Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) — the Central Government’s flagship health insurance programme launched by Prime Minister Narendra Modi on 23 September 2018 in Ranchi, Jharkhand — is the world’s largest government-funded health insurance scheme by beneficiary coverage, providing ₹5 lakh annual health insurance per family for secondary and tertiary hospitalisation to approximately 55 crore beneficiaries (approximately 12 crore families) from India’s most economically vulnerable population segments identified through the Socio-Economic Caste Census (SECC) 2011 and subsequently expanded through the PM-JAY AB expansion to include additional beneficiary categories including senior citizens above 70 years across all income categories under the Ayushman Bharat Vaya Vandana expansion announced in 2024. The scheme’s fundamental policy objective — ensuring that no Indian family suffers financial catastrophe from a health emergency requiring hospitalisation — is implemented through a cashless, paperless, and portable health entitlement that functions at any empanelled public or private hospital across India, creating a genuinely portable health security whose national reach differentiates PM-JAY from state-specific schemes like Rajasthan’s Chiranjeevi (₹25 lakh, state-only) or Odisha’s Biju Swasthya Kalyan Yojana.
The AB-PMJAY’s economic significance in India’s healthcare landscape is extraordinary. With 7+ crore hospitalisations facilitated since its launch and over ₹1 lakh crore in total claims processed, the scheme has measurably prevented the medical impoverishment cycle, in which a single hospitalisation pushes families below the poverty line due to catastrophic out-of-pocket expenditure. India’s pre-PM-JAY healthcare financing context — where 65% of total health expenditure was out-of-pocket (among the world’s highest) — has been partially addressed by PM-JAY’s hospitalisation coverage, whose 1,949 medical packages eliminate the direct inpatient cost for covered procedures. For the 50 crore Indians whose economic vulnerability makes a ₹1 lakh hospital bill equivalent to 2 to 3 years of family income, PM-JAY’s ₹5 lakh annual coverage is not supplementary insurance but the primary financial mechanism separating treatable illness from financial ruin.
AB-PMJAY: Key Programme Parameters
| Parameter | Details |
|---|---|
| Scheme Full Name | Ayushman Bharat Pradhan Mantri Jan Arogya Yojana |
| Launch Date | 23 September 2018 |
| Launched By | PM Narendra Modi, Government of India |
| Annual Health Coverage | ₹5 lakh per family per year |
| Beneficiaries | Approximately 55 crore (12 crore families) |
| Eligibility Basis | SECC 2011 data, additional categories |
| Expansion 2024 | Senior citizens 70+ years — all income categories |
| Medical Packages | 1,949+ packages covering secondary and tertiary care |
| Empanelled Hospitals | 28,000+ public and private hospitals |
| Cashless Feature | Yes — no cash payment at empanelled hospitals |
| Portability | National — valid at empanelled hospitals across all states |
| Implementing Agency | National Health Authority (NHA) |
| Application Portal | pmjay.gov.in |
| Beneficiary App | Ayushman App (Android, iOS) |
| Helpline | 14555 (toll-free, all states) |
| Ayushman Card | Personalised health identity card for each beneficiary |
Eligibility: Who Qualifies for AB-PMJAY
Primary Eligibility — SECC 2011 Data (Rural Categories):
| SECC Rural Deprivation Category | Description | Approximate Families |
|---|---|---|
| D1 — Only one room with kachcha walls and roof | Poorest housing category | 1.5 crore+ |
| D2 — No adult member (16-59) in family | Female-headed, elderly, disabled households | 1.5 crore+ |
| D3 — Female-headed household with no adult male (16-59) | Widows, abandoned women | 1.2 crore+ |
| D4 — Disabled member — no able-bodied adult | Physical disability households | 0.8 crore+ |
| D5 — SC/ST households | Scheduled Caste and Scheduled Tribe families | 5 crore+ |
| D7 — Landless households deriving income from manual casual labour | Agricultural labourers, daily wage workers | 5 crore+ |
| Automatically included — beggars, ragpickers, domestic workers, construction workers | Occupational vulnerability | 1 crore+ |
Urban Beneficiary Categories (SECC Urban):
| Urban Occupational Category | Examples |
|---|---|
| Rag pickers | Waste collection workers |
| Beggars | Homeless, destitute |
| Domestic workers | Household helpers, maids |
