Ayushman Bharat (PM-JAY)

Ayushman Bharat, formally the Pradhan Mantri Jan Arogya Yojana (PM-JAY), was announced in the Union Budget of February 2018 and launched by Prime Minister Narendra Modi on 23 September 2018 at Ranchi, Jharkhand. The scheme operationalises recommendations of the National Health Policy 2017, which committed the state to achieving Universal Health Coverage (UHC) in line with Sustainable Development Goal 3.8. It is administered by the National Health Authority (NHA), an autonomous body under the Ministry of Health and Family Welfare constituted by a Cabinet resolution in 2019, which replaced the earlier National Health Agency. PM-JAY subsumed and expanded the Rashtriya Swasthya Bima Yojana (RSBY) of 2008 and the Senior Citizen Health Insurance Scheme, broadening per-family annual cover from RSBY's ₹30,000 to ₹5 lakh. It is a Centrally Sponsored Scheme with cost shared between the Union and states, ordinarily in a 60:40 ratio (90:10 for Himalayan and North-Eastern states, and full central funding for Union Territories without legislatures).

Ayushman Bharat rests on two complementary pillars. The first is the Health and Wellness Centres (HWCs), since rebranded Ayushman Arogya Mandirs, which upgrade existing sub-centres and primary health centres to deliver Comprehensive Primary Health Care, including non-communicable disease screening, maternal and child services, and free essential drugs and diagnostics. The second pillar is PM-JAY itself, the insurance-cum-assurance component covering secondary and tertiary hospitalisation. A beneficiary identified as eligible obtains an Ayushman card; on reaching an empanelled public or private hospital, an Arogya Mitra facilitator verifies identity against the beneficiary database. The hospital raises a pre-authorisation request against the relevant Health Benefit Package (HBP), the treatment is delivered cashless and paperless, and the hospital submits a claim to the State Health Agency or the insurer for adjudication and reimbursement at notified package rates. The cover of ₹5 lakh is on a family floater basis with no cap on family size, age, or gender, and pre-existing conditions are covered from day one.

States exercise considerable discretion in the delivery model. They may run PM-JAY through a trust or society (the assurance model), through an insurance company selected by tender (the insurance model), or through a hybrid combining both. Empanelment of hospitals follows NHA quality and infrastructure norms, and packages span more than 1,900 procedures across specialties including cardiology, oncology, neurosurgery, and orthopaedics, with periodic revision of rates under successive HBP versions. Portability is a defining feature: a beneficiary from one state may avail treatment in an empanelled hospital in another, a capability material for migrant workers. The scheme is delivered alongside several state-specific extensions and convergences, and is increasingly integrated with the Ayushman Bharat Digital Mission (ABDM) of 2021, which issues the unique ABHA (Ayushman Bharat Health Account) identifier to build interoperable digital health records.

Eligibility was originally determined not by application but by deprivation criteria drawn from the Socio-Economic and Caste Census (SECC) 2011, covering roughly 10.74 crore poor and vulnerable families—about 50 crore individuals—across specified rural deprivation categories (D1–D7) and defined urban occupational groups. The list has since expanded: in 2022 the target was revised upward to cover the bottom 40 percent of the population, and on 11 September 2024 the Union Cabinet approved Ayushman Vay Vandana, extending ₹5 lakh cover to all citizens aged 70 and above irrespective of income. Frontline workers under schemes such as the construction worker welfare boards and, from 2024, gig and platform workers registered on the e-Shram portal have been progressively included. State governments such as Rajasthan, Tamil Nadu, and Maharashtra operate enhanced parallel schemes that converge with PM-JAY at differing benefit ceilings.

PM-JAY must be distinguished from adjacent instruments. Unlike the Central Government Health Scheme (CGHS), which serves serving and retired central government employees and pensioners, PM-JAY targets the economically vulnerable identified by deprivation criteria. It differs from the Employees' State Insurance (ESI) scheme, a contributory social-security arrangement for organised-sector workers funded by employer and employee contributions, in being non-contributory and tax-financed at the point of use. It is also distinct from the HWC primary-care pillar with which it shares the Ayushman Bharat umbrella: PM-JAY funds hospitalisation, whereas HWCs deliver outpatient primary care. Critically, PM-JAY excludes outpatient department (OPD) expenses, which constitute the largest share of out-of-pocket health spending in India.

Controversies have accompanied the scheme's scale. The Comptroller and Auditor General's 2023 performance audit flagged ineligible beneficiaries, duplicate and implausible registrations against a single mobile number, and weaknesses in claims-fraud detection, prompting NHA to strengthen Aadhaar-based authentication and anti-fraud analytics. Several large states, notably Delhi (until 2025) and West Bengal, declined to implement PM-JAY, citing fiscal-sharing terms and overlap with their own programmes; West Bengal continues to run its Swasthya Sathi scheme outside the PM-JAY framework. Persistent concerns include private-hospital empanelment in underserved districts, the adequacy of package rates relative to actual costs, delayed reimbursements straining provider participation, and the OPD exclusion that leaves a substantial protection gap.

For the working practitioner—whether a UPSC aspirant addressing GS Paper II governance and welfare questions, a health-policy researcher, or a desk officer tracking social-sector outlays—Ayushman Bharat is the principal lens through which India's pursuit of Universal Health Coverage is assessed. It exemplifies the demand-side, purchaser–provider-split financing model contrasted with supply-side public-hospital strengthening, and it sits at the centre of debates on out-of-pocket expenditure, federal cost-sharing, and digital health infrastructure. Mastery of its legal genesis, two-pillar architecture, eligibility basis, and documented audit findings is indispensable for any informed analysis of Indian health governance.