Quick Overview:
- Ayushman Bharat Yojana, also known as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY), is a health insurance scheme initiated by the Government of India in 2018.
- The scheme gives free health insurance up to 5 lakh per family per year in secondary and tertiary hospitalisation.
- It offers cashless treatment at empanelled government and private hospitals across India.
- Coverage is provided on a family floater basis, with no limit on family size, age, or gender.
- Pre-existing diseases are covered from day one, with no waiting period.
- Eligibility is based on the Socio-Economic Caste Census (SECC) 2011 data for rural and urban households.
- Benefits are mobile across the country, which means that they can be treated in any empanelled hospital, no matter the state.
- The plan saves a lot of out-of-pocket medical costs for families who are economically disadvantaged.
Ayushman Bharat Yojana is a government-sponsored health insurance programme that is one of the largest in the world to offer financial security and access to quality healthcare to Indian families that are economically disadvantaged. The flagship programme of the Government of India is officially titled the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), and it is expected to mitigate out-of-pocket medical costs and enhance the healthcare system in the country.
Overview of Ayushman Bharat Yojana
What is Ayushman Bharat Yojana?
Ayushman Bharat Yojana, introduced in September 2018, is a national health protection scheme that covers free secondary and tertiary healthcare services to eligible families. It is an insurance aspect of the bigger Ayushman Bharat programme that is also aimed at empowering primary healthcare using Health and Wellness Centres.
The insurance arm of the scheme is called the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY). Under PMJAY, eligible families receive health coverage of up to ₹5 lakh per family per year for hospitalisation-related expenses. The scheme is financed entirely by the central and state governments and is operated by empanelled public and private hospitals in India.
Objectives of Ayushman Bharat Pradhan Mantri Yojana
The Ayushman Bharat Pradhan Mantri Yojana has the following key objectives:
- Offering financial security against the high medical expenses.
- Provision of access to quality healthcare services.
- Cutting down poverty due to healthcare costs.
- Encouraging equity in healthcare among the vulnerable groups.
Key Benefits of Ayushman Bharat Yojana
The following are the main advantages that make Ayushman Bharat Yojana one of the most effective public insurance programmes in India.
Benefit |
Explanation |
Free Health Coverage up to ₹5 Lakh |
Includes health insurance coverage of up to 5 lakh per family per annum for secondary and tertiary hospitalisation. |
Cashless Hospitalisation Across India |
Provides beneficiaries with the ability to be treated in empanelled government and private hospitals in the country in a cashless manner. |
Coverage for Pre and Post-Hospitalisation |
Pays pre-admission costs and post-discharge costs based on approved treatment packages. |
Coverage for Entire Family |
Offers family floater coverage, allowing all eligible family members to use the total sum insured. |
No Age or Family Size Restriction |
There is no age limit, gender limitation, or limitation on the number of individuals covered by the scheme. |
Coverage for Pre-Existing Diseases |
Existing diseases are also covered without any waiting period. |
Wide Range of Medical Treatments |
Provides thousands of surgical and medical procedures in various specialties. |
Nationwide Portability |
Treatment can be accessed in any of the empanelled hospitals around India, irrespective of the home state of the beneficiary. |
No Premium Payment Required |
Central and state governments completely finance the scheme, and the beneficiaries do not have to pay any premium. |
Access to Public and Private Hospitals |
It enables treatment at the government hospitals as well as the empanelled private healthcare providers. |
Financial Protection for Vulnerable Families |
Minimises out-of-pocket costs and avoids financial difficulties caused by healthcare crises. |
Easy Access Through Ayushman Bharat Health Card |
One health card facilitates easy access to benefits in hospitals. |
Coverage Details Under Ayushman Bharat Yojana
Coverage for the Entire Family
Ayushman Bharat Yojana offers a family floater, which implies that the limit of 5 lakh is considered as a family limit. The family does not have an individual cap.
No Restriction on Age, Gender, or Family Size
No age restrictions, gender restrictions, or family size restrictions. The scheme covers all the qualified members of the family equally.
Pre-Existing Diseases Coverage from Day One
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is unlike most of the private health insurance plans because the pre-existing illnesses are covered on the very first day, and hence the beneficiaries do not have to wait.
Eligibility Criteria for Ayushman Bharat Yojana
Ayushman Bharat Yojana Eligibility for Rural Households
The eligibility criteria in rural areas are based on the Socio-Economic Caste Census (SECC) 2011. The households that are eligible are:
- Families without shelter
- Households of manual scavengers.
- Primitive tribal groups
- Homeless families that rely on manual labour.
Eligibility for Urban Beneficiaries
Urban beneficiaries are distinguished according to occupational groups, including:
- Domestic workers
- Street vendors
- Construction workers
- Transport workers
- Sanitation workers
Special Provisions for Senior Citizens
No distinct age-based eligibility exists, although senior citizens who are a part of the eligible households enjoy full coverage without any exclusions.
How to Check Eligibility for Ayushman Bharat Yojana
Online Eligibility Check Process
Eligibility can be checked online using:
- Mobile number
- Ration card number
- PMJAY ID
The official PMJAY portal provides the opportunity for beneficiaries to check whether they are registered in the database.
Offline Verification Methods
The eligibility can also be checked by the beneficiaries by visiting:
- Nearest empanelled hospital
- Common Service Centres (CSCs)
Role of CSC Centres and Hospitals
The CSC operators and hospital help desks support the beneficiaries in checking their eligibility, documentation, and enrolling in the scheme.
Documents Required for Ayushman Bharat Yojana
Identity Proof Requirements
Any government-issued photo ID, such as an Aadhaar card, voter ID, or PAN card, can be used for verification.
Address and Family Verification Documents
Ration cards or SECC-related documents are used to verify household eligibility and family composition.
