PM-JAY Ayushman Bharat is the world’s largest publicly funded health assurance scheme. Pradhan Mantri Jan Arogya Yojana, the insurance pillar of Ayushman Bharat, gives a ₹5 lakh per year per family cover for secondary and tertiary care hospitalisation at empanelled public and private hospitals. PM-JAY Ayushman Bharat was launched on 23 September 2018 from Ranchi and covers about 55 crore beneficiaries from the bottom 40 per cent of the population — making it bigger by population than Obamacare in the United States or the German statutory health insurance system.
PM-JAY Ayushman Bharat is one of two pillars of the Ayushman Bharat programme announced in the 2018-19 Union Budget. The other pillar is the network of Ayushman Arogya Mandirs (formerly Health and Wellness Centres) that delivers comprehensive primary care. Together they were designed to bend India’s stubborn out-of-pocket expenditure curve, which still accounts for nearly 47 per cent of total health spending. This explainer walks through the design of PM-JAY Ayushman Bharat, the beneficiary base, the empanelment model, the integration with the Ayushman Bharat Digital Mission (ABDM), and the September 2024 Ayushman Bharat 70+ expansion.
Origins and Launch
PM-JAY Ayushman Bharat replaced and absorbed the earlier Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizens Health Insurance Scheme. RSBY, launched in 2008, gave a ₹30,000 cover and had documented problems — low awareness, poor empanelment, fraud at private hospitals, and an inability to cover the cost of tertiary procedures. PM-JAY raised the cover, removed the family-size cap, and shifted to a defined-benefit package on a cashless basis.
The National Health Policy 2017 set the strategic frame. The High-Level Expert Group on Universal Health Coverage chaired by K. Srinath Reddy in 2011 had recommended tax-financed assurance for the poor. Niti Aayog detailed the operational design through 2017-18 and the National Health Authority (NHA) was established as the implementing agency. The scheme was launched by the Prime Minister on 23 September 2018, with payouts beginning the same day.
What PM-JAY Ayushman Bharat Covers
PM-JAY Ayushman Bharat is a cashless, paperless secondary and tertiary care hospitalisation assurance. Each beneficiary family gets up to ₹5 lakh per year, with no cap on family size. Pre-existing conditions are covered from day one. There is no enrolment fee, no premium, and no co-payment for beneficiaries.
Coverage extends to 1,961 procedures across 27 medical specialities including cardiology, oncology, neurosurgery, paediatric surgery, orthopaedics, urology, and burns management. Three days of pre-hospitalisation costs and 15 days of post-hospitalisation expenses for diagnostics and medicines are included. The benefit is portable across the country — a beneficiary identified in Bihar can use it at an empanelled hospital in Tamil Nadu.
Who Is a Beneficiary?
PM-JAY Ayushman Bharat does not work on application. Eligibility is automatically determined from the Socio-Economic Caste Census 2011 (SECC-2011) deprivation criteria for rural households and occupational categories for urban households. Six deprivation criteria identify rural beneficiaries — for example, households with no adult member aged 16-59, manual scavenger households, landless households deriving major income from manual casual labour, and so on. Eleven occupational categories cover urban informal workers like rag pickers, beggars, domestic workers, and construction workers.
Building on this base, several states have expanded coverage. Tamil Nadu, Andhra Pradesh, and Telangana use state-funded top-ups to enrol all ration card holders. Kerala has integrated PM-JAY with its Karunya Arogya Suraksha Padhathi. As of February 2026, about 38 crore Ayushman cards have been issued, with 9.3 crore hospital admissions and ₹1.32 lakh crore worth of treatment authorised since launch.
Empanelment of Hospitals
PM-JAY Ayushman Bharat works through a network of empanelled hospitals — public and private. As of February 2026, the network covers about 32,000 hospitals, of which roughly 58 per cent are public and 42 per cent private. Empanelment is done at the state level on the basis of National Health Authority standards — bed strength, staffing norms, equipment, and accreditation.
Hospitals are paid through a pre-defined Health Benefit Package (HBP) rate. The HBP master is revised periodically — the latest HBP 2.2 came into force in November 2024 with revised rates for cardiology and oncology procedures. Claims are submitted electronically, processed by State Health Agencies (SHAs), and paid through the Transaction Management System (TMS) of NHA. Average claim turnaround in FY 2024-25 was 14 days.
Fraud Control
Fraud is the most-discussed risk in PM-JAY Ayushman Bharat. NHA’s National Anti-Fraud Unit uses analytics to flag suspicious claims patterns — same procedure code across thousands of patients, unusually short stays followed by readmission, or female-specific procedures billed for male patients. By March 2025, more than 1,500 hospitals had been suspended or de-empanelled for fraud, and recoveries of ₹780 crore had been completed. The Standing Committee on Health (2024) recommended a public dashboard of de-empanelled hospitals — implemented in October 2024.
The Ayushman Bharat Digital Mission (ABDM)
PM-JAY Ayushman Bharat is increasingly linked to the Ayushman Bharat Digital Mission, launched on 27 September 2021. ABDM creates the digital backbone of Indian healthcare around the Ayushman Bharat Health Account (ABHA) — a 14-digit unique health ID for every resident.
ABHA links a person’s longitudinal health record across hospitals, labs, and pharmacies, with consent-based sharing. The Healthcare Professional Registry, Health Facility Registry, and Personal Health Records system are the four building blocks of ABDM. As of February 2026, over 70 crore ABHA IDs had been generated, 53 crore health records were linked, and 4.6 lakh health facilities were on the registry.
