Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Current Affairs & Government Schemes › Health and Nutrition Schemes · Topic 4.1
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a Centrally Sponsored Scheme of the Ministry of Health and Family Welfare that gives a health cover of Rs 5 lakh per family per year for secondary and tertiary hospitalisation. It was launched on 23 September 2018 at Ranchi and targeted about 12 crore poor and vulnerable families, roughly 55 crore people, identified from the Socio-Economic Caste Census 2011. It is cashless and paperless and is run by the National Health Authority. In October 2024 the cover was extended to every citizen aged 70 years and above, irrespective of income.
6 min read · UPSC Prelims · Current Affairs & Government Schemes · Health and Nutrition Schemes
At a Glance
- Ministry Health and Family Welfare
- Launched 23 September 2018, Ranchi
- Type Centrally Sponsored Scheme
- Cover Rs 5 lakh per family per year
- Implementing body National Health Authority
- Exam link UPSC Prelims, Current Affairs and Government Schemes: Health and Nutrition Schemes
Where Does It Fit?
This is the first topic of the macro on health and nutrition. It is the insurance pillar of Ayushman Bharat, and the other pillars, covering primary care and digital records, follow in the next topics. Previous topic: National Mission on Natural Farming. Next topic: Ayushman Bharat – Health and Wellness Centres (HWCs).
What Does PM-JAY Offer and Who Is Covered?
| Feature | Detail |
|---|---|
| Benefit | Cashless cover of Rs 5 lakh per family per year for secondary and tertiary care in empanelled public and private hospitals, with no cap on family size or age |
| Pre-existing diseases | Covered from day one of enrolment |
| Eligible families | Deprived rural families and occupational categories of urban workers listed in the Socio-Economic Caste Census 2011, plus families under earlier schemes such as RSBY |
| Packages | About 1,400 packages at launch, expanded later to over 1,900 procedures, covering surgery, medical care, day care, and follow-up, with rates fixed by the National Health Authority |
| Portability | A beneficiary can take treatment in an empanelled hospital in any state |
| Identification | Beneficiary Identification System and an Ayushman card, with an ABHA link for records |
| Funding | Cost shared between Centre and states, generally 60:40, with higher central shares for the north-eastern and Himalayan states and full central funding for Union Territories without legislatures |
How Is the Scheme Run and What Changed in 2024?
- National Health Authority: the apex body, set up in 2018 as a registered society and later given the status of an attached office of the Health Ministry, which runs PM-JAY and the Ayushman Bharat Digital Mission
- State Health Agency: each state sets up a State Health Agency to run the scheme locally, either through a trust, a society or an insurance company
- Insurance versus trust model: states choose between buying insurance from companies or paying hospitals directly from a state trust, or a mixed model
- Empanelment: public and private hospitals apply and are checked against minimum standards before they are empanelled
- Vay Vandana expansion: the Union Cabinet approved the extension on 11 September 2024 and it began on 29 October 2024 for all citizens aged 70 years and above, who get the Ayushman Vay Vandana card
- Top-up for seniors: eligible seniors get a separate Rs 5 lakh per year cover that is shared by all seniors in the family, and families already on PM-JAY share the Rs 5 lakh with the senior
- Enrolment figures: as reported by the Health Ministry, about 43.5 crore Ayushman cards had been created by February 2026, including over 1 crore Vay Vandana cards
- Grievance redress: a national helpline, state grievance officers and an anti-fraud unit work to check fake claims and wrongful denial
What Else Should You Remember?
- Origin: the scheme was announced in Union Budget 2018-19 as the National Health Protection Scheme and was renamed PM-JAY at launch. It replaced the Rashtriya Swasthya Bima Yojana, which gave a cover of Rs 30,000
- Ayushman Bharat: the umbrella programme has two pillars: Health and Wellness Centres for primary care and PM-JAY for hospital care, as in Ayushman Bharat – Health and Wellness Centres (HWCs)
- Pillar for data: the Ayushman Bharat Digital Mission links health records and gives each person an ABHA number, as in Ayushman Bharat Digital Mission (ABDM)
- Policy aim: to reduce catastrophic out-of-pocket health spending, which pushes many families below the poverty line, and to move towards universal health coverage under Sustainable Development Goal 3
- Scale: it is often described as one of the largest government funded health assurance schemes in the world by number of people eligible
- States outside: a few states and Union Territories ran their own schemes or joined late. Delhi and Odisha joined in 2025, as reported, and West Bengal had remained outside the scheme
- Own state schemes: Rajasthan, Tamil Nadu, Kerala and others run larger state schemes and combine them with PM-JAY, which is why benefit levels differ between states
- Package rates: the rates of packages are revised from time to time, and private hospitals have complained that rates are low, which affects willingness to stay empanelled
- Fraud and misuse: audits have found duplicate cards, unnecessary procedures and claims from ineligible hospitals, which the anti-fraud unit tries to curb using data analytics
- Supply gap: empanelled hospitals are concentrated in cities and richer states, so access in remote districts is weaker
- Financing: public health spending is still around 2 per cent of GDP, below the 2.5 per cent target of the National Health Policy 2017
- Out-of-pocket spending: Indian households still bear a large share of health costs, and insurance for hospital care does not cover outpatient costs, which are a major part of spending
Why Does It Matter for the Exam?
