Ayushman Bharat PM-JAY
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world's largest government-funded health insurance scheme in India, providing cashless hospitalisation cover of Rs 5 lakh per family per year for secondary and tertiary care at empanelled public and private hospitals, targeting the bottom 40% of India's population by economic vulnerability.
PM-JAY was launched on 23 September 2018 under the Ayushman Bharat umbrella, which also includes Health and Wellness Centres (primary care). The scheme was designed to provide financial protection against catastrophic health expenditure — the leading cause of poverty entrenchment in India — for approximately 10.74 crore poor and vulnerable families (roughly 50 crore individuals) identified based on the Socio-Economic Caste Census (SECC) 2011 data. No family size or age cap applies; all members of the eligible family are covered under the single Rs 5 lakh annual benefit.
Eligibility is determined at the household level through the SECC 2011 database, which ranked families by deprivation criteria including housing type, land ownership, income source, and caste. Families classified under the eight deprivation criteria (D1 to D7 and automatically included categories) qualify. Beneficiaries verify their eligibility at empanelled hospitals using an Ayushman Card (also called the Golden Card), generated using Aadhaar-based biometric authentication, and receive cashless treatment without any premium payment.
The premium is entirely funded by the central and state governments in a 60:40 ratio for most states (90:10 for hilly states and special category states). States that have expanded PM-JAY beyond the SECC list to include additional beneficiaries (such as the Ayushman Bharat – Mukhyamantri Yojana in several states) fund the marginal cost through their own budgets. The central allocation for PM-JAY in the Union Budget has grown from Rs 6,400 crore in 2018-19 to significantly higher amounts as enrollment and utilisation increased.
Empanelled hospitals — both public and private — provide covered procedures from a defined Health Benefit Package (HBP) that includes over 1,900 treatment procedures across 27 specialties. Packages include surgical procedures, maternity care, cancer treatment, cardiac surgeries, orthopaedic surgeries, and critical care. Each package has a fixed rate defined by the National Health Authority (NHA), which negotiates with hospitals. Private hospitals in Tier 2 and Tier 3 cities significantly expanded their capacity under PM-JAY incentives, as the government-assured payment reduced revenue uncertainty.
As of March 2025, over 30 crore Ayushman Cards had been issued and over 7 crore hospitalisation claims were processed since launch, with a total claim value exceeding Rs 1 lakh crore. The scheme has had documented impact in reducing out-of-pocket health expenditure for beneficiaries, though challenges around fraud (multiple fake claims at some empanelled hospitals), sub-optimal package rates (causing provider disengagement in some specialties), and awareness gaps among eligible households remain ongoing policy challenges.