Ayushman Card

Key Information’s About The Hospital

  • Coverage and Scale: AB-PMJAY provides ₹5 lakh per family per year, covering approximately 50 crore beneficiaries from the bottom 40% of the population, with over 9.19 crore hospitalizations authorized since the scheme’s launch.
  • Latest Eligibility Expansion (2024-2025): The scheme was expanded to cover all senior citizens aged 70 years and above regardless of their socio-economic status, resulting in the issuance of over 93 lakh Ayushman Vay Vandana Cards as of December 2025. Eligibility was also extended to ASHAs, AWWs, and AWHs and their families.
  • Exclusions and New Implementations (2025): The scheme is now implemented in 35 States/UTs. Delhi and Odisha have recently joined the scheme in 2025, leaving only a few states (like West Bengal) running their own separate major schemes.
  • Financial Basis and Services: The scheme is cashless and paperless, covering over 1,900 treatment procedures and pre-existing diseases from day one. Total treatment cost incurred stands at approximately ₹1.29 lakh crore as of late 2025, demonstrating success in reducing Out-of-Pocket Expenditure (OOPE).
  • Funding Ratio: The cost of implementation is shared between the Centre and States, primarily in a 60:40 ratio, which shifts to 90:10 for Northeastern and Himalayan States (e.g., Himachal Pradesh, Uttarakhand).
  • Digital Infrastructure: PM-JAY relies on mandatory Aadhaar e-KYC for beneficiary identification and leverages the Ayushman Bharat Health Account (ABHA), with over 79.9 crore ABHA numbers created as of late 2025.
  • Portability: Beneficiaries can avail treatment anywhere in the country; states like Uttar Pradesh, Madhya Pradesh, and Bihar are the top source states for “out-migration” for treatment.
  • Provider Network: The scheme utilizes a network of over 31,000 empanelled hospitals, with private facilities handling the majority of total treatment costs (66%).

Overview of the Hospital

Ayushman Bharat Yojana is a health insurance scheme launched by the Government of India in 2018. The main aim of this scheme is to provide free medical treatment to families who cannot afford healthcare due to poverty. It offers significant support to common people, as they no longer have to worry about hospital expenses.

The primary purpose of this scheme is universal health coverage, meaning that healthcare services reach every poor and vulnerable family in the country. Earlier, only a few people could afford expensive medical facilities, but Ayushman Bharat Yojana has removed this barrier.

The government’s vision was to create a scheme that does not push any family into a financial crisis during illness. With this idea, the scheme was launched in 2018. It is also known as PMJAY (Pradhan Mantri Jan Arogya Yojana) and is considered the largest government-funded health insurance scheme in the world.

  • Under the scheme, more than 270 million Ayushman Cards have been generated.
  • Over 50 million hospital admissions have taken place for free treatment.
  • Across India, more than 28,000 hospitals have been empanelled, including both private and government hospitals.

(Source: National Health Authority – Ayushman Bharat Dashboard)

Contents

Ayushman Bharat Yojana Objectives

The primary objective of Ayushman Bharat Yojana is to ensure that poor families can access healthcare without any barriers. Health surveys in India show that every year, over 60 million people face financial difficulties due to medical expenses caused by poverty. This scheme was designed to provide a financial safety net to such families so that no family is pushed deeper into poverty just because of hospital costs.

The second major objective of this scheme is to make healthcare services available in remote areas. Around 65% of India’s population lives in rural regions, many of whom do not have access to quality healthcare. Through Ayushman Bharat, a network of primary health centres and empanelled hospitals has been created, making healthcare accessible even in villages and far-flung areas.

The third important objective is to provide comprehensive healthcare coverage, not limited to emergencies or surgeries. The scheme is designed so that patients receive primary care (like routine check-ups), secondary care (specialist treatment), and tertiary care (complex surgeries) — all under a single health cover. This ensures that healthcare becomes a complete package, rather than just partial support.

  • According to the National Health Policy 2017, India’s goal was to achieve Universal Health Coverage (UHC). Ayushman Bharat implements the core objectives of this policy.
  • The World Health Organization (WHO) has also described PMJAY as “one of the world’s most ambitious healthcare programs”, with the primary aim of reducing poverty and health inequalities.

(Sources: WHO – Universal Health Coverage in India, National Health Policy 2017 – MoHFW)

Ayushman Bharat Yojana Features

The biggest feature of Ayushman Bharat Yojana is that each family gets annual health coverage of up to ₹5 lakh. This means a family can receive treatment worth this amount in a year, whether it’s a minor surgery or a major medical emergency. Every family member is included in this coverage, so there is no need to buy separate policies.

Another feature that makes this scheme unique is the cashless and paperless treatment system. This means the patient does not have to worry about paying bills at the hospital counter. The hospital directly claims the insurance, and the beneficiary receives treatment without paying any money. This process is facilitated through the Ayushman Card, which acts as proof for availing benefits.

