Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is a publicly financed health assurance scheme that provides eligible people cashless hospital treatment at empanelled facilities. Its core entitlement is up to Rs 5 lakh per family per year on a family-floater basis for secondary and tertiary hospitalization. The benefit applies to specified treatment packages rather than unrestricted medical expenditure.

Scope of the entitlement

• Beneficiaries receive cashless and paperless treatment for covered packages at empanelled public and private hospitals.
• The packages include expenses such as medicines, diagnostics, accommodation, surgery and other treatment-related services.
• The entitlement covers up to 3 days of pre-hospitalization and 15 days of post-hospitalization expenses associated with the treatment.
• Pre-existing conditions are covered from the first day, and national portability permits treatment at any empanelled hospital across India.

Eligibility and family coverage

The original beneficiary base comprises poor and vulnerable households identified mainly through deprivation and occupational criteria in the Socio-Economic and Caste Census, 2011. Coverage also extends to all persons aged 70 years or above, irrespective of socioeconomic status.

• For an eligible household, there is no restriction on family size, age or gender, and the annual cover can be used by one or more family members.
• Senior citizens aged 70 years or above in families already covered under PM-JAY receive an additional Rs 5 lakh top-up for eligible senior members, without sharing it with members below 70 years.

How the benefit is delivered

The National Health Authority oversees the scheme nationally, while State Health Agencies implement it through trust, insurance or mixed models. Beneficiaries do not pay at the point of service for an approved package, but treatment must ordinarily be obtained from an empanelled hospital under the scheme.