital bills themselves.

💡Hospitalization

Hospitalization refers to the process of receiving medical care in a hospital. The video discusses the coverage provided by the health insurance scheme for hospitalization expenses, including room charges, treatment, diagnostic tests, and post-treatment care, all capped at a certain limit per year.

💡Enrollment

Enrollment in the context of insurance refers to the process of signing up or registering for an insurance plan. The script explains that to avail of the benefits of the Ayushman Bharat scheme, individuals must enroll by providing identification proof and other required documents, after which they receive a health insurance card.

💡Beneficiaries

Beneficiaries are the individuals who receive the benefits or services provided by an insurance policy or government scheme. The video mentions that a significant number of hospital admissions have been made under the Ayushman Bharat scheme, with billions of rupees worth of benefits availed by the public, indicating the large number of beneficiaries served by the program.

Highlights

Health insurance is more affordable for younger individuals, with premiums often ranging from 7000 to 15000.

As age increases, especially for those above 60 or 70 years, health insurance premiums can become significantly higher, sometimes exceeding 50000 to 70000.

The high premiums for older individuals are due to increased chances of diseases and potential complications, leading insurance companies to expect higher payouts.

The government is striving to ensure that more people have insurance to prevent financial burdens on families in case of health issues.

Under the Ayushman Bharat Health Insurance scheme, the government has provided free insurance coverage of 5 lakhs for all citizens above 70 years.

The Ayushman Bharat scheme is the world's largest publicly funded health assurance scheme, aiming to provide affordable health care to vulnerable sections of society.

The scheme covers approximately 12 crore poor and vulnerable families, with around 55 crore beneficiaries.

The main objective of the Jan Arogya plan launched in 2018 is to provide affordable health care to the vulnerable sections of society.

The National Health Policy of 2017 aimed for Universal Health Coverage, ensuring no individual in the country is left uncovered.

The scheme covers everything from primary to tertiary level care, including hospitalization charges, treatment, diagnostic medicine, and post-treatment care.

The Ayushman Bharat plan has two main components: Health and Wellness Centers and the insurance-based Prime Minister's Jan Arogya plan.

The eligibility criteria for the scheme include rural areas, scheduled castes and tribes, homeless, landless, and those with no individual between 16 to 59 years in the family.

Urban workers' families, those enrolled in the Rashtriya Swasthya Bima Yojana, and those in the socio-economic census of 2011 are also covered.

The benefits of the scheme include up to 5 lakhs in benefits per year, covering hospitalization charges, treatment, diagnostic medicine, surgery, and post-treatment care.

The services are cashless, meaning no out-of-pocket expenses for the insured.

There is no cap on the number of family members, and pre and post-hospitalization expenses for up to 3 days before and 15 days after are also covered.

The scheme covers almost 1929 procedures, including room charges, ICU care, and almost everything that normal insurance covers.

For senior citizens aged 70 and above, an additional benefit of 5 lakhs is provided on top of the family's existing 5 lakhs coverage.

Around 7.37 crore hospital admissions have been made under this insurance scheme, with benefits amounting to approximately 1 lakh crore rupees.

The government plans to continuously expand this beneficial scheme, which initially covered 10.74 crore families in 2018 and was expanded to 12 crore families in 2022.

The government's aim is to provide insurance to all citizens in the country, whether they are paying for it themselves or being provided by the government.