Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a government-funded health insurance scheme that gives eligible poor and vulnerable families free, cashless hospital treatment, and is described as the world's largest such government-funded health protection scheme.

Basic Details

  • Launched and implemented by: Ministry of Health and Family Welfare, Government of India; launched by Prime Minister Narendra Modi.
  • Launched in: 23 September 2018, at Ranchi, Jharkhand, as the health-insurance component of the broader Ayushman Bharat programme, alongside Health and Wellness Centres.
  • Beneficiaries: About 10.74 crore poor and vulnerable families (roughly 50 crore people), identified from the Socio-Economic Caste Census (SECC) 2011 database, plus families earlier covered under the Rashtriya Swasthya Bima Yojana (RSBY).
  • Type of Scheme: Centrally Sponsored Scheme, funded jointly by the Centre and States.

Aim and Objectives

  • To reduce catastrophic out-of-pocket health expenditure for poor and vulnerable families by covering hospitalisation costs.
  • To provide cashless and paperless access to health-care services at the point of care, across public and empanelled private hospitals.
  • To improve access to secondary and tertiary care for families who previously had no health insurance cover.

Key Features

  • Coverage: Provides a health cover of up to ₹5 lakh per family per year for secondary and tertiary care hospitalisation.
  • No Caps: There is no cap on family size, age, or pre-existing conditions.
  • Portability: Coverage is portable across India — a beneficiary can access treatment at an empanelled hospital in any State.
  • Cashless Treatment: Covers pre- and post-hospitalisation expenses, diagnostics and medicines across around 1,350 medical packages and procedures, with no upfront payment at empanelled hospitals.
  • Hospital Network: Empanels both public and private hospitals; over 15,600 hospital empanelment applications had been received by the scheme's launch.

Significance

  • Scale: Described as the world's largest government-funded health assurance scheme by number of people covered.
  • Financial Protection: Aims to reduce the catastrophic health expenditure that pushes households into poverty because of hospitalisation.
  • Current Policy Debate: A Parliamentary Standing Committee has recommended that large corporate hospitals earning from medical tourism and high-net-worth patients be required to reserve beds for AB-PMJAY beneficiaries at regulated rates, and that insurance schemes reward appropriate care rather than higher procedure volumes.