The Ayushman Bharat Health Insurance Scheme (AB-PMJAY)

Context: The Centre’s Ayushman Bharat and West Bengal’s Mukhyamantri Swasthya Bima Yojana were rolled out in the State, providing cashless secondary and tertiary healthcare through empanelled hospitals.

About The Ayushman Bharat Health Insurance Scheme (AB-PMJAY):

What It Is?

• The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is the world’s largest government-funded health assurance/insurance scheme. Implemented by the National Health Authority (NHA) under the Ministry of Health and Family Welfare, it provides comprehensive financial protection for secondary and tertiary care hospitalization to the bottom 40% of India’s vulnerable and low-income population.

Launch Date: September 23, 2018.

Policy Genesis: Recommended by the National Health Policy 2017 to achieve Universal Health Coverage (UHC) and Sustainable Development Goal 3 (Good Health and Well-Being).

Core Pillars of Ayushman Bharat:

• AB-PMJAY: Tertiary & secondary hospitalization assurance.
• Ayushman Arogya Mandirs (AAMs): Decentralized comprehensive primary healthcare.
• Ayushman Bharat Digital Mission (ABDM): Integrated digital health infrastructure and ABHA IDs.
• PM-ABHIM: Health infrastructure upgradation across rural and urban centers.

Aim: To reduce catastrophic health expenses by providing cashless, quality inpatient care to vulnerable households through public and empanelled private hospitals.

Key Features of AB-PMJAY:

• ₹5 Lakh Annual Risk Cover: Provides a health cover of ₹5 lakh per family per year for secondary and tertiary healthcare procedures across thousands of empaneled public and private hospitals.
• Day-One Pre-Existing Condition & Procedure Scope: Covers all pre-existing illnesses from the very first day of policy activation, encompassing over 1,900+ medical and surgical packages, along with 3 days of pre-hospitalization and 15 days of post-hospitalization diagnostic/medication costs.
• No Cap on Family Size or Age: Operates without any restriction on family size, gender, or age, ensuring that women, children, and elderly dependents are fully included.
• Universal 70+ Senior Citizen Expansion: Extends distinct health insurance coverage of ₹5 lakh annually to all senior citizens aged 70 years and above, irrespective of their socio-economic status.
• 100% Cashless, Paperless & Nationally Portable: Beneficiaries receive a dedicated Ayushman Card enabling seamless, paperless, and cashless treatment at any empaneled hospital across India, regardless of their home state.

Significance:

• Reducing Healthcare Costs: Cuts out-of-pocket medical expenses and protects poor families from debt and poverty.
• Strengthening Healthcare Delivery: Integrates public and private hospitals through standard treatment rates, quality norms, and digital claims processing.