Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY): A Comprehensive Guide to India’s Largest Health Insurance Scheme

The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY), often referred to as Modicare, is a flagship health insurance scheme launched by the Government of India to provide affordable and accessible healthcare to the economically disadvantaged sections of society. Aimed at achieving Universal Health Coverage (UHC), PMJAY is the world’s largest government-funded health assurance program, covering over 55 crore individuals across India. This article provides an in-depth look at the scheme, including its launch details, key features, vision, impact, FAQs, and a set of 10 multiple-choice questions (MCQs) with detailed solutions to enhance understanding.

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What is Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY)?

Launched on September 23, 2018, in Ranchi, Jharkhand, by Hon’ble Prime Minister Shri Narendra Modi, PMJAY is a critical component of the Ayushman Bharat initiative, introduced under the National Health Policy 2017. The scheme aims to provide cashless health insurance coverage of up to ₹5 lakh per family per year for secondary and tertiary care hospitalization to over 12 crore vulnerable families, constituting approximately the bottom 40% of India’s population.

PMJAY aligns with the Sustainable Development Goals (SDGs), particularly the commitment to “leave no one behind,” by ensuring financial protection against catastrophic health expenditures and reducing out-of-pocket expenditure (OOPE), which previously pushed millions into poverty annually.

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Key Features of PMJAY

PMJAY is designed to be comprehensive, inclusive, and accessible. Below are the key pointers of the scheme:

1. Massive Coverage:
   • Covers over 12 crore families (approximately 55 crore beneficiaries), targeting the bottom 40% of India’s population.
   • Provides ₹5 lakh per family per year for hospitalization expenses.
2. Cashless and Paperless:
   • Beneficiaries can avail of treatment at empanelled hospitals without upfront payments.
   • Services are paperless, with digital verification using the Ayushman Card.
3. Eligibility Criteria:
   • Based on the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas.
   • Rural criteria include families living in single-room houses with kutcha walls, landless households, and manual laborers.
   • Urban criteria cover occupations like domestic workers, ragpickers, and sanitation workers.
   • Expanded in 2024 to include all senior citizens aged 70 and above (approximately 6 crore individuals) and 37 lakh Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs), and Anganwadi Helpers (AWHs).
4. Comprehensive Health Benefits:
   • Covers 1,961 procedures, including medical examination, treatment, diagnostics, pre- and post-hospitalization expenses (up to 15 days), and critical illnesses like cancer and heart diseases.
   • Includes COVID-19 testing and treatment.
5. Empanelled Hospitals:
   • Over 30,000 public and private hospitals across India are empanelled.
   • All government hospitals with in-patient services are deemed empanelled.
   • Private hospitals are incentivized with revised Health Benefit Packages (HBPs) and faster claim settlements.
6. Portability:
   • Beneficiaries can avail of treatment at any empanelled hospital across India, regardless of their state of residence.
7. Health and Wellness Centres (HWCs):
   • Complements PMJAY by establishing 1.5 lakh HWCs to provide primary healthcare, disease prevention, and health promotion.
8. Partnership with ESIC:
   • Integrated with the Employees’ State Insurance Corporation (ESIC) to allow cross-access to empanelled hospitals, enhancing service availability.
9. Grievance Redressal:
   • A three-tier system at district, state, and national levels ensures resolution of beneficiary complaints.
   • A dedicated helpline (14413) supports hospitals and beneficiaries.
10. Technology-Driven:
    • Uses IT systems for beneficiary identification, hospital empanelment, and claim processing.
    • The Hospital Engagement Module (HEM 2.0) streamlines hospital onboarding.

PMJAY Key Features at a Glance

 

PMJAY Beneficiary Eligibility Criteria

 

Examples of Covered Medical Procedures under PMJAY

 

PMJAY Exclusions

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Vision of PMJAY

The vision of PMJAY is to create a healthy, productive, and prosperous India by ensuring Universal Health Coverage (UHC). Key objectives include:

• Financial Protection: Shielding vulnerable families from catastrophic health expenditures, reducing poverty caused by medical costs.
• Quality Healthcare Access: Providing free, high-quality secondary and tertiary care to underserved populations.
• Equity in Healthcare: Bridging the gap between rural and urban healthcare access and ensuring inclusivity.
• Health System Reform: Strengthening public and private healthcare infrastructure through standardized services and increased government health expenditure.
• Sustainable Development: Aligning with SDGs to improve health outcomes and reduce disease burden.