ABDM is voluntary and the data architecture follows the consent manager model pioneered by the DEPA framework. Critics — notably the Internet Freedom Foundation — have flagged the absence of a sector-specific health data law and the risks of inferred data use.
Ayushman Bharat 70+ Expansion
On 11 September 2024, the Union Cabinet approved the most consequential expansion of PM-JAY Ayushman Bharat since launch — universal coverage for all citizens aged 70 years and above, regardless of income. The scheme was rolled out from 29 October 2024.
Under Ayushman Bharat 70+, all senior citizens above 70 are eligible for a ₹5 lakh family floater cover, distinct from the cover available to other members of their household. About 4.5 crore families and 6 crore senior citizens fall under the new tier. Where a senior citizen is already in a family that holds a PM-JAY card, the 70+ benefit is an additional ₹5 lakh top-up specifically for that senior. Where the family is otherwise ineligible, the senior alone gets the ₹5 lakh cover.
The 70+ expansion is fully Centrally funded and is implemented in addition to existing state schemes. By February 2026, about 1.2 crore Ayushman Vay Vandana cards (the new card for seniors) had been issued. The estimated annual outlay for the 70+ tier alone is ₹3,437 crore.
Why the 70+ Tier Matters
India is ageing fast — the population aged 60+ will rise from 14.9 crore in 2022 to 34.7 crore by 2050. Out-of-pocket health spending is highest in older age cohorts; the LASI Wave-1 study found that 25 per cent of seniors had borrowed money or sold assets for a single hospitalisation episode. Universal coverage for 70+ addresses both the catastrophic expenditure problem and the political concern that the affluent elderly were the only group structurally outside Ayushman Bharat.
Financial Architecture
PM-JAY Ayushman Bharat is jointly funded by the Centre and States in a 60:40 ratio for most states, 90:10 for the North-Eastern and Himalayan states, and 100 per cent Centrally funded for Union Territories without legislature. The Union Budget 2025-26 allocated ₹9,406 crore for PM-JAY excluding the 70+ component, and ₹3,437 crore separately for Ayushman Bharat 70+.
Six states and three Union Territories — Odisha (which joined in 2024), West Bengal, Delhi, Telangana (joined in 2024), Kerala (operating a separate model), Tamil Nadu, Goa, and a few others — have varying relationships with PM-JAY. As of 2026, all states except West Bengal and Delhi are formally part of the scheme.
Outcomes and Critiques
Evaluations of PM-JAY Ayushman Bharat have been broadly positive on access and mixed on financial protection. A National Health Authority study (2023) found that the share of catastrophic health expenditure for SECC families fell from 18 per cent before PM-JAY to 11 per cent after enrolment. A Lancet Global Health study (2024) found a 21 per cent increase in tertiary care utilisation among eligible families in three large states.
Critiques focus on three areas. First, the package rates for some specialties — particularly cardiac surgery and oncology — remain below private-sector benchmarks, limiting participation by top-tier private hospitals. Second, the SECC-2011 base is outdated, which excludes households that have since become poor. Third, primary care under Ayushman Arogya Mandirs has scaled to 1.74 lakh centres but quality and prescription patterns vary widely across states.
Frequently Asked Questions
What is PM-JAY Ayushman Bharat?
PM-JAY (Pradhan Mantri Jan Arogya Yojana) Ayushman Bharat is a Central health assurance scheme that gives ₹5 lakh per family per year for secondary and tertiary care hospitalisation at empanelled hospitals. Launched on 23 September 2018, it covers about 55 crore beneficiaries.
How do I check if I am eligible for PM-JAY?
Eligibility is determined automatically from the Socio-Economic Caste Census 2011. You can check on pmjay.gov.in by entering your mobile number and ration card, or call the helpline 14555. State health agencies also run camps to issue Ayushman cards.
What is the difference between PM-JAY and Ayushman Bharat?
Ayushman Bharat is the umbrella programme with two pillars — Ayushman Arogya Mandirs for primary care and PM-JAY for secondary and tertiary hospitalisation. PM-JAY is the cashless health insurance component of Ayushman Bharat.
How many procedures are covered under PM-JAY?
The Health Benefit Package covers 1,961 procedures across 27 medical specialities, including cardiac surgery, oncology, neurosurgery, paediatrics, and burns management. The package is revised periodically by the National Health Authority.
What is Ayushman Bharat 70+?
Ayushman Bharat 70+ is the September 2024 expansion that gives a ₹5 lakh per year health cover to every Indian citizen aged 70 and above, regardless of income. The benefit is delivered through the new Ayushman Vay Vandana card.
Are private hospitals part of PM-JAY?
Yes. About 42 per cent of the 32,000 empanelled hospitals under PM-JAY Ayushman Bharat are private. They are paid through fixed Health Benefit Package rates. Hospitals can be de-empanelled if found involved in fraudulent claims.
What is ABHA and is it mandatory?
ABHA (Ayushman Bharat Health Account) is a 14-digit unique health ID under the Ayushman Bharat Digital Mission. It links your health records across providers with your consent. It is voluntary but useful for PM-JAY claim processing.
Which states are not part of PM-JAY Ayushman Bharat?
As of February 2026, West Bengal and Delhi are the major states not formally implementing PM-JAY. Odisha and Telangana, which were earlier outside, joined in 2024. Most other states use a 60:40 funding pattern with the Centre.
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