Ayushman Bharat – Pradhan Mantri Jan Arogya Yojna (AB – PM JAY)

On September 23, 2018, the Prime Minister Narendra Modi launched the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojna (AB-PM JAY), world's largest government-funded healthcare scheme to help reduce the financial burden on poor and vulnerable groups arising out of catastrophic hospital episodes and to ensure their access to quality health services was conceived.

The scheme is targeted at poor, deprived rural families and identified occupational category of urban workers' families. According to the Socio-Economic Caste Census (SECC) 2011 data, 8.03 crore families in rural and 2.33 crore in urban areas are entitled under these scheme, i.e., it will cover around 50 crore people.

AB-PM JAY will have a defined benefit cover of Rs. 5 lakh per family (on a family floater basis) per year for secondary and tertiary care hospitalisation. It will offer a benefit cover of Rs 5 lakh per family per year.

Beneficiary Covered

To ensure that everyone is covered (especially women, children and the elderly from the family), there is no capping on the number and age of family members under the AB-PM JAY. Every family covered under SECC 2011 data are entitled under this scheme. The beneficiaries are identified based on the deprivation categories (D1, D2, D3, D4, D5, and D7) identified under the SECC database for rural areas and for urban areas, the 11 occupational criteria will determine entitlement.

This scheme does not require any enrolment. By presenting any Government approved identification card, the beneficiary can avail the benefits of this scheme.

Additionally, families with an active RSBY cards as of 28 February 2018 will covered. No additional new families can be added under AB-PM JAY. However, names of additional family members can be added for those families whose names are already on the SECC list.

Beneficiary Identification and Hospitalization Process

The beneficiaries are not required to pay any charges and premium for the hospitalisation expenses as the scheme is completely cashless and paperless at public hospitals and empanelled private hospitals. The benefit also include pre- and post-hospitalisation expenses. Every eligible beneficiaries are given letters having dedicated AB- PM JAY family identification number along with QR codes which can be scanned and a demographic authentication can be conducted for identification and to verify his or her eligibility to avail the benefits of the scheme.

Each empanelled hospital will have an 'Ayushman Mitra' to assist patients and will coordinate with beneficiaries and the hospital. They are located at AB – PM JAY Kiosk to check documents and verify the eligibility under this scheme.

A list of eligible families has been shared with State government as well as district level departments like the ANMs, BMO, and BDOs. Only families whose name is on the list are entitled for the benefits of AB – PM JAY.

AB – PM JAY also offers National Portability which means benefits under this scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.

Services Covered under AB – PM JAY

AB-PM JAY will cover medical and hospitalisation expenses for almost all secondary care and most of tertiary care procedures. There are more than 1,350 packages in the scheme under which treatment major illnesses such as coronary bypass, knee replacements and stenting among others would be provided.

Empanelled Health Care Providers

Services under the scheme can be availed at all public hospitals and empaneled private health care facilities. Empanelment of the hospitals under AB-PM JAY will be conducted through an online portal by the state government after required physical verification completed. Information about empaneled hospitals is available on this website under Download section.