Ayushman Bharat, one of the most ambitious healthcare initiatives by the Government of India, was launched with the vision of providing Universal Health Coverage (UHC) to the country’s underserved population. This initiative was introduced as a key component of the National Health Policy 2017, with a strong commitment to leaving no one behind in the pursuit of better health and wellbeing.
Aimed at addressing the need for comprehensive healthcare, Ayushman Bharat takes a holistic approach to healthcare delivery by focusing on prevention, promotion, and treatment across all levels: primary, secondary, and tertiary. The flagship scheme is divided into two inter-related components—Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojana (PM-JAY). Together, these components aim to overhaul India’s health services and make them accessible to all, particularly for those who are most in need.
The Essence of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Launched by the Hon’ble Prime Minister of India, Shri Narendra Modi, on September 23, 2018, in Ranchi, Jharkhand, Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world’s largest health assurance scheme. The scheme was designed to provide financial protection to over 10.74 crore poor and vulnerable families—roughly 50 crore beneficiaries—who belong to the bottom 40% of India’s population. The scheme focuses on providing secondary and tertiary care hospitalization with a health cover of ₹5,00,000 per family per year.
The eligibility for the scheme is determined based on the deprivation and occupational criteria outlined in the Socio-Economic Caste Census (SECC) 2011. PM-JAY targets households that are considered among the most deprived in both rural and urban India, aiming to ensure that they have access to quality healthcare without the burden of high medical costs.
Key Benefits of Ayushman Bharat – PM-JAY
One of the core features of PM-JAY is the cashless coverage provided to eligible families for secondary and tertiary care services. This means that all medical expenses related to hospitalization, surgery, and medical treatment, including both pre- and post-hospitalization care, are covered under the scheme. The benefits of the ₹5,00,000 cover are provided on a family floater basis, which means the entire family can use this coverage, without any cap on the number of members or their age. Furthermore, pre-existing conditions are covered right from the day of enrollment, offering a major relief to families who have members with ongoing medical needs.
- Medical Examination, Treatment, and Consultation: All necessary medical evaluations, treatments, and consultations are covered under the scheme.
- Pre-Hospitalization Expenses: Expenses related to diagnosis and initial treatment before hospitalization are also covered.
- Hospitalization Costs: Medical costs incurred during the hospitalization, including medicines, medical consumables, and intensive care, are fully covered.
- Surgical and Medical Implantation: The scheme includes coverage for surgeries and medical implantations when required.
- Accommodation and Food Services: In-patient accommodation charges and food services are also covered under the scheme.
- Post-Hospitalization Care: Follow-up care for up to 15 days after the treatment is included.
PM-JAY ensures that no beneficiary is left behind, regardless of their age or family size. Whether a person needs emergency care, surgeries, or long-term treatment, PM-JAY aims to ensure that these essential services are within reach, without pushing families into financial hardship.
Eligibility Criteria
The eligibility for Ayushman Bharat – PM-JAY is determined based on specific criteria for both rural and urban households.
- Rural Beneficiaries: The rural population’s eligibility is based on deprivation criteria. A household is eligible if it falls under one or more of the following categories:
- Disabled member with no able-bodied adult member.
- SC/ST households.
- Landless households dependent on manual casual labor for income.
- Urban Beneficiaries: For urban areas, the scheme targets workers from 11 key occupational categories. These include:
- Ragpickers
- Beggars
- Domestic workers
- Street vendors and hawkers
- Construction workers, plumbers, masons, painters, security guards, etc.
- Sanitation workers and many others.
Required Documents
To avail the benefits under PM-JAY, beneficiaries are required to provide certain documents:
- Age and Identity Proof: Aadhar Card, PAN Card, or any valid government-issued ID.
- Proof of Address: To verify the beneficiary’s residential address.
- Contact Details: Mobile number and email address for communication.
- Caste Certificate: Required for verification of social status.
- Income Certificate: To determine eligibility based on income.
- Family Status Document: Proof of whether the family is joint or nuclear.