A third important feature is nationwide portability. If a beneficiary travels from their village to another city or state, they can still use the Ayushman Card at any empanelled hospital. This portability is especially useful for people who relocate frequently for work or livelihood.

The scale of the scheme itself is also a significant feature. Under this scheme, the Government of India has covered over 10 crore families, including both rural and urban poor households. In fact, this makes Ayushman Bharat one of the largest health insurance schemes in the world, targeting such a massive population base.

  • Under Ayushman Bharat, more than 28 crore Ayushman Cards have been issued so far.
  • The scheme’s network has expanded to over 28,000 empanelled hospitals.
  • Every day, approximately 60,000 or more patients receive free treatment through Ayushman Bharat.

(Source: Press Information Bureau – Government of India)

Ayushman Bharat Yojana Eligibility Criteria

The primary eligibility criterion for Ayushman Bharat Yojana is that the scheme is designed for rural and urban poor households. This means families living below or near the poverty line can avail free medical treatment through this scheme. Landless laborers in villages and daily wage workers in cities form the largest portion of beneficiaries.

To determine eligibility, the scheme uses the SECC (Socio-Economic Caste Census) 2011 database. This database contains a list of families classified as backward or vulnerable based on their financial and social conditions. If a family’s name appears in the SECC list, they are eligible for Ayushman Bharat.

So, who can get an Ayushman Card? If your family is included in the SECC list, or if your name is verified in the state health agency’s list, you can apply for an Ayushman Card. With this card, you can avail cashless treatment at both government and private empanelled hospitals.

  • In rural areas, approximately 8.03 crore households, and in urban areas, about 2.33 crore households are considered eligible for Ayushman Bharat.
  • This means that a total of 10.74 crore families are included in the beneficiary list.

(Source: NITI Aayog – Health Insurance for India’s Poor Report, 2021)

Diseases & Treatments Covered under Ayushman Bharat Yojana

One of the biggest benefits of the Ayushman Bharat – PMJAY scheme is that it provides complete coverage for serious and high-cost illnesses. Under the scheme, over 1,500 treatment packages have been designed, including major medical procedures such as cardiac surgeries, cancer treatment, kidney and liver transplants, orthopedic surgeries, neurosurgeries, burn management, and neonatal care.

The scheme not only covers hospitalization but also pre-hospitalization costs (up to 3 days) and post-hospitalization costs (up to 15 days). This means that expenses for tests, medicines, room charges, ICU costs, implants, and follow-up treatment are all taken care of by Ayushman Bharat.

However, the scheme also has some exclusions to prevent misuse. These include OPD treatment, cosmetic surgeries (such as plastic surgery and hair transplant), fertility treatment, donor costs for organ transplants, and drug rehabilitation therapy.

In this way, the disease coverage under Ayushman Bharat is designed so that poor families do not need to spend their savings or take loans for high-end surgeries or chronic disease treatment.

Source: NHA PMJAY Treatment Packages Guidelines (National Health Authority)

Empanelled Hospitals under Ayushman Bharat

One of the strongest pillars of Ayushman Bharat Yojana is its network of empanelled hospitals. Under this scheme, both government and private hospitals across the country are included. This means that beneficiaries are not limited to government hospitals—they can also receive free treatment at private hospitals, as long as the hospital is empanelled under PMJAY.

The process of empanelling a hospital is formal and is managed jointly by the National Health Authority (NHA) and State Health Agencies. Each hospital is verified based on its infrastructure, availability of doctors, ICU facilities, operation theatres, and specialty departments. Only hospitals that meet these standards are included in Ayushman Bharat. The purpose of this process is to ensure that patients receive quality treatment and to prevent misuse of the scheme.

If you want to check for Ayushman Bharat hospitals in your area, the process is quite simple. The official PMJAY portal provides a “Hospital Empanelment Search” option, where you can select your state, district, or specialty to view the list of hospitals. Additionally, you can confirm hospital details by calling the Ayushman Bharat helpline or visiting a nearby Common Service Centre (CSC).

  • So far, over 28,300 hospitals have been empanelled in India under Ayushman Bharat.
  • Around 46% of these are private hospitals, giving poor people access to high-quality treatment facilities in the private sector.
  • On average, 15–20 lakh admissions take place every month in Ayushman empanelled hospitals.

(Source: National Health Authority – Hospital Empanelment Module (HEM))

How to Apply for Ayushman Card

The process of getting an Ayushman Card is very simple. You can either apply online from home or get it through your nearest CSC centre or an empanelled hospital—both options are available. The government has made the entire system digital and transparent so that even the poorest beneficiaries can easily obtain their card.

1. Online Registration Process (PMJAY Portal)

First, you need to visit the official Ayushman Bharat PMJAY website: https://mera.pmjay.gov.in. Here, by entering your mobile number, ration card, or Aadhaar details, you can check whether your family is eligible for the scheme. If your eligibility is confirmed, you can generate your e-card.

