The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a national public health insurance scheme of the Government of India, launched on September 23, 2018, to provide free access to healthcare for low-income earners. The scheme is the insurance arm of the larger Ayushman Bharat program, which also includes the establishment of Health and Wellness Centres for primary healthcare. It was created to solve the problem of high out-of-pocket expenditure on healthcare, which pushes millions of vulnerable Indians into poverty annually.
The scheme works by providing a health cover of up to ₹5 lakh per family per year for secondary and tertiary care hospitalization. Eligibility is entitlement-based, primarily determined by the deprivation and occupational criteria from the Socio-Economic Caste Census (SECC) 2011 data, covering approximately 12 crore vulnerable families. Key provisions include cashless and paperless treatment at any empanelled public or private hospital across the country, with all pre-existing medical conditions covered from day one. The coverage is on a family floater basis, with no restriction on family size, age, or gender. It also covers three days of pre-hospitalization and fifteen days of post-hospitalization expenses, including diagnostics and medicines.
The scheme is a centrally sponsored scheme, jointly funded by the Union and State governments, and is administered by the National Health Authority (NHA), which was established by the Ministry of Health and Family Welfare. A significant recent change occurred in September 2024, when the Union Cabinet approved the expansion of the scheme to cover all senior citizens aged 70 years and above, irrespective of their economic status, providing them with the same ₹5 lakh annual health coverage. This expansion is set to benefit around 6 crore senior citizens. The scheme replaced the earlier Rashtriya Swasthya Bima Yojana (RSBY), incorporating its beneficiaries into the new framework.