1/17/2019 About Pradhan Mantri Jan Arogya Yojana (PM-JAY) | Ayushmaan Bharat

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About Pradhan Mantri Jan Arogya Yojana (PM-JAY)

India has achieved signi cant public health gains and improvements in health care
access and quality over the last three decades. The health sector is amongst the
largest and fasting growing sectors, expected to reach US$ 280 billion by 2020.  At
the same time, India’s health sector faces immense challenges. It continues to be
characterized by high out-of-pocket expenditure, low nancial protection, low health
insurance coverage amongst both rural and urban population. It is a matter of grave
concern that we incur a high out-of-pocket expenditure on account of health and
medical costs. 62.58% of our population has to pay for their own health and
hospitalization expenses and are not covered through any form of health protection.
Besides using their income and savings, people borrow money or sell their assets to
meet their healthcare needs, thereby pushing 4.6% of the population below the
poverty line. The Government of India is committed to ensuring that its population
has universal access to good quality health care services without anyone having to
face nancial hardship as a consequence.

Under the ambit of Ayushman Bharat, a Pradhan Mantri Jan Arogya Yojana (PM-
JAY) to reduce the nancial burden on poor and vulnerable groups arising out of
catastrophic hospital episodes and ensure their access to quality health services
was conceived. PM-JAY seeks to accelerate India’s progress towards achievement
of Universal Health Coverage (UHC) and Sustainable Development Goal - 3 (SDG3).

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Pradhan Mantri Jan Arogya Yojana (PM-JAY) will provide nancial protection
(Swasthya Suraksha) to 10.74 crore poor, deprived rural families and identi ed
occupational categories of urban workers’ families as per the latest Socio-Economic
Caste Census (SECC) data (approx. 50 crore bene ciaries). It will have offer a
bene t cover of Rs. 500,000 per family per year (on a family oater basis). 

PM-JAY will cover medical and hospitalization expenses for almost all secondary
care and most of tertiary care procedures. PM-JAY has de ned 1,350 medical
packages covering surgery, medical and day care treatments including medicines,
diagnostics and transport.

To ensure that nobody is left out (especially girl child, women, children and elderly),
there will be no cap on family size and age in the Mission. The scheme will be
cashless & paperless at public hospitals and empanelled private hospitals. The
bene ciaries will not be required to pay any charges for the hospitalization
expenses. The bene t also includes pre and post-hospitalization expenses. The
scheme is an entitlement based, the bene ciary is decided on the basis of family
being gured in SECC database. When fully implemented, the PM-JAY will become
the world’s largest government funded health protection mission.

Bene ts of PM-JAY
Bene ciary Level
Government provides health insurance cover of up to Rs. 5,00,000 per family per year.
More than 10.74 crore poor and vulnerable families (approximately 50 crore
bene ciaries) covered across the country.
All families listed in the SECC database as per de ned criteria will be covered. No cap
on family size and age of members.
Priority to girl child, women and and senior citizens.
Free treatment available at all public and empaneled private hospitals in times of need.
Covers secondary and tertiary care hospitalization.
1,350 medical packages covering surgery, medical and day care treatments, cost of
medicines and diagnostics.
All pre-existing diseases covered. Hospitals cannot deny treatment.
Cashless and paperless access to quality health care services.
Hospitals will not be allowed to charge any additional money from bene ciaries for the
treatment.
Eligible benei ciares can avail services across India, offering bene t of national
portability. Can reach out for information, assistance, complaints and grievances to a
24X7 helpline number - 14555

Health System

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1/17/2019 About Pradhan Mantri Jan Arogya Yojana (PM-JAY) | Ayushmaan Bharat

Help India progressively achieve Universal Health Coverage (UHC) and Sustainable
Development Goals (SDG).
Ensure improved access and affordability, of quality secondary and tertiary care
services through a combination of public hospitals and well measured strategic
purchasing of services in health care de cit areas, from private care providers,
especially the not-for pro t providers. 
Signi cantly reduce out of pocket expenditure for hospitalization. Mitigate nancial risk
arising out of catastrophic health episodes and consequent impoverishment for poor
and vulnerable families.
Acting as a steward, align the growth of private sector with public health goals.
Enhanced used to of evidence based health care and cost control for improved health
outcomes.
Strengthen public health care systems through infusion of insurance revenues.
Enable creation of new health infrastructure in rural, remote and under-served areas.
Increase health expenditure by Government as a percentage of GDP.
Enhanced patient satisfaction.
Improved health outcomes.
Improvement in population-level productivity and e ciency
Improved quality of life for the population

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