- Cover and agency: Rs 5 lakh per family per year, National Health Authority, and Centrally Sponsored Scheme status
- Eligibility: SECC 2011 data for families, and age only for the 70 plus category
- Pillars: Ayushman Bharat has Health and Wellness Centres plus PM-JAY
- Reforms: portability, no family size cap and pre-existing diseases covered
- Traps: PM-JAY covers hospital care, not routine outpatient visits, and it is not a Central Sector Scheme
As an analytical point, PM-JAY has widened access to hospital care, but a cover for hospital stays alone leaves outpatient costs, medicines and diagnostics uncovered. Better primary care, stronger public hospitals and fair package rates are needed for the cover to translate into better outcomes.
Why Is This Topic Important?
- Facts Cover, agency, launch date
- Policy Universal health coverage
- Mains Design and implementation gaps
What Came Next?
The next topic covers the primary care pillar of Ayushman Bharat. Next topic: Ayushman Bharat – Health and Wellness Centres (HWCs).
Key People and Terms
- AB PM-JAY Health assurance scheme
- NHA Apex agency
- SHA State Health Agency
- SECC Eligibility data source
- Empanelment Hospital enrolment
- Vay Vandana 70 plus cover
Exam Corner
Points to Remember
- Launch: 23 September 2018, Ranchi.
- Cover: Rs 5 lakh per family per year.
- Agency: National Health Authority.
- Seniors: 70 plus from 29 October 2024.
- Replaced: RSBY in effect, Rs 30,000 cover.
Do Not Confuse With
- PM-JAY and Ayushman Bharat The insurance part versus the whole programme with primary care
- PM-JAY and CGHS Poor family scheme versus a scheme for central government staff
- PM-JAY and ESIC Social insurance for workers with payroll contributions
Memory Hook
Five lakh, one family, one year, cashless in any empanelled hospital.
Mains Angle
Mains questions ask about design gaps, financing and the link between insurance and primary care. These points help.
- Strengths Cashless, portable, large reach
- Gaps Fraud, low rates, supply gap
- Way forward Primary care and outpatient cover
A Question You May Face
An original practice question, not a past paper question.
“Examine the achievements and limitations of Ayushman Bharat PM-JAY in moving India towards universal health coverage.”
How to Answer
- Intro State the Rs 5 lakh hospital cover and its scale.
- Gains Reach, portability, less catastrophic spending.
- Limits Outpatient gap, fraud, supply.
- Way Primary care, rates, audit and data.
GS Relevance
Frequently Asked Questions
What is Ayushman Bharat PM-JAY?
Ayushman Bharat PM-JAY is a Centrally Sponsored Scheme launched on 23 September 2018 that gives a cashless health cover of Rs 5 lakh per family per year for hospital care. It targets about 12 crore poor and vulnerable families and is run by the National Health Authority.
Who is eligible for PM-JAY?
Eligible families are identified from the Socio-Economic Caste Census 2011 deprivation and occupational criteria, along with families covered under earlier schemes. Since 29 October 2024 every citizen aged 70 years and above is eligible irrespective of income, and receives the Ayushman Vay Vandana card.
Which body implements PM-JAY?
The National Health Authority implements PM-JAY at the national level under the Ministry of Health and Family Welfare. In each state a State Health Agency runs the scheme and chooses an insurance, trust or mixed model to pay empanelled public and private hospitals for treatment.
How is PM-JAY funded?
PM-JAY is a Centrally Sponsored Scheme, so cost is shared between the Centre and states, generally 60:40. The central share is higher for north-eastern and Himalayan states, and Union Territories without a legislature are funded fully by the Centre.
What does PM-JAY not cover?
PM-JAY covers secondary and tertiary hospitalisation, including day care procedures. It does not cover routine outpatient consultations, most medicines bought outside hospital stays or diagnostics without admission. That is why experts suggest linking it with primary care centres and outpatient cover.
PYQ Practice — Statement Analysis
1 PM-JAY gives a cover of Rs 5 lakh per family per year.
This is the headline benefit.
2 PM-JAY is a Central Sector Scheme funded fully by the Centre.
It is a Centrally Sponsored Scheme with cost sharing.
3 PM-JAY is implemented at the national level by the National Health Authority.
State Health Agencies work at state level.
4 PM-JAY replaced the Rashtriya Swasthya Bima Yojana in effect.
RSBY gave a smaller cover of Rs 30,000.
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