Documents Needed at the Hospital
At the time of treatment, beneficiaries need:
- Ayushman Bharat Health Card (physical or digital)
- Valid ID proof
How to Enrol Under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana
Enrolment under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a structured and beneficiary-friendly process designed to ensure that eligible families can easily access healthcare benefits. The government provides both online and offline enrolment options to make the scheme widely accessible.
Eligibility Verification
The enrolment process begins with eligibility verification based on the Socio-Economic Caste Census (SECC) 2011 database. Beneficiaries can check their eligibility by visiting a Common Service Centre (CSC), an empanelled hospital, or an authorised Ayushman Bharat help desk. Basic details such as mobile number, ration card, or government-issued ID are used for verification.
Document Verification and Authentication
Once eligibility is confirmed, beneficiaries must submit valid identity documents such as an Aadhaar card, a voter ID, or a ration card. Biometric authentication may be conducted to verify identity and prevent duplication. Family details are also verified to determine the members covered under the scheme.
Registration Under PMJAY
After successful verification, eligible beneficiaries are registered under PMJAY by authorized operators. The registration process ensures accurate recording of personal and family details in the official PMJAY database.
Issuance of Ayushman Bharat Health Card
Upon completion of registration, an Ayushman Bharat Health Card is issued. The card contains a unique PMJAY identification number and beneficiary details. It can be provided as a printed card or accessed digitally and is required to avail cashless treatment at empanelled hospitals.
Offline Enrolment Through CSCs and Hospitals
For beneficiaries without access to online services, Common Service Centres (CSCs) and empanelled government or private hospitals offer free offline enrolment. These centres assist with eligibility checks, document verification, biometric authentication, and health card issuance.
Using the Health Card After Enrolment
Once enrolled, beneficiaries can use the Ayushman Bharat Health Card to access cashless hospitalisation at any empanelled hospital across India. The scheme offers nationwide portability, allowing treatment outside the beneficiary’s home state without any restrictions.
There is no enrolment fee under the scheme, and beneficiaries should rely only on authorised CSCs or hospital help desks. Keeping identity documents updated and carrying the health card during hospital visits ensures a smooth and hassle-free experience under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.
Hospitals Covered Under Ayushman Bharat Yojana
Government Hospitals Coverage
All major government hospitals across states and union territories are empanelled under PMJAY.
Private Empanelled Hospitals
A large number of private hospitals are also empanelled, ensuring wider access to quality healthcare.
Nationwide Portability of Benefits
The scheme offers pan-India portability, allowing beneficiaries to seek treatment in any empanelled hospital regardless of their home state.
Importance of Ayushman Bharat Yojana in India’s Healthcare System
- Reducing Financial Burden on Families - Ayushman Bharat Yojana greatly lessens the out-of-pocket healthcare costs by covering the expensive hospital services, thus enabling families to escape the financial hardships and medical debts.
- Improving Access to Quality Healthcare - The empanelling of the public and the private hospitals puts the scheme in a position to provide the beneficiaries with quality and advanced medical treatments, which were previously unaffordable or unavailable to the beneficiaries.
- Strengthening Health Insurance Coverage - PMJAY enhances the health insurance ecosystem of India by covering the economically disadvantaged sections of the population that are usually left out of the private health insurance covers.
- Enhancing Healthcare Equity - The plan encourages fair access to care by offering equal benefits to socio-economic groups and areas.
- Encouraging Timely Medical Treatment - Financial obstacles are minimised, which means that beneficiaries will be more willing to get timely medical care before minor illnesses develop into more serious ones.
- Supporting Rural and Marginalised Communities - Ayushman Bharat Yojana is important in enhancing access to healthcare in rural and remote locations by providing a comprehensive network of empanelled hospitals.
- Reducing Dependence on High-Interest Borrowing - The scheme can assist the families by covering the primary medical costs, which prevents the families from resorting to loans or selling property to meet the medical costs.
- Improving Health Outcomes Nationwide - With greater access to quality healthcare, more beneficiaries will be diagnosed, treated, and have better health outcomes.
- Strengthening Public–Private Healthcare Collaboration - The programme promotes cooperation between the government and the private healthcare services, enhancing service delivery and infrastructure.
- Contributing to Universal Health Coverage Goals - PMJAY is contributing to the ultimate objective of the country, which is to have universal health coverage and a more sustainable healthcare system.
Why You Should Opt for ManipalCigna Health Insurance Along with Ayushman Bharat Yojana
Although the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana offers the necessary coverage, it is limited in its packages and has predetermined inclusions of treatment. A full-fledged private health insurance plan, such as ManipalCigna, in combination with PMJAY, would assist in covering the extra costs, higher room types, OPD costs, and treatment beyond the limits of the PMJAY package to provide a more comprehensive financial coverage.
FAQs on Ayushman Bharat Yojana
What is Ayushman Bharat Yojana, and how does it work?
Ayushman Bharat Yojana is a government-funded health insurance plan that covers 5 lakh per family per year in hospitalisation within empanelled hospitals.
Who is eligible for Ayushman Bharat Yojana benefits?
Eligibility is based on SECC 2011 data for rural and urban households identified by socio-economic and occupational criteria.
How much health coverage is provided under PMJAY?
Under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, beneficiaries receive up to ₹5 lakh per family per year.
Can the Ayushman Bharat card be used in private hospitals?
Yes, the Ayushman Bharat Health Card can be applied in government and empanelled private hospitals in India.
Is Ayushman Bharat Yojana applicable in Rajasthan?
Yes, the Ayushman Bharat Yojana Rajasthan is carried out within a hybrid framework comprising PMJAY along with the state health assurance scheme, and providing coverage to eligible residents of Rajasthan.
