Ayushman Bharat PM-JAY (AB-PMJAY): Coverage, Four Pillars, Senior Citizen Cover and Facts

Context

• The Centre’s Ayushman Bharat and West Bengal’s Mukhyamantri Swasthya Bima Yojana were rolled out in the State, providing cashless secondary and tertiary healthcare through empanelled hospitals – bringing one of the last large states into the national scheme.
• Since October 2024 all citizens aged 70 and above get a Rs 5 lakh cover under AB-PMJAY through the Ayushman Vay Vandana card, irrespective of income, adding about 6 crore senior citizens in roughly 4.5 crore families.

What Is AB-PMJAY?

• Launched: 23 September 2018 at Ranchi, as the hospitalisation pillar of Ayushman Bharat, recommended by the National Health Policy 2017 to move towards Universal Health Coverage and SDG 3.
• Implemented by: the National Health Authority (NHA) under the Ministry of Health and Family Welfare, with State Health Agencies in every implementing state.
• Who is covered: the bottom 40% of the population – about 12 crore families (55 crore people) identified through the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 – plus ASHA and anganwadi workers and helpers (added in 2024) and all persons aged 70 and above.
• Type: a Centrally Sponsored Scheme funded 60:40 between the Centre and the states (90:10 for North-Eastern and Himalayan states; 100% Central for Union Territories without a legislature).

Key Features

• Rs 5 lakh cover per family per year for secondary and tertiary care; no cap on family size, age or gender.
• Cashless and paperless treatment; pre-existing conditions covered from day one; over 1,900 medical and surgical packages, including 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses.
• Nationally portable: the Ayushman card works at any empanelled hospital in any implementing state.
• About 30,000 empanelled hospitals, more than half of them private; states may run the scheme in trust mode, insurance mode or a hybrid.
• Fraud control through the National Anti-Fraud Unit, Aadhaar-based e-KYC and biometric verification at admission.

The Four Pillars of Ayushman Bharat

• AB-PMJAY – the hospitalisation assurance described above.
• Ayushman Arogya Mandirs (AAMs) – the former Health and Wellness Centres (renamed in 2023), about 1.75 lakh centres delivering comprehensive primary care, screening and free drugs and diagnostics.
• Ayushman Bharat Digital Mission (ABDM, 2021) – the digital health backbone: ABHA health IDs, health facility and professional registries and linked health records.
• PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM, 2021) – Rs 64,180 crore for critical-care blocks, public health labs and surveillance capacity in every district.

Progress

• More than 8 crore hospital admissions worth over Rs 1 lakh crore have been authorised since 2018; over 35 crore Ayushman cards have been issued.
• Most states and Union Territories implement the scheme; Odisha (January 2025), Delhi (April 2025) and West Bengal joined late, often by merging their own state schemes with PM-JAY.
• The scheme is complemented by state schemes with wider eligibility and by the Ayushman Vay Vandana cards for senior citizens.

FAQs

Is AB-PMJAY an insurance policy?

It is a health assurance scheme: the government pays hospitals directly (trust mode) or through an insurer (insurance mode); the beneficiary pays no premium and no bill at the hospital.

Does the scheme cover outpatient treatment?

No. It covers hospitalisation and day-care procedures; primary and outpatient care is meant to come from the Ayushman Arogya Mandirs.

Why is AB-PMJAY asked in NABARD and RBI exams?

It is the flagship social-security scheme in the ESI syllabus; the launch date, cover amount, beneficiary numbers, the four pillars and the 2024 senior-citizen expansion are the standard questions.