| Street vendors and cobblers | Informal micro-enterprise |
| Home-based workers | Artisans, craftspeople |
| Construction workers | Masons, painters, labourers |
| Plumbers, electricians, mechanics | Informal service workers |
| Transport workers | Rickshaw pullers, auto-rickshaw, cart workers |
| Sweepers and sanitation workers | Manual scavenging — explicitly protected |
| Gardeners, peons | Informal contract service workers |
2024 Expansion — Ayushman Bharat Vaya Vandana: PM-JAY’s most significant 2024 expansion provides ₹5 lakh health coverage to all senior citizens aged 70 years and above, regardless of income — creating a universal senior citizen health entitlement whose social policy significance is comparable to PM-KISAN’s universal farming family baseline:
- All persons aged 70+ with Aadhaar
- No income test — applicable across General, OBC, and higher-income categories
- Additional ₹5 lakh top-up for families already enrolled in PM-JAY (effectively ₹10 lakh for senior members of PM-JAY families)
- Separate Ayushman Vaya Vandana card for 70+ individuals
Ayushman Card: The Health Identity Instrument
The Ayushman Card (AB-PMJAY Card) — a personalised health identity card issued to each PM-JAY beneficiary — is the operational gateway to cashless hospitalisation:
How to Get Your Ayushman Card:
Method 1 — Ayushman App (Fastest):
- Download “Ayushman App” from Google Play Store or Apple App Store
- Select “Get Ayushman Card”
- Enter the mobile number linked to Aadhaar
- Enter Aadhaar number and OTP
- Verify eligibility — name appears in PM-JAY database
- Download and save the Ayushman Card to your phone (digital card)
- Print at the nearest CSC or print shop for a physical card
Method 2 — pmjay.gov.in Online:
- Visit pmjay.gov.in
- Click “Am I Eligible” — enter mobile number and Aadhaar
- Confirm PM-JAY eligibility
- Click “Download Ayushman Card”
- Aadhaar OTP verification
- Download the PDF card with the QR code
Method 3 — CSC (Common Service Centre):
- Visit the nearest Jan Seva Kendra, CSC
- CSC operator accesses the PM-JAY portal
- Biometric Aadhaar verification for card generation
- Physical Ayushman Card printed and issued
- Nominal CSC charge: ₹30 per card
Method 4 — Government Hospital Ayushman Help Desk:
- Visit any empanelled government hospital
- Approach the Ayushman Bharat Help Desk (mandatory at all empanelled hospitals)
- Hospital help desk staff verify eligibility and generate a card on-site
- Useful for emergencies where a card is needed immediately
Ayushman Card Features:
| Feature | Details |
|---|---|
| Card Format | Physical card or digital (both valid) |
| QR Code | Encodes family and individual health ID |
| Unique ID | Beneficiary ID, family ID |
| Portability | Valid at all 28,000+ empanelled hospitals nationally |
| Validity | No expiry — valid as long as family remains eligible |
| Family Members | Separate card for each family member or one family card |
| Senior Citizen 70+ | Separate Vaya Vandana card issued |
Medical Packages Covered Under PM-JAY
Coverage Categories and Examples:
| Medical Specialty | Package Count | Examples of Covered Procedures |
|---|---|---|
| Cardiology and Cardiothoracic | 130+ packages | Coronary artery bypass, angioplasty, valve replacement, pacemaker |
| Oncology | 100+ packages | Cancer surgery, chemotherapy cycles, radiation therapy |
| Orthopaedics | 90+ packages | Hip replacement, knee arthroplasty, spinal surgery, fracture fixation |
| Neurology and Neurosurgery | 80+ packages | Brain tumour surgery, epilepsy management, spinal cord procedures |
| General and Laparoscopic Surgery | 150+ packages | Appendectomy, hernia repair, cholecystectomy, gallbladder |
| Neonatology (Newborn ICU) | 60+ packages | Premature newborn care, NICU management, neonatal surgery |
| Burns Management | 50+ packages | Major burn treatment, skin grafting, wound management |
| Pulmonology | 70+ packages | COPD management, TB, pneumonia ICU |
| Ophthalmology | 40+ packages | Cataract surgery, vitreoretinal procedures, and glaucoma |
| Renal Disease | 50+ packages | Dialysis (limited sessions), kidney stone, nephrostomy |
| Mental Health | 30+ packages | Psychiatric inpatient, de-addiction residential |
| COVID and Infectious Disease | 80+ packages | ICU critical care, ventilator management |
| Emergency and Trauma | 80+ packages | Major trauma, poly-trauma management, road accident |
Package Rate Examples:
| Procedure | PM-JAY Package Rate | Market Private Hospital Cost |
|---|---|---|
| Cataract surgery (per eye) | ₹9,000 to ₹10,000 | ₹15,000 to ₹30,000 |
| Knee replacement (single) | ₹90,000 to ₹1,20,000 | ₹2.5 lakh to ₹4 lakh |
| Coronary angioplasty (PTCA) | ₹60,000 to ₹1,20,000 | ₹2 lakh to ₹3.5 lakh |
| Cancer chemotherapy (per cycle) | ₹20,000 to ₹40,000 | ₹50,000 to ₹1 lakh |
| ICU per day | ₹5,000 to ₹8,000 | ₹15,000 to ₹30,000 |
| Normal delivery | ₹10,000 to ₹15,000 | ₹20,000 to ₹50,000 |
Empanelled Hospital Network: Where PM-JAY Works
Hospital Empanelment Categories:
| Hospital Type | Count | Empanelment Requirement |
|---|---|---|
| Government hospitals — district and above | 12,000+ | Automatically empanelled |
| Government community health centres | 8,000+ | Block-level coverage |
| Private hospitals (NABH-accredited or qualifying) | 8,000+ | Quality criteria + PMJAY agreement |
| Total empanelled | 28,000+ | Across all states and UTs |
Hospital Search for PM-JAY Empanelment: Visit hospitals.pmjay.gov.in — enter state, district, speciality — find nearest empanelled hospitals with:
- Hospital name and address
- Specialities covered under PM-JAY
- Current empanelment status (active, suspended, terminated)
- PM-JAY help desk contact number
Portability Across States: PM-JAY’s national portability means:
- A Bihar farmer working in Delhi receives PM-JAY at Delhi empanelled hospitals
- A Rajasthan family travelling for medical treatment in Mumbai uses PM-JAY there
- No state boundary restriction — valid at any of 28,000+ empanelled hospitals nationally
How to Use the Ayushman Card at the Hospital
Step 1 — Choose Empanelled Hospital: Verify the hospital is currently PM-JAY empanelled at hospitals.pmjay.gov.in — empanelment can be suspended for quality violations, making current status verification important.
Step 2 — Present Ayushman Card at PM-JAY Help Desk: Every empanelled hospital mandatorily maintains a PM-JAY Arogyamitra (Help Desk) — a trained scheme facilitator whose specific role is beneficiary admission:
- Present Ayushman Card (physical or digital on phone)
- Arogyamitra scans QR code — verifies identity and ₹5 lakh balance
- Confirms treatment package availability under PM-JAY
- Initiates pre-authorisation if required
Step 3 — Pre-Authorisation for Planned Treatment:
- Hospital submits treatment request through the PM-JAY portal
- Insurance company (empanelled) or TPA approves within 24 to 48 hours
- Approval confirmation sent to the hospital electronically
- Patient admitted under cashless cover
Step 4 — Emergency Admission — Immediate Cover: Emergency cases are admitted immediately — pre-authorisation completed retrospectively within 48 hours of admission without interrupting treatment.
Step 5 — Cashless Discharge:
- The hospital raises a claim electronically through the PM-JAY portal
- Patient pays nothing for covered procedures within the ₹5 lakh annual limit
- Discharge summary includes PM-JAY claim transaction ID
PM-JAY State Integration
AB-PMJAY operates in integration or coordination with state health schemes through two models:
AB State Integration (Fully Integrated): States that merged their existing state health scheme with PM-JAY — creating a unified “AB-State” scheme with combined coverage:
- Rajasthan: PM-JAY + Chiranjeevi = Effective ₹25 lakh (Chiranjeevi being the primary state layer)
- Andhra Pradesh: PM-JAY + YSR Aarogyasri = Combined coverage
- Karnataka: PM-JAY + Arogya Karnataka = Expanded package
- Tamil Nadu: PM-JAY + Chief Minister’s Comprehensive Health Insurance
States with Separate State Schemes (Not Integrated):
- Odisha (BSKY covers non-SECC families)
- West Bengal (does not participate in PM-JAY — state runs its own scheme)
- Delhi (runs its own Arogyakosh)
- Telangana (TSMHA runs a separate state scheme)
PM-JAY Grievance and Fraud Prevention
Grievance Resolution:
- Online: pmjay.gov.in — “Grievance” section
- Helpline: 14555 (toll-free, 24/7)
- Grievance types: Denial of treatment, improper charging, Ayushman card issue
- Resolution timeline: 7 to 14 working days
PM-JAY Fraud Prevention: National Health Authority’s fraud prevention measures:
- Vigilance calls — NHA calls beneficiaries randomly post-discharge to verify treatment
- Digital audit trails — every treatment step logged in the PM-JAY portal
- Hospital delisting — hospitals with fraud patterns are suspended or terminated
- Beneficiary complaint portal — anonymous reporting at pgportal.gov.in