2. Ayushman Card Download Step-by-Step

  • Log in to the website or the PMJAY app.
  • Open your profile by entering your Beneficiary ID (BIS ID) or Aadhaar number.
  • Click on the “Download Ayushman Card” option to save the e-card in PDF format.
  • You can show this e-card at the hospital to avail cashless treatment.

The entire process is paperless and instant. Verification is completed using just your Aadhaar and registered mobile number.

3. Applying through CSC Centres and Hospitals

If someone faces difficulty applying online, they can also get their card through the nearest CSC (Common Service Centre) or an empanelled Ayushman hospital. There, an Ayushman Mitra verifies the beneficiary’s details and issues the card instantly.

Supporting Data: According to a report by the National Health Authority, more than 27 crore Ayushman Cards have been generated so far, of which approximately 40% were issued through CSC centres.

(Source: National Health Authority – Beneficiary Identification System (BIS))

Documents Required for Ayushman Bharat Yojana

To avail the benefits of Ayushman Bharat Yojana, some basic documents are required. These documents help verify the beneficiary’s identity and eligibility. If you want to get an Ayushman Card for yourself or your family, keeping these documents ready is the first step.

The most important document is the Aadhaar Card. Aadhaar serves as your unique identity proof, allowing the government to verify your biometric and demographic data. Linking your Ayushman Card to Aadhaar is mandatory to prevent duplicate or fraudulent entries.

The second essential proof is a Ration Card or Voter ID. These documents primarily act as residential proof and show family structure. The Ration Card helps the government know how many members are in a family and their income category. The Voter ID is also used for address and identity verification.

Additionally, to confirm your eligibility, proof from the SECC (Socio-Economic Caste Census) database is required. This database contains a list of poor households, which is used to select PMJAY beneficiaries. If your name is in the SECC list, you can directly receive the benefits of the scheme.

Official Reference: According to the National Health Authority guidelines, the Aadhaar Card is compulsory as identity proof, while the Ration Card and SECC list are used for eligibility verification.

(Source: National Health Authority – PMJAY Guidelines PDF)

To get an Ayushman Bharat Card, you need to keep your Aadhaar, Ration Card/Voter ID, and SECC proof ready. If these documents are correct, there will be no issues in generating the card or using it at hospitals.

Implementation & Funding

The implementation of Ayushman Bharat Yojana is a shared responsibility between the central and state governments. The scheme is designed and monitored by the National Health Authority (NHA) at the central level. Each state forms its own State Health Agency (SHA), which coordinates with hospitals and handles local implementation.

The funding mechanism of the scheme is also shared between the centre and the states. As a general rule, 60% of the expenses are borne by the Central Government and 40% by the State Government. However, for North-Eastern states and hilly regions like Jammu & Kashmir, Himachal Pradesh, and Uttarakhand, the funding ratio is 90:10. This ensures that even poorer states can provide the full benefits of the scheme to their citizens.

Another key role in implementation is played by Ayushman Mitras. These are trained professionals who assist beneficiaries at hospitals. Their responsibilities include explaining the scheme benefits to patients, verifying their documents, and making the entire admission-to-discharge process smooth. This ensures that patients do not face difficulties with paperwork or technical procedures.

  • The government has trained and deployed over 1.2 lakh Ayushman Mitras in hospitals so far.
  • In the FY 2023-24 budget, the Central Government allocated ₹7,200 crore for Ayushman Bharat.
  • Through State Health Agencies, over 28,000 hospitals have been successfully empanelled.

(Source: NITI Aayog – Health Financing & PM-JAY Report)

The implementation of Ayushman Bharat Yojana is a team effort, where central policies, state-level management, and hospital-level support (Ayushman Mitras) work together to deliver the scheme to beneficiaries.

Impact & Statistics of Ayushman Bharat Yojana

The biggest impact of Ayushman Bharat Yojana is that it has provided free health coverage to crores of families. According to government data, over 30 crore beneficiaries have been verified under the scheme so far. This number shows that the scheme’s reach is not limited to paperwork but is effectively reaching people on the ground.

The availability of hospitals is another significant impact of the scheme. Currently, over 29,000 government and private hospitals are part of the Ayushman Bharat network. This makes it easier for patients to find empanelled hospitals near their city or village. The inclusion of private hospitals is particularly important as it provides beneficiaries with better infrastructure and medical facilities.

The scale of treatment also highlights the scheme’s success. According to official figures, over 6 crore hospital admissions have been successfully carried out under the scheme. These include major procedures such as cardiac surgeries, kidney transplants, cancer treatments, and orthopedic surgeries. This demonstrates that the scheme is not limited to basic care but also supports patients in critical care situations.

  • Over 30 crore beneficiaries have been verified under PMJAY
  • More than 29,000 empanelled hospitals across India
  • Over 6 crore hospital admissions recorded
  • Since the launch of the scheme, hospital expenditures exceeding ₹75,000 crore have been covered

(Source: NITI Aayog – Ayushman Bharat Annual Report 2023-24)

Ayushman Bharat Yojana has worked not just as a policy but as a real change. It has improved accessibility in the health sector, connected both private and public healthcare, and most importantly, provided financial security to poor families.

