AB-PMJAY: Cover, Four Pillars and Senior Citizen Expansion
Why in the news
West Bengal brought the scheme into the State alongside its own Mukhyamantri Swasthya Bima Yojana, adding one of the last big states to the national cashless-care network.
Key facts
- World’s largest government-funded health assurance scheme.
- Launched 23 September 2018, Ranchi; follows National Health Policy 2017 and aims at Universal Health Coverage and SDG 3.
- Run by the National Health Authority (NHA), which sits within the health ministry, along with State Health Agencies.
- Annual limit of Rs 5 lakh per family for secondary and tertiary care; no limit on family size, age or gender.
Who is covered
- The poorest 40%: roughly 12 crore families (55 crore people), picked using SECC 2011 deprivation and occupational criteria.
- ASHA workers, anganwadi workers and helpers, included in 2024.
- All persons aged 70 and above from 29 October 2024, via the Ayushman Vay Vandana card; roughly 6 crore seniors in about 4.5 crore families.
Funding
| Region | Centre : State |
|---|---|
| Most states | 60:40 |
| North-Eastern and Himalayan states | 90:10 |
| Union Territories without a legislature | 100% Central |
It is a Centrally Sponsored Scheme.
Features
- Cashless and paperless care; pre-existing conditions covered from day one.
- Over 1,900 packages, including 3 days pre- and 15 days post-hospitalisation costs.
- Portable across the country at any empanelled hospital; about 30,000 hospitals, over half private.
- States may choose trust, insurance or hybrid mode.
- Misuse is curbed by the National Anti-Fraud Unit, with Aadhaar e-KYC and biometrics when a patient is admitted.
Four pillars of Ayushman Bharat
| Pillar | Role |
|---|---|
| AB-PMJAY | Hospitalisation assurance |
| Ayushman Arogya Mandirs | Renamed Health and Wellness Centres (2023); about 1.75 lakh centres for primary care, screening, free drugs and diagnostics |
| Ayushman Bharat Digital Mission (2021) | Digital backbone: ABHA IDs, registries, linked records |
| PM-ABHIM (2021) | Rs 64,180 crore to build critical-care blocks, public health labs and surveillance capacity district-wise |
Progress
- Over 8 crore admissions worth more than Rs 1 lakh crore authorised since 2018; over 35 crore cards issued.
- Late entrants: Odisha (January 2025), Delhi (April 2025) and West Bengal, often after folding in their own state schemes.
Exam angle
- It covers hospitalisation and day-care, not outpatient care, and is not a premium-based policy for the beneficiary.
- Remember: launch date, Rs 5 lakh cover, 60:40 funding, 70+ expansion, four pillars.
- Implementing body: National Health Authority.