Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is the world’s largest publicly funded health assurance scheme which provides health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization to 55 crore individuals corresponding to 12.34 crore families. All members of the eligible families irrespective of age are covered under the scheme. The scheme is being implemented in 33 States/UTs except for the NCT of Delhi, West Bengal, and Odisha. Currently, there is no proposal to open the scheme beyond the existing beneficiary base on the contribution of premium.

Initially, 10.74 crore beneficiary families under AB PM-JAY were identified based on the Socio-economic Caste Census (SECC) of 2011 using select deprivation and occupational criteria separately for rural and urban areas. In January 2022, the beneficiary base was expanded to 12.34 crore families and States/UTs have been given the flexibility to use other digitized databases of similar socio-economic conditions for identification of beneficiaries under the scheme. Accordingly, States/UTs have provided Aadhaar-seeded databases of poor and vulnerable families for verification under the scheme. Beneficiaries can now access cashless treatment at any empaneled public or private hospital nationwide. Treatment is provided free of charge based on the hospital’s diagnosis. After discharge, the hospital submits the claim for reimbursement.

The Minister of State in the Ministry of Health & Family Welfare, Shri Prataprao Jadhav stated this in a written reply in the Lok Sabha today.

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HFW/New Health Schemes for Senior Citizens under PMJAY/26 July 2024/6