PMJAY aims to transform India’s healthcare system from a fragmented, out-of-pocket model to a comprehensive, demand-led, and need-based framework.

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Impact of PMJAY

Since its inception, PMJAY has made significant strides in transforming India’s healthcare landscape. Key impacts include:

1. Financial Savings:
   • Saved over ₹1.25 lakh crore in out-of-pocket expenditure for beneficiaries, as per the Economic Survey 2024-25.
   • Reduced OOPE from 62.6% in FY 2015 to 39.4% in FY 2022, increasing government health expenditure from 29% to 48%.
2. Increased Access:
   • Over 36.9 crore Ayushman Cards issued as of March 24, 2025.
   • Benefited more than 1 crore people, as stated by PM Modi in May 2020.
3. Improved Health Outcomes:
   • A 36% increase in early detection and treatment of cancer over six years, with a 90% improvement in timely treatment for beneficiaries compared to 30% for non-enrollees, according to The Lancet.
   • Reduced hospitalization needs through preventive care at HWCs.
4. Strengthened Infrastructure:
   • Increased revenue for government hospitals and improved facilities due to reimbursements.
   • Enhanced private hospital participation through revised HBPs and faster claim settlements.
5. Poverty Alleviation:
   • Prevented 50–60 million Indians from slipping into poverty annually due to medical expenses.
6. State Participation:
   • Initially, 20 states joined in February 2018, with expansions over time. States like Odisha and Delhi joined in 2025, while some, like West Bengal and Telangana, opted for regional schemes.

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How to Register for PMJAY?

To avail of PMJAY benefits, eligible families need an Ayushman Card. Here’s a step-by-step guide:

1. Visit the official PMJAY website: pmjay.gov.in.
2. Click on the “Am I Eligible” tab.
3. Enter your mobile number, verify with OTP, and fill in the captcha.
4. Select your state, district, and search criteria (e.g., name, ration card number).
5. If eligible, your name will appear in the results.
6. Click “Apply” to authenticate using your Aadhaar card via OTP.
7. Fill in required details to complete registration and download your Ayushman Card.

Note: No separate registration is needed for senior citizens aged 70+ or ASHA/AWW/AWH families, as they are automatically included.

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Diseases Covered Under PMJAY

PMJAY covers a wide range of treatments, including but not limited to:

• Critical Illnesses: Cancer, heart diseases, kidney and liver disorders.
• Surgeries: Bypass surgery, knee replacement, organ transplants.
• Diagnostics: Lab tests, imaging, and consultations.
• Pre- and Post-Hospitalization: Expenses up to 3 days before and 15 days after hospitalization.
• COVID-19: Testing and treatment.

Exclusions: Cosmetic surgeries, fertility treatments, and outpatient care (except at HWCs).

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Frequently Asked Questions (FAQs)

1. Who is eligible for PMJAY?

Families identified under SECC 2011 (rural: kutcha house residents, manual laborers; urban: ragpickers, domestic workers), senior citizens aged 70+, and ASHA/AWW/AWH families are eligible.

2. How can I check my eligibility?

Visit pmjay.gov.in, click “Am I Eligible,” and enter your mobile number or Aadhaar details to verify.

3. Is PMJAY free?

Yes, it provides cashless treatment at empanelled hospitals for eligible beneficiaries.

4. Can I use PMJAY in any state?

Yes, the scheme is portable, allowing treatment at any empanelled hospital across India.

5. What documents are needed?

Only a valid Ayushman Card or Aadhaar card is required at empanelled hospitals.

6. Are private hospitals included?

Yes, over 30,000 public and private hospitals are empanelled under PMJAY.

7. Does PMJAY cover COVID-19 treatment?

Yes, it includes free COVID-19 testing and treatment.

8. How do I lodge a complaint?

Use the grievance redressal portal or call the helpline 14413.

9. What is the role of HWCs in PMJAY?

HWCs provide primary care, preventive services, and health promotion to reduce hospitalization needs.

