Overview of Ayushman Bharat PM-JAY
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a flagship health insurance scheme of the Government of India. It provides a health cover of ₹5 lakh per family per year for both secondary and tertiary care hospitalization. The scheme aims to offer financial protection to vulnerable families against high medical expenses.
Funding Pattern and Beneficiary Identification
The premium cost for the scheme is shared between the Central and State Governments in a 60:40 ratio for all states except North-Eastern and Himalayan states, where the ratio is 90:10. For Union Territories without a legislature, the central government funds 100% of the cost. Beneficiaries under the core scheme are identified primarily based on the Socio-Economic and Caste Census (SECC) 2011 dataset, using specific deprivation criteria for rural areas and occupational criteria for urban areas.
Institutional Mechanism
The National Health Authority (NHA) is the apex body responsible for implementing PM-JAY at the national level. However, the NHA is not a statutory body; it was reconstituted as an attached office to the Ministry of Health and Family Welfare via an executive Cabinet decision. At the state level, State Health Agencies (SHAs) are required to implement the scheme, operating through trust, insurance, or hybrid models.
First Pillar: Health and Wellness Centres
Ayushman Bharat comprises two pillars. The first pillar involves the creation of 1.5 lakh Health and Wellness Centres (HWCs), now branded as Ayushman Arogya Mandir, to deliver comprehensive primary health care closer to people's homes. These centres provide maternal health services, free essential drugs, and diagnostic tests. The second pillar is the PM-JAY insurance component.
Recent Expansion for Senior Citizens
In a major policy expansion, the Union Cabinet extended free health coverage under AB-PMJAY to all senior citizens aged 70 years and above, irrespective of their socio-economic status. Eligible senior citizens will receive a distinct, additional top-up cover of ₹5 lakh per year exclusively for themselves. This top-up is separate from the existing family cover, meaning senior citizens from families already covered by PM-JAY do not have to share this additional amount with other family members under 70. Senior citizens with private health insurance or Employee State Insurance (ESI) schemes are also eligible to opt for this card. According to the government, this expansion ensures that no vulnerable person is left out, as there is no cap on family size, age, or gender in the scheme.