Challenges & Criticism of Ayushman Bharat Yojana

Ayushman Bharat Yojana has ushered in a new era of making healthcare accessible to poor families, but it also faces some challenges. Understanding these challenges is important because addressing them can make the scheme even more effective.

The first challenge is the lack of healthcare infrastructure. In rural areas of India, hospitals, doctors, and advanced medical equipment are still limited. As a result, while beneficiaries are entitled to free treatment, they often struggle to access proper facilities. In some places, hospitals are empanelled, but they may lack specialist doctors or operation facilities.

The second major issue is lack of awareness. Many people who are eligible for the scheme still do not know whether their names are on the list. A survey by the National Health Authority found that a significant portion of beneficiaries have no knowledge about the Ayushman Card application process or hospital admission rules. Because of this, the scheme’s full benefits do not always reach the ground level.

The third concern is the participation of private hospitals. Many large private hospitals are not actively participating in the scheme because they feel the reimbursement rates offered by the government are lower than their actual treatment costs. This restricts beneficiaries’ access to quality private hospitals, especially in big cities.

  • According to the 2023 NITI Aayog report, under the scheme, only 55% of potential beneficiaries have actively used the services, while the rest are either unaware or face difficulties in accessing hospitals.
  • A study published in Lancet Public Health (2022) reported that in rural India, there are only 6 government hospital beds per 10,000 population, which is far below the demand.

(Sources: NITI Aayog – Annual Health Review, The Lancet Public Health Journal)

For the success of Ayushman Bharat Yojana, it is not enough to just create the policy; it is equally important to implement it effectively at the ground level and raise awareness among people.

Future of Ayushman Bharat

The future of Ayushman Bharat is based on a major expansion plan. The government aims to extend the scheme’s coverage to even more families, ensuring that no poor family is left without health insurance. In the coming years, the focus will be on increasing both the depth (covering more treatments) and the breadth (covering more families) of the scheme. To achieve this, new medical procedures and advanced treatments are being added to the package list.

Another important future direction of the scheme is digital health integration. The ABHA Card (Ayushman Bharat Health Account) has been introduced, providing a unique digital health ID. Through this card, a patient’s complete medical history, reports, and prescriptions are securely stored on a single digital platform. This allows healthcare providers to access patient records instantly and ensures transparency in treatment.

Future reforms under Ayushman Bharat will also give a new direction to India’s healthcare system. The focus will not remain limited to hospital treatment; it will also include preventive healthcare, telemedicine, and wellness centres. The government’s goal is to create a holistic healthcare model through Ayushman Bharat, which alerts patients before the onset of illness and integrates the treatment process with modern technology.

  • The government launched the National Digital Health Mission (NDHM) in 2022, which is being integrated with Ayushman Bharat through the ABHA card.
  • According to NITI Aayog reports, India’s target is to achieve Universal Health Coverage for 100% of the population by 2030.
  • The goal for the Digital Health ID is to issue 1 billion ABHA numbers.

(Sources: NITI Aayog – Health Systems for a New India, National Digital Health Mission – MoHFW)

The future of Ayushman Bharat is proof that India is preparing to create a healthcare system for its citizens that is not only for today but also sustainable and digitally empowered.

Types of Ayushman Bharat Yojana / Schemes Under PMJAY

Ayushman Bharat Yojana consists of two main components that make India’s healthcare system more comprehensive. The first component is the Health & Wellness Centres (HWCs), and the second is the Hospitalization Scheme. Additionally, several states have introduced their own state-specific variants, designed to address local healthcare needs.

1. Health & Wellness Centres (Primary Care)

Health & Wellness Centres (HWCs) provide primary healthcare services in India. These centres are established in both rural and urban areas to ensure easy access to routine check-ups, preventive care, vaccinations, and maternal & child health services. The main objective of HWCs is to reduce the burden on hospitals by diagnosing and treating minor health issues at the community level itself, preventing them from escalating to emergency situations.

2. Hospitalization Scheme (Secondary & Tertiary Care)

The Hospitalization Scheme is the component of PMJAY that covers serious illnesses and surgeries. It includes secondary care (such as specialist consultations and minor surgeries) as well as tertiary care (including major surgeries, ICU treatment, cancer care, and cardiac procedures). Beneficiaries receive cashless and paperless treatment under this scheme, which is implemented through empanelled hospitals across all states.

3. State-specific Variants of PMJAY

Some states have customized the base framework of PMJAY according to their local requirements. For example:

These state-specific variants provide additional benefits along with the basic PMJAY coverage, such as higher coverage limits, maternity benefits, or specialized regional treatments.

  • In India, over 1.5 lakh Health & Wellness Centres are operational.
  • Under PMJAY, more than 28,000 empanelled hospitals are serving beneficiaries across the country.
  • State-specific variants are still integrated under the PMJAY umbrella, ensuring nationwide portability.

