Ayushman Bharat Yojana (PM-JAY)

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Ayushman Bharat PM-JAY Health Scheme India

 

Introduction

India, with its vast population and socio-economic diversity, has long struggled to provide affordable healthcare to all. To address this, the Government of India launched the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) in 2018. This ambitious scheme is the world’s largest publicly funded health insurance program, offering cashless and paperless health coverage of ₹5 lakh per family per year for secondary and tertiary care hospitalization.

In this article, we will cover the complete details of Ayushman Bharat, including its objectives, benefits, eligibility criteria, registration process, ABHA integration, challenges, and future roadmap.

What is Ayushman Bharat?

Ayushman Bharat is a flagship health scheme under the National Health Policy 2017, designed to achieve the vision of Universal Health Coverage (UHC).

It has two main components:

  1. Health and Wellness Centres (HWCs): Provide comprehensive primary healthcare services (preventive, promotive, and curative).

  2. Pradhan Mantri Jan Arogya Yojana (PM-JAY): Provides financial protection for hospitalization expenses.

Objectives of Ayushman Bharat

  • To provide financial protection to poor and vulnerable families.

  • To reduce out-of-pocket expenditure on healthcare.

  • To ensure cashless treatment at public and empaneled private hospitals.

  • To create a robust health database for policymaking.

  • To move towards universal health coverage in India.

Key Features of PM-JAY

  • Coverage of ₹5 lakh per family per year.

  • Covers secondary and tertiary hospitalization.

  • Cashless & paperless access to healthcare services.

  • Coverage for pre-existing conditions from day one.

  • Pan-India portability – beneficiaries can avail treatment anywhere in India.

  • Family size, age, and gender – no restrictions.

  • Empanelled public and private hospitals included.

Eligibility Criteria

PM-JAY is targeted at poor and vulnerable families as identified from the Socio-Economic Caste Census (SECC) 2011.

Rural Beneficiaries Include:

  • Families living in kutcha houses.

  • Landless households earning through manual labor.

  • SC/ST households.

  • Households without adult earning members.

  • Families of beggars, rag pickers, or bonded laborers.

Urban Beneficiaries Include:

  • Street vendors, rickshaw pullers, construction workers.

  • Domestic workers, security guards, sanitation workers.

  • Cobblers, hawkers, plumbers, electricians, sweepers, etc.

Who is Not Eligible?

  • Families owning 2/3/4-wheeler vehicles.

  • Government employees.

  • Families with income tax payers.

  • Families with landholding more than 10 acres.

Documents Required

  1. Aadhaar Card.

  2. Ration Card.

  3. SECC-based eligibility proof.

  4. Mobile number.

  5. Address proof.

  6. Family details.

Registration Process

You can check eligibility and register using:

  • Online via PM-JAY website: https://pmjay.gov.in

  • Common Service Centres (CSCs).

  • Empanelled hospitals.

Steps:

  1. Visit PM-JAY portal.

  2. Enter Aadhaar or ration card number.

  3. Verify OTP.

  4. Upload documents.

  5. If eligible, an Ayushman Bharat Card (Golden Card) will be issued.

Ayushman Bharat Golden Card

  • It is the health card issued to eligible beneficiaries.

  • Acts as proof for availing cashless treatment.

  • Must be shown at empaneled hospitals during admission.

What is ABHA (Ayushman Bharat Health Account)?

  • ABHA is a 14-digit digital health ID under the Ayushman Bharat Digital Mission.

  • Helps maintain digital medical records.

  • Can be linked to Ayushman Bharat Card for seamless health access.

  • Not an insurance — just a digital identity.

Benefits of Ayushman Bharat

  1. Financial Protection: ₹5 lakh annual coverage per family.

  2. Cashless Treatment: No upfront payment required.

  3. Wide Coverage: Includes surgery, maternity, cancer, heart diseases.

  4. Pre-existing Diseases Covered: From day one.

  5. Portability: Can be used across India.

  6. Private Hospital Access: Even empaneled private hospitals included.

  7. Support for Women & Elderly: No age or gender discrimination.

Diseases Covered

  • Heart surgeries (CABG, stents).

  • Cancer treatments (chemotherapy, radiation).

  • Kidney transplants and dialysis.

  • Joint replacement surgeries.

  • Neurological disorders.

  • Burns and trauma care.

  • Maternity and child health services.

Diseases Not Covered

  • Cosmetic surgeries.

  • Fertility treatments.

  • OPD (outpatient) services.

  • Non-allopathic treatments (unless approved).

How Hospitals Get Empaneled?

  • Hospitals apply to the State Health Agency (SHA).

  • Must meet infrastructure and manpower standards.

  • Approved hospitals receive PM-JAY empanelment status.

Current Status and Achievements

  • Over 23 crore Ayushman Cards issued.

  • More than 5 crore hospital admissions recorded.

  • Over 27,000 empaneled hospitals.

  • Over ₹60,000 crore worth of claims settled.

Challenges

  • Low awareness in remote areas.

  • Fraudulent claims by some hospitals.

  • Exclusion of lower-middle-income families.

  • Dependence on SECC 2011 data (outdated).

Government Initiatives to Improve

  • Awareness campaigns in rural India.

  • Use of ABHA digital ID to track beneficiaries.

  • Expansion of hospital empanelment.

  • Linking with state schemes like Bhamashah, Aarogyasri.

State-Specific Schemes Linked with Ayushman Bharat

  • Chhattisgarh – Dr. Khubchand Baghel Swasthya Yojana.

  • Andhra Pradesh – Aarogyasri.

  • Maharashtra – Mahatma Jyotiba Phule Jan Arogya Yojana.

  • Karnataka – Arogya Karnataka.

PM-JAY

Future of Ayushman Bharat

  • Expansion of coverage beyond SECC data.

  • Integration with National Digital Health Mission.

  • Linking with Jan Dhan Yojana & Aadhaar for auto-enrollment.

  • Covering outpatient expenses in the future.

FAQs (Frequently Asked Questions)

Q1. Is Ayushman Bharat free?
Yes, it is completely free for eligible families.

Q2. Can I apply if I’m not in SECC list?
Currently no, but government plans to update the list.

Q3. Is there an age limit?
No age limit, coverage is for entire family.

Q4. Can I use the card in another state?
Yes, it is pan-India portable.

Q5. Does it cover maternity expenses?
Yes, normal and cesarean deliveries are covered.

Conclusion

The Ayushman Bharat – PM-JAY scheme is a historic step in India’s healthcare journey, offering free medical coverage of ₹5 lakh per family per year. With its wide reach, portability, and integration with digital health IDs (ABHA), it aims to revolutionize healthcare access for millions.

Though challenges like awareness and fraud need attention, Ayushman Bharat has already become a lifeline for poor and vulnerable families, protecting them from catastrophic health expenditures and moving India closer to universal health coverage.


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