Ayushman Bharat is a flagship health initiative launched by the Government of India under the National Health Policy 2017, aiming to achieve Universal Health Coverage (UHC). It adopts a holistic approach to healthcare, covering preventive, promotive, and curative services across primary, secondary, and tertiary levels. The scheme comprises two components:
- Health and Wellness Centres (HWCs)
- Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Launched on 23rd September 2018, PM-JAY is one of the largest health assurance programs globally. It aims to provide a health cover of ₹5,00,000 per family per year for secondary and tertiary care hospitalization to 10.74 crore poor and vulnerable families (approx. 50 crore beneficiaries), constituting the bottom 40% of India’s population.
The beneficiaries are chosen based on Socio-Economic Caste Census (SECC) 2011 data, using deprivation and occupational criteria in rural and urban areas. PM-JAY is entirely funded by the government, with its cost shared between the Central and State Governments.
Key Benefits
- Coverage: Up to ₹5,00,000 per family per annum on a family floater basis, covering:
- Secondary and tertiary care conditions.
- Pre-existing diseases from day one.
- Cashless Services:
- Medical examination, treatment, and consultation.
- Pre-hospitalization.
- Medicines and medical consumables.
- Non-intensive and intensive care services.
- Diagnostic and laboratory investigations.
- Medical implants (where necessary).
- Accommodation and food services during treatment.
- Post-hospitalization follow-up care (up to 15 days).
- No Age/Family Size Limit:
- No cap on age or family size.
- Pre-existing illnesses covered from the first day.
- National Portability:
- Beneficiaries can receive treatment anywhere in India at empanelled hospitals.
Eligibility
Rural Beneficiaries
Families meeting at least one of the following deprivation criteria or listed under automatic inclusion:
- One room with kucha walls and roof.
- No adult member between ages 16–59.
- No adult male member between ages 16–59.
- Any disabled member and no able-bodied adult member.
- SC/ST households.
- Landless families deriving major income from manual labor.
- Automatic Inclusion: Destitute, living on alms, manual scavenger households, primitive tribal groups, legally released bonded laborers.
Urban Beneficiaries
Based on 11 occupational categories of workers:
- Ragpicker
- Beggar
- Domestic worker
- Street vendor/cobbler/hawker
- Construction worker/plumber/mason/laborer/painter/welder/security guard/coolie/head-load worker
- Sweeper/sanitation worker/gardener (mali)
- Home-based worker/artisan/handicrafts worker/tailor
- Transport worker/driver/conductor/helper/cart/rickshaw puller
- Shop worker/assistant/peon in small establishment/helper/delivery assistant/attendant/waiter
- Electrician/mechanic/assembler/repair worker
- Washer-man/chowkidar
Exclusions
Certain households are excluded from PM-JAY coverage:
- Owning a two, three, or four-wheeler or motorized fishing boat.
- Owning mechanized agricultural equipment.
- Holding a Kisan card with a credit limit ≥ ₹50,000.
- Employed by the government.
- Working in government-managed non-agricultural enterprises.
- Earning a monthly income ≥ ₹10,000.
- Owning a refrigerator or landline.
- Living in a solidly built house.
- Owning ≥ 5 acres of agricultural land.
Application Process (Offline)
Verification & E-Card Issuance
- Approach Empanelled Health Care Provider (EHCP) or Community Service Centre (CSC):
- Submit PM letter/ RSBY URN/ RC Number/ mobile number for searching the beneficiary data.
- Search in BIS:
- The operator (Arogya Mitra) checks the SECC 2011 or RSBY or other state scheme databases.
- Individual Identification:
- If found eligible, upload Aadhaar (or any govt. ID) and a Ration Card/family ID.
- Family Identification:
- Family details verified from ration card or alternative ID. Documents are uploaded for approval.
- Approval/Rejection:
- The insurance company/trust reviews. Finally, the State Health Agency (SHA) confirms approval/rejection.
- E-Card Issuance:
- On approval, the beneficiary receives an e-card for cashless treatment.
Documents Required
- Age & Identity Proof (Aadhaar/PAN Card).
- Address Proof.
- Contact Details (mobile, email).
- Caste Certificate (if applicable).
- Income Certificate (if required).
- Family Status Proof (joint/nuclear).
- Aadhaar Card (compulsory for beneficiaries).
Frequently Asked Questions (FAQs)
- Will beneficiaries have to pay anything to get covered under this scheme?
No, PM-JAY is fully funded by the government, providing cashless coverage at empanelled hospitals. - What is the enrollment process? Is there any time period for enrollment?
Eligible families are identified via SECC 2011 or state databases. There’s no set enrollment window; beneficiaries just need to verify their identity and get the PMJAY e-card. - Will a card be given to the beneficiary?
Yes, once verified, an e-card is generated, enabling cashless services under PM-JAY. - Are pre-existing illnesses covered?
Yes, all pre-existing conditions are covered from day one. - Are benefits available for a newborn child under this scheme?
A child born into an eligible family is also covered, subject to guidelines. - Are RSBY cardholders covered under the scheme?
All RSBY families are automatically included under PM-JAY if meeting the criteria. - Can benefits under this scheme be availed without an Aadhaar Card?
Aadhaar is preferred, but other government IDs may be used to confirm identity if Aadhaar is unavailable. - Who is an Arogya Mitra?
An Arogya Mitra is a facilitator/operator stationed at empanelled hospitals or CSCs to guide beneficiaries, handle pre-authorization, and ensure smooth claims. - How does the claim submission process work?
Once admitted, the hospital raises a pre-authorization request. If approved, treatment is cashless, and the hospital gets reimbursed directly. - What is Pradhan Mantri Jan Arogya Yojana (PM-JAY)?
It’s a health assurance scheme providing up to ₹5 lakh per eligible family per year for secondary and tertiary treatments. - What health services are available under PM-JAY?
It covers 1,500+ treatment packages, including medicines, tests, room charges, and follow-up care. - Where can beneficiaries avail services under PM-JAY?
At any empanelled hospital (public or private) across India. - Will beneficiaries pay anything for coverage?
No, coverage is cashless and fully funded by Government of India and states. - How are beneficiaries identified?
Identification uses SECC 2011 data or RSBY lists, along with approved state databases. - Can families not on the list still avail the scheme?
No, only those who meet inclusion criteria in the SECC/RSBY or state-identified categories are covered. - What is the maximum time required for approval of claim submission requests?
Generally, 24-72 hours, but states may have specific timelines. - Who are the members of various grievance committees?
Usually representatives from State Health Agency, insurance companies, hospitals, and concerned government officials.