(Source: National Health Authority – PMJAY)

Ayushman Bharat Yojana is not just a hospital insurance scheme; it covers the entire healthcare ecosystem — from primary care to tertiary care, including state-specific requirements.

Ayushman Card Verification Process

Verifying the Ayushman Card is very important for hospitals to ensure that the patient is an eligible beneficiary and can receive cashless treatment. The verification process is fully digital, which helps prevent false claims and fraud. Hospitals have a secure online system where card details can be entered to check the beneficiary’s status.

One simple method is QR code scanning. Every Ayushman Card carries a unique QR code that can be scanned using a hospital scanner or mobile app for instant verification. This displays the cardholder’s basic details and eligibility status on the screen, allowing the hospital to provide treatment immediately.

Another method is online database verification. Hospitals can use the PMJAY portal by entering the card number or family ID to validate the beneficiary. This ensures that the records match in the database and the patient is eligible under the scheme. The process is real-time and paperless, making the hospital staff’s work easier and reducing waiting time for patients.

  • On the Ayushman Bharat digital platform, both QR code verification and online authentication are enabled, as per the guidelines of the National Health Authority (NHA).
  • According to the NHA dashboard, more than 50 lakh verification requests are successfully processed every month across India.

(Source: National Health Authority – PMJAY Digital Operations)

Through this verification system, the authenticity and eligibility of the Ayushman Card are checked quickly and securely, making the process transparent and trustworthy for both hospitals and patients.

Role of Health & Wellness Centres (HWCs) in Ayushman Bharat

Under Ayushman Bharat, Health & Wellness Centres (HWCs) serve as a key pillar. Their main purpose is to provide preventive and promotive healthcare. This means not only treating illnesses but also raising awareness and delivering basic health services to help people avoid diseases. At HWCs, trained staff guide communities on lifestyle, nutrition, and health education to improve overall well-being.

HWCs offer routine check-ups, health screenings, and vaccinations. Immunization programs are available for both children and adults. In addition, screenings for diabetes, hypertension, and other common diseases are conducted, enabling early detection and timely treatment. This approach reduces unnecessary hospital emergency visits and lessens the burden on the healthcare system.

Another important feature is their integration with PMJAY. If a patient is found to be in a serious condition, they can be directly referred from an HWC to a PMJAY-empanelled hospital. This integration ensures seamless care for patients and allows them to fully benefit from government coverage. It also builds a strong connection between rural and urban health facilities.

  • In India, more than 1,75,000 Health & Wellness Centres have become operational, as part of the National Health Mission target initiated in 2022.
  • Through HWCs, primary healthcare services have reached nearly 70% of the rural population.
  • According to National Health Mission data, there has been a 25–30% improvement in preventive services such as vaccinations and health screenings.

(Source: National Health Mission – Ministry of Health and Family Welfare)

The role of HWCs shows that Ayushman Bharat is not just a treatment-based scheme, but a holistic healthcare system that integrates preventive, promotive, and curative care together.

State-wise Implementation Differences of Ayushman Bharat Yojana

The core framework of Ayushman Bharat Yojana remains the same, but its implementation varies across different states. Each state has the authority to customize the scheme according to its local healthcare infrastructure and population needs. Because of this, treatment processes, empanelled hospitals, and claim settlement procedures can differ from one state to another.

In states like Kerala and Tamil Nadu, private hospitals have significant participation, providing beneficiaries in both urban and rural areas with more options. On the other hand, in states like Bihar and Madhya Pradesh, government hospitals still dominate the network, with a stronger focus on rural coverage.

There are also differences in state-specific hospitals and coverage. For example, in Maharashtra, more specialized empanelled hospitals are available for cardiac and cancer surgeries under PMJAY, whereas in the North-Eastern states, infrastructure is still developing. This flexibility helps states ensure that the healthcare needs of every region are efficiently covered.

Some states have also launched state-specific top-up schemes to enhance PMJAY coverage. For instance, Gujarat integrated the “Mukhyamantri Amrutam Yojana” with PMJAY, providing the local population with additional benefits such as maternity and pediatric care. This state-specific adaptation makes the scheme more relevant and effective.

  • As per the NITI Aayog Health Index, states like Kerala and Tamil Nadu have achieved higher hospital empanelment and claim settlement rates under PMJAY, while Uttar Pradesh and Bihar are still in the scale-up stage.
  • Nationwide, more than 28,000 hospitals are empanelled under the scheme, but their distribution across states remains uneven.

(Source: NITI Aayog – Health Index 2022-23)

Ayushman Bharat is a centralized scheme, but with state-level adaptations, the local health needs and infrastructure of each state are taken into account, making the scheme more impactful and practical.

