Update on Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)
As on 24th March 2025, more than 36.9 crore Ayushman cards have been created under the scheme
Between FY 2015 and FY 2022, Government Health Expenditure (GHE) increased from 29.0% to 48.0%; while Out-of-Pocket Expenditure (OOPE) declined from 62.6% to 39.4% with recorded savings over Rs. 1.25 lakh crore
Eligibility criteria under the scheme were expanded in March 2024 to include 37 lakh ASHAs, Anganwadi Workers, Anganwadi Helpers and their families
On 29th October 2024, AB PM-JAY was expanded to provide free treatment benefits of up to ?5 lakh per year to almost 6 crore senior citizens aged 70 years and above, irrespective of their socio-economic status
Under AB PM-JAY, a three-tier grievance redressal system is in place at District, State, and National level for resolving the issues faced by beneficiaries in utilizing healthcare services
Various steps have been taken to empanel more privat
The Economic Survey 2024-25 highlights the impact of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) in reducing Out-of-Pocket Expenditure (OOPE) through increased social security and primary health spending, with recorded savings over Rs. 1.25 lakh crore. The report also states that Government-supported insurance schemes like AB PM-JAY, Rashtriya Swasthya Bima Yojana (RSBY), and state-specific programs contribute 2.63% to healthcare financing and the rise in government health spending has significantly reduced financial hardship for households. Between Fiscal Year 2015 and Fiscal Year 2022, Government Health Expenditure (GHE) increased from 29.0% to 48.0%, while Out-of-Pocket Expenditure (OOPE) declined from 62.6% to 39.4%.
As on 24th March 2025, more than 36.9 crore Ayushman cards have been created under the scheme.
Under AB-PMJAY, the eligibility criteria for the beneficiary families were initially identified from the Socio-Economic Caste Census (SECC) of 2011 on the basis of 6 deprivation and 11 occupational criteria across rural and urban areas respectively. Further, in January 2022, on the basis of decadal growth rate of 11.7%, Government of India revised the beneficiary base to 12 crore families and provided the flexibility to States/UTs to use other databases (of similar socioeconomic profile) for verification of beneficiaries against such SECC beneficiaries who could not be identified and verified. Many of the States and Union Territories (UTs) implementing AB-PMJAY have further expanded the beneficiary base at their own cost under the scheme using non-SECC data sources (including National Food Security Act, State specific datasets).
In March 2024, the eligibility criteria under the scheme were expanded to include 37 lakh Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs), Anganwadi Helpers (AWHs) and their families. Further, on 29th October 2024, the government expanded AB-PMJAY to provide free treatment benefits of up to ₹5 lakh per year to approximately 6 crore senior citizens aged 70 years and above, belonging to 4.5 crore families, irrespective of their socio-economic status.
As per the terms and conditions of empanelment, hospitals cannot deny treatment to eligible beneficiaries of the scheme. In case of denial of services by the empaneled hospital, beneficiaries can lodge grievances. Under AB PM-JAY, a three-tier grievance redressal system at District, State, and National level has been created to resolve the issues faced by beneficiaries in utilizing healthcare services. At each level, there is a dedicated nodal officer and Grievance Redressal Committees to address the grievances.
Beneficiaries can also file their grievance using different mediums including web-based portal Centralized Grievance Redressal Management System (CGRMS), Central & State call centers (14555), email, letter to State Health Agencies (SHAs), etc. Based on the nature of grievance, necessary action, including providing support to the beneficiaries in availing treatment under the scheme, for resolution of grievances is taken.
All Government hospitals with in-patient services are deemed empanelled under AB-PMJAY. Further, public hospitals are reimbursed for the services provided under the scheme at par with private hospitals. In order to improve the participation of more private hospitals, following actions have been taken:
- National Health Authority (NHA) has released a revised Health Benefit Package (HBP) with increased number of procedures (1961). Further, rates have been increased for 350 packages and new packages have been added.
- Claim settlement is monitored at the highest level and it is ensured that claim is settled within defined turnaround time.
- NHA has launched an improved version of the Hospital Engagement Module (HEM 2.0) for enhancing the empanelment process of the hospitals.
- Virtual and physical capacity-building of hospitals are undertaken.
- A hospitalspecific call center (14413) has been set-up to address their concern on a real-time basis.
- District Implementation Units (DIUs) have been setup to regularly visit empaneled hospitals to understand the issues faced by beneficiaries and hospitals.
The Union Minister of State for Health and Family Welfare, Shri Prataprao Jadhav stated this in a written reply in the Lok Sabha today.
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HFW/Update on AB PM-JAY/28March 2025/2
(Release ID :269460)