Ayushman Bharat PMJAY

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world’s largest publicly funded health insurance scheme, providing health cover of Rs 5 lakh per family per year to over 50 crore people from economically vulnerable households. Launched in September 2018, it covers hospitalisation for over 1,900 medical procedures across secondary and tertiary care.

What Is Ayushman Bharat PM-JAY?

PM-JAY is the insurance component of the Ayushman Bharat initiative (the other component being Health and Wellness Centres for primary care). It targets families identified as poor and vulnerable based on the Socio-Economic Caste Census (SECC) 2011 data.

The scheme covers:
– Hospitalisation for medical and surgical conditions
– Pre and post-hospitalisation expenses (3 days before, 15 days after)
– Medicines, diagnostics, and ICU charges
– Pre-existing diseases from day one (no waiting period)
– Day-care procedures

Key Features

– **Cover amount**: Rs 5 lakh per family per year (family-floater basis)
– **Beneficiaries**: approximately 10.74 crore families (50+ crore individuals) from BPL and other vulnerable categories
– **Cashless treatment**: available at empanelled government and private hospitals
– **Portability**: beneficiaries can access treatment at any empanelled hospital in India, not just their home state
– **No premium**: beneficiaries pay nothing; the central and state governments share the cost

Who Is Eligible?

Eligibility is based on SECC 2011 data. Families are identified by criteria such as:
– No proper housing
– Female-headed households
– Manual scavengers
– SC/ST households
– Landless agricultural labourers

You can check eligibility at the official PMJAY website or at Common Service Centres.

How to Access the Scheme

1. Check eligibility online or at a CSC
2. Get an Ayushman Bharat card (Golden Card) from empanelled hospitals or CSCs
3. Visit any empanelled hospital and show the card for cashless treatment

Practical Example

Lakshmi, a daily wage worker’s wife, is diagnosed with a kidney condition requiring surgery. The family cannot afford treatment costs of Rs 1.8 lakh. She shows her Ayushman Bharat card at an empanelled government hospital. The entire Rs 1.8 lakh bill is covered under PM-JAY, including surgery, medicines, and post-operative care for 15 days. The family pays nothing.

Key Takeaways

– Ayushman Bharat PM-JAY provides Rs 5 lakh per family per year for hospitalisation
– Over 10 crore families from economically vulnerable groups are eligible, with no premium to pay
– Pre-existing diseases are covered from day one, unlike regular health insurance
– Cashless treatment is available at empanelled hospitals across India
– It is the world’s largest government-funded health assurance scheme by beneficiary count