Ayushman Bharat Helpline & Support

Ayushman Bharat has a dedicated customer support system available for beneficiaries. If anyone faces issues related to scheme benefits, hospital admission, or card verification, they can get immediate assistance through the PMJAY helpline. This helpline is available 24×7 and provides support in local languages across states, making it easier for both rural and urban citizens to explain their problems.

Another important aspect is complaint redressal and grievance management. If a beneficiary faces difficulties during treatment in a hospital, such as billing issues, claim rejection, or service-related problems, they can register a complaint through the Ayushman Bharat grievance portal or helpline. These complaints are systematically tracked and resolved, which helps in building user trust and ensuring transparency.

Additionally, the Ayushman Bharat helpline and support system also include a feedback mechanism. This allows patients to share their opinions about treatment and service quality. The government uses this feedback to improve the scheme further, ensuring overall quality assurance.

  • PMJAY Helpline: 14555
  • Through the grievance portal, more than 1 lakh complaints have already been successfully resolved.
  • The scheme’s feedback system continuously monitors improvements in hospital and service quality.

(Source: National Health Authority – PMJAY Helpline & Grievance)

The support and grievance system ensures that beneficiaries never feel alone and that every problem gets an immediate solution. In this way, the scheme not only provides free treatment but also builds a transparent and reliable healthcare support system.

Comparison with Other Health Schemes

Ayushman Bharat Yojana (PMJAY) vs RSBY

RSBY (Rashtriya Swasthya Bima Yojana) was launched in 2008 and provided health insurance to poor families. However, RSBY offered coverage of only ₹30,000 per family per year and was mostly limited to hospitalization. PMJAY has increased this limit to ₹5 lakh per family per year and also covers primary, secondary, and tertiary care. This means that PMJAY surpasses RSBY in both scale and benefits.

Comparison with State Health Schemes

Several states run their own schemes, such as Tamil Nadu’s Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) or Maharashtra’s Mahatma Jyotiba Phule Jan Arogya Yojana. These schemes operate at the state level with limited resources and hospitals. The advantage of PMJAY is that it provides nationwide portability and a larger network with central funding, enabling wider coverage in both rural and urban areas.

Comparison with Private Health Insurance

Private health insurance requires payment of a premium, and coverage depends on the terms of each policy. It can be difficult for low-income families to afford. Under PMJAY, treatment is completely free, and the claims process is also simplified. Additionally, the PMJAY empanelled hospital network extends to over 28,000 hospitals, which is significantly larger than the smaller networks of private insurance.

Coverage, Benefits, and Reach in Numbers:

  • PMJAY: ₹5 lakh per family, 10 crore+ families, 28,000+ hospitals (central + state funding)
  • RSBY: ₹30,000 per family, 3 crore+ families, ~10,000 hospitals
  • State Schemes: Varies per state, mostly 50,000–2 lakh per family, limited hospital network
  • Private Insurance: Premium-based, affordability issue for low-income families

(Source: World Bank Report – India Health Insurance Schemes 2022, MoHFW – Ayushman Bharat)

The main advantage of PMJAY is that it surpasses all other schemes in scale, coverage, and ease of access, providing a strong healthcare safety net for low-income and rural families.

Awareness Campaigns & Outreach Programs

Ayushman Bharat Yojana has an important component of awareness campaigns, because the scheme can only succeed when people receive the correct information about it. The government has used TV ads, radio jingles, newspapers, and digital platforms for this purpose. In villages and towns, wall paintings and posters have also been used to convey the message that Ayushman Card can provide them with free treatment.

To take awareness to the ground level, Ayushman Mitras have been deployed to assist beneficiaries in hospitals. They explain to patients how to use the card and what the treatment process involves. This support is particularly helpful for those who are uneducated or find the system confusing.

NGOs and civil society groups have also made significant contributions to this mission. Many NGOs have organized camps in villages to inform people about Ayushman Bharat. At these camps, free registration, card issuance, and eligibility checks become easy. In this way, NGOs have helped the scheme reach remote areas.

At the local level, ASHA workers and health volunteers also play a key role in outreach. They visit homes to inform families about their eligibility for the scheme, help them apply for the Ayushman Card, and guide them to empanelled hospitals.

  • In 2023, the Ministry of Health reported that over 8 million awareness camps and outreach events were organized.
  • According to an evaluation by NITI Aayog, after these outreach programs, PMJAY awareness in rural households increased from 40% to 70%.

(Source: NITI Aayog – Evaluation Study of Ayushman Bharat PM-JAY)

These awareness and outreach programs show that Ayushman Bharat is not just a policy document, but a movement actively reaching people through proactive engagement.

Digital Integration & ABHA Health ID

Ayushman Bharat Yojana now includes digital integration, making the scheme and its processes easier for beneficiaries. For this, the ABHA (Ayushman Bharat Health Account) Health ID has been introduced. It is a unique digital ID that securely stores each beneficiary’s health records.

Linking PMJAY and ABHA means that all treatment records are digitally available at hospitals. If you visit any empanelled hospital, your previous test reports, prescriptions, and treatment history can be easily accessed by doctors. This helps avoid repetitive tests and paperwork.

