Can Senior Citizens Over 70 Benefit from Both ESIC and Ayushman Bharat?

Healthcare security becomes increasingly important with age, making access to senior citizen health insurance crucial for individuals over 70. Government schemes like ESIC (Employees’ State Insurance Corporation) and Ayushman Bharat aim to provide affordable healthcare coverage, but the eligibility and benefits for senior citizens can vary. Understanding these schemes is essential to ensure comprehensive health insurance for senior citizens.

ESIC: What it offers for senior citizens

ESIC is designed to provide financial and healthcare support to employees and their families. While the scheme primarily caters to the working population, it extends benefits to retired individuals under certain conditions.

Eligibility for ESIC benefits after retirement

ESIC benefits are available to retirees who have completed the minimum contribution period (typically five years). The individual must register as a beneficiary post-retirement to continue receiving medical benefits under senior citizen health insurance.

Key benefits for senior citizens under ESIC

Medical care for life: Retired individuals and their dependents can avail themselves of medical care at ESIC dispensaries and hospitals.
Access to speciality services: Senior citizens have access to advanced diagnostic and treatment facilities at empanelled hospitals.
Low-cost healthcare: ESIC provides affordable treatments, reducing the financial burden on retired individuals.

Ayushman Bharat: An inclusive healthcare scheme

Ayushman Bharat, also known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), aims to provide healthcare coverage to economically weaker sections of society. It offers a broad range of benefits for senior citizens, making it a critical component of health insurance for families and individuals.

Eligibility criteria for Ayushman Bharat

Beneficiaries are selected based on Socio-Economic Caste Census (SECC) data. Families listed as deprived or belonging to specific vulnerable categories are eligible for the scheme.

Key benefits for senior citizens under Ayushman Bharat

Coverage for hospitalisation costs: The scheme covers up to Rs. 5 lakh per family per year for secondary and tertiary care hospitalisation.
Wide network of hospitals: Beneficiaries can access cashless treatment at empanelled public and private hospitals across India, offering flexibility under senior citizen health insurance.
Focus on geriatric care: Specialised treatments and support for age-related ailments are available, making the scheme highly beneficial for senior citizens.

Can senior citizens over 70 avail benefits from both ESIC and Ayushman Bharat?

Senior citizens can benefit from both schemes if they meet the eligibility criteria. Here’s how they complement each other:

Comprehensive coverage: ESIC primarily focuses on providing affordable healthcare through its network of hospitals, while Ayushman Bharat extends coverage to include private hospitals. Together, these schemes can provide expansive health insurance support.
Dual accessibility: If a senior citizen qualifies for ESIC and is also listed as a beneficiary under Ayushman Bharat, they can use both schemes depending on their healthcare requirements. For instance, ESIC facilities can be utilised for outpatient care, while Ayushman Bharat can cover expensive hospitalisations at private institutions.
No overlap in benefits: The two schemes operate independently, ensuring there is no duplication of benefits but rather a broader range of services for eligible individuals.

Challenges and limitations

ESIC limitations

Restricted to ESIC hospitals: Medical care under ESIC is limited to its dispensaries and hospitals, which may not always be conveniently located.
Eligibility requirement: Only retired individuals who have contributed for the required period can avail ESIC benefits under senior citizen health insurance.

Ayushman Bharat limitations

Eligibility based on SECC data: Only families identified as economically disadvantaged can enrol, potentially excluding some senior citizens from this health insurance benefit.
Capping on coverage: The annual coverage limit of Rs. 5 lakh may not suffice for certain high-cost treatments.

Benefits of combining ESIC and Ayushman Bharat

Senior citizens who are eligible for both schemes can enjoy:

Broader healthcare access: ESIC provides access to government hospitals, while Ayushman Bharat includes private hospitals, ensuring more treatment options.
Cost-effective healthcare: Both schemes minimise out-of-pocket expenses, enabling affordable access to quality medical care under comprehensive senior citizen health insurance.
Specialised geriatric care: Ayushman Bharat’s focus on secondary and tertiary care, combined with ESIC’s outpatient services, addresses a wide range of healthcare needs for senior citizens.

How to maximise benefits

Verify eligibility: Senior citizens must ensure they meet the criteria for both schemes. For ESIC, retirees need to confirm their contribution record and register as beneficiaries. Ayushman Bharat eligibility depends on SECC data, so beneficiaries should verify their inclusion in the list.

Understand the claim processes: Familiarise yourself with the documentation and processes required for each scheme. Maintain records like ESIC contribution details and Ayushman Bharat health cards to ensure seamless access to health insurance benefits.

Utilise network hospitals: Identify and use the hospitals associated with each scheme to maximise benefits. For ESIC, visit designated dispensaries and empanelled hospitals, while Ayushman Bharat offers access to private and public healthcare facilities.

Plan healthcare needs strategically: Use ESIC for routine outpatient care and less expensive treatments, while reserving Ayushman Bharat benefits for high-cost hospitalisations. This approach helps in optimising the coverage provided by both schemes.

Conclusion

For senior citizens over 70, accessing both ESIC and Ayushman Bharat can provide a comprehensive safety net for their healthcare needs. These schemes, though distinct, work together to offer affordable, quality medical care that addresses both everyday health concerns and major medical emergencies. By understanding eligibility criteria and leveraging the benefits of senior citizen health insurance, seniors can ensure a healthier and financially secure future.