10. Can senior citizens above 70 enroll separately?

No separate enrollment is needed; all citizens aged 70+ are automatically covered.

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Top 10 MCQs on PMJAY with Detailed Solutions

Below are 10 multiple-choice questions to test your knowledge of PMJAY, along with detailed solutions.

1. When was PMJAY launched?

• A) March 2018
• B) September 2018
• C) February 2017
• D) April 2019 Answer: B) September 2018 Solution: PMJAY was launched on September 23, 2018, in Ranchi, Jharkhand, by PM Narendra Modi.

2. What is the annual health coverage provided by PMJAY per family?

• A) ₹2 lakh
• B) ₹3 lakh
• C) ₹5 lakh
• D) ₹7 lakh Answer: C) ₹5 lakh Solution: PMJAY provides ₹5 lakh per family per year for secondary and tertiary care hospitalization.

3. Which census data is used to determine PMJAY eligibility?

• A) Census 2001
• B) SECC 2011
• C) Census 2011
• D) SECC 2001 Answer: B) SECC 2011 Solution: Eligibility is based on the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban deprivation criteria.

4. Which group was included in PMJAY coverage in October 2024?

• A) Farmers
• B) Senior citizens aged 70+
• C) Government employees
• D) Students Answer: B) Senior citizens aged 70+ Solution: In October 2024, PMJAY was expanded to include all senior citizens aged 70 and above, covering approximately 6 crore individuals.

5. What is the primary goal of PMJAY?

• A) Free education
• B) Universal Health Coverage
• C) Employment generation
• D) Housing for all Answer: B) Universal Health Coverage Solution: PMJAY aims to achieve Universal Health Coverage (UHC) by providing financial protection and quality healthcare.

6. Which of the following is NOT covered under PMJAY?

• A) Cancer treatment
• B) Cosmetic surgery
• C) Heart surgery
• D) COVID-19 treatment Answer: B) Cosmetic surgery Solution: PMJAY covers critical illnesses and COVID-19 treatment but excludes cosmetic surgeries and outpatient care.

7. How many Ayushman Cards were issued by March 24, 2025?

• A) 20 crore
• B) 36.9 crore
• C) 50 crore
• D) 10 crore Answer: B) 36.9 crore Solution: As per the Economic Survey 2024-25, over 36.9 crore Ayushman Cards were created by March 24, 2025.

8. Which organization oversees PMJAY implementation?

• A) Ministry of Education
• B) National Health Authority (NHA)
• C) NITI Aayog
• D) Ministry of Finance Answer: B) National Health Authority (NHA) Solution: The National Health Authority (NHA) is responsible for implementing and monitoring PMJAY.

9. What is the role of Health and Wellness Centres (HWCs) in Ayushman Bharat?

• A) Provide tertiary care
• B) Offer primary care and prevention
• C) Issue Ayushman Cards
• D) Conduct surgeries Answer: B) Offer primary care and prevention Solution: HWCs focus on primary care, disease prevention, and health promotion to reduce hospitalization needs.

10. Which state joined PMJAY in April 2025?

- A) West Bengal
- B) Odisha
- C) Telangana
- D) Kerala
**Answer**: B) Odisha
**Solution**: **Odisha** joined PMJAY in **April 2025** after the BJP’s electoral win in 2024, though its state scheme (BSKJ) was initially deemed more beneficial.[](https://en.wikipedia.org/wiki/Ayushman_Bharat_Yojana)

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Conclusion

The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) is a transformative initiative that has revolutionized healthcare access in India. By providing ₹5 lakh annual coverage to over 55 crore beneficiaries, reducing out-of-pocket expenditure, and strengthening healthcare infrastructure, PMJAY is paving the way for Universal Health Coverage. Its expansion to include senior citizens and frontline health workers, coupled with technological advancements, ensures inclusivity and efficiency. For more details or to check eligibility, visit pmjay.gov.in or contact the helpline 14413.

Sources:

• National Health Authority: nha.gov.in
• Ministry of Health and Family Welfare: mohfw.gov.in
• ClearTax: cleartax.in
• Wikipedia: en.wikipedia.org
• PMC: pmc.ncbi.nlm.nih.gov