The benefit of digital health records through the ABHA Health ID is that patients can view their complete medical history online and share it with other hospitals if needed. This system supports cashless and hassle-free treatment while also enabling better diagnosis and enhancing patient safety.

  • By 2024, ABHA Health IDs have been generated for over 10 crore beneficiaries.
  • Under the National Digital Health Mission, 95% of hospitals with health records are now connected through digital integration.

(Source: National Digital Health Mission – Ministry of Health and Family Welfare)

Digital integration has transformed Ayushman Bharat into a modern, tech-enabled healthcare system, which not only makes treatment accessible and transparent but also ensures a smooth and safe health journey for patients.

Ayushman Card Guide: Step-by-step Tips for First-time Users

If you are using the Ayushman Card for the first time, the first thing is to have a basic understanding of the scheme and your benefits. Keep your card ready and verify that you are an eligible beneficiary. This first step helps you avoid unnecessary confusion.

The second tip is to choose the right hospital to avail the benefits. Cashless treatment with the Ayushman Card is available only at empanelled hospitals. You can check the hospital empanelment list on the PMJAY official portal or mobile app. During your first visit, ensure that the hospital staff is trained in the Ayushman Card process.

The third tip is to follow the step-by-step process. At the hospital entry, show your Ayushman Card and government ID, confirm your personal and family details at the admission desk, and carefully follow the instructions of the hospital staff. This simple step helps you avoid errors in paperwork.

The fourth tip is to make a checklist for the hospital visit:

  • Ayushman Card (printed or digital copy)
  • Aadhaar card / Ration card / SECC proof
  • Previous medical reports (if available)
  • Any required consent forms or referral letters

Following this checklist ensures a smooth admission process and prevents delays in treatment.

The final tip is to avoid confusion and fraud. Never share your card details through any third party and always process claims only at the hospital’s authorized counter. This simple precaution protects you from unnecessary stress and financial loss.

According to the guidelines of the National Health Authority, first-time Ayushman Card beneficiaries have access to orientation sessions and Ayushman Mitra support at every empanelled hospital.

(Source: National Health Authority – PMJAY Operational Guidelines)

Ayushman Bharat Yojana FAQs

How does the PM-JAY’s standard ₹5 Lakh limit change in states that run a converged scheme, such as Maharashtra and Tamil Nadu?

While PM-JAY provides a standard ₹5 Lakh cover nationwide, states that have merged it with their own schemes often offer expanded benefits:

  • Maharashtra (Mahatma Jyotirao Phule Jan Arogya Yojana – MJPJAY): Following convergence with MJPJAY, the total financial cover for state residents can exceed ₹5 Lakh. This merger aims for Universal Health Coverage, extending the beneficiary base beyond the PM-JAY SECC list.
  • Tamil Nadu (Chief Minister’s Comprehensive Health Insurance Scheme – CMCHIS): Tamil Nadu maintains the ₹5 Lakh PM-JAY cover while utilizing the CMCHIS framework to provide additional packages and top-up coverage for state-specific diseases or procedures.

Are the package rates for health services under PM-JAY uniform across the country, or do they vary by state?

The Health Benefit Packages and their rates under PM-JAY do vary between states.

  • National Standard: The NHA sets a national standard pricing framework for the 1,949 covered procedures.
  • State Flexibility: State Health Agencies (SHAs) have the flexibility to set their package rates up to 10% to 15% above or below the national standard. This allows them to adjust rates based on local costs and market dynamics. For example, states with high medical costs like Karnataka or Gujarat might offer higher rates for certain tertiary procedures.

What is the difference in PM-JAY funding between General States and Himalayan/Northeastern States?

The funding ratio depends on the state’s classification:

  • General States: The ratio is 60% Central Government : 40% State Government. This applies to states like Uttar Pradesh, Rajasthan, and Madhya Pradesh.
  • Northeastern and Himalayan States: To provide greater financial support, the ratio is 90% Central Government : 10% State Government. This applies to states like Assam, Himachal Pradesh, and Uttarakhand.

Which major states have not implemented PM-JAY, and under which state schemes are their residents covered?

Some states have not implemented the central PM-JAY scheme, preferring to run their own comprehensive state-funded programs:

  • Odisha: Runs the Biju Swasthya Kalyan Yojana (BSKY).
  • West Bengal: Runs the Swasthya Sathi scheme.
  • NCT of Delhi: Runs its own health scheme.

Beneficiaries in these states do not have access to the nationwide portability feature of PM-JAY.

Besides the SECC 2011 data, which states use other databases for beneficiary identification?

States have the flexibility to expand coverage at their own expense using verifiable state data.

  • Expanded Use: Many states now use other databases. For instance, Gujarat has included beneficiaries from its MA Vatsalya scheme, and many states utilize National Food Security Act (NFSA) ration card data to include families who may have been missed in the 2011 SECC.

Is the Ration Card mandatory for PM-JAY card generation in any state, even if central guidelines don’t mandate it?

Yes. While Aadhaar e-KYC is the central standard, some states emphasize the Ration Card for local verification.

  • State-Specific Rules: In states like Uttar Pradesh and Bihar, where the SECC data verification process can be complex, the Ration Card is often used as a crucial supplementary identifier to locate and authenticate the family unit, especially when converging with NFSA data.

Are there any states where non-Aadhaar verification methods are accepted for e-KYC?

Yes. Aadhaar e-KYC is the primary method, but NHA has provided flexibility for states with low biometric/network penetration.

  • State Flexibility: In specific circumstances, SHAs in states facing such issues (often in remote areas) may permit document-based verification using other government IDs (like Ration Card or Voter ID) as a temporary measure, though this is tightly controlled compared to the standard Aadhaar e-KYC.

Does the minimum standard for empanelment of private hospitals vary by state?

While the NHA provides a detailed framework (e.g., minimum 10 beds), the final criteria can vary.

  • State Variation: State Health Agencies (SHAs) can impose additional or stricter criteria within the NHA framework, suitable for their local healthcare market. For instance, the quality and specialization standards for empanelment in Kerala or Delhi might be significantly higher than those in some developing states.

Are State Governments allowed to add their own packages and rates for special conditions, such as during the COVID-19 pandemic?

Yes. States have the flexibility to respond to local health crises.

  • Special Packages: State Health Agencies (SHAs) are permitted to create and fund their own special packages and rates for specific diseases (like COVID-19 or Mucormycosis) that were not originally covered or were inadequately priced under PM-JAY. Maharashtra and Karnataka were prominent examples of states that implemented such state-funded emergency packages.

Do all states use the same IT platform for claim processing?

No. There are differences, particularly among “Brownfield” states.

  • Brownfield States: States that had major pre-existing schemes (e.g., Andhra Pradesh, Tamil Nadu) often use their own robust State-specific IT Platforms to process claims initially, which then integrate with the NHA’s central Transaction Management System (TMS) via Application Programming Interfaces (APIs).

Which states have the lowest availability of empanelled hospitals (EHCPs per lakh beneficiaries), and how does this affect utilization?

According to the CAG report, some states have significantly low EHCP density, impacting access.

  • Low EHCP States (EHCPs per lakh beneficiaries): States like Bihar, Assam, and Uttar Pradesh reported EHCP densities significantly lower than the national average.
  • Impact: Low density leads to reduced utilization, forcing beneficiaries in these states to travel longer distances for covered treatment, increasing their hidden out-of-pocket expenditure.

Why have beneficiaries in some states been forced to pay money despite the PM-JAY being a “Zero-Out-of-Pocket” scheme?

This is a violation, but CAG reports documented such cases where hospitals charged patients.

  • Examples: States like Himachal Pradesh, Jammu & Kashmir, and Meghalaya had documented instances where empanelled hospitals illegally charged beneficiaries for items not covered under the package or for services falsely billed outside the claim.

Under portability, if a beneficiary from Bihar receives treatment in a Kerala hospital, which State Health Agency (SHA) pays the claim?

The claim is paid by the Servicing State, where the treatment was rendered, regardless of the beneficiary’s home state.

  • Payment Process: The Kerala SHA pays the hospital, and subsequently, the Kerala SHA requests reimbursement from the Bihar SHA. This inter-state settlement process is managed by the NHA’s IT system.

What is the status of implementing the expanded coverage for senior citizens (70+ years) across different states?

The coverage for all senior citizens (70 years and above) was announced in late 2024.

  • Implementation Status: States are actively integrating this new Ayushman Vay Vandana (AVV) Card scheme. States like Uttar Pradesh and Gujarat have shown proactive implementation in identifying and generating cards for this new, expanded beneficiary pool, which is funded based on the standard PM-JAY 60:40 ratio.

Are there specific states where PM-JAY has been notably successful in driving the creation of ABHA (Health) numbers?

Yes. The implementation of the Ayushman Bharat Digital Mission (ABDM), which issues the ABHA number, varies significantly.

  • Leading States: Uttar Pradesh and Madhya Pradesh have led the nation in generating the highest number of ABHA IDs, demonstrating strong penetration of digital health infrastructure.

Which states have implemented additional anti-fraud measures beyond the NHA’s national framework?

Several states have localized their anti-fraud systems to tackle regional malpractices.

  • Examples: Gujarat and Karnataka have implemented stricter pre-authorization rules and mandatory physical audits for high-value claims. The Jammu and Kashmir SHA created dedicated field monitoring teams to investigate suspected fraud cases promptly.

In which states have the maximum number of hospital empanelments been cancelled due to fraudulent activities?

The NHA maintains a strict list of de-empanelled hospitals.

  • High De-Empanelment: States with a high volume of transactions and identified fraud, such as Gujarat, Uttar Pradesh, and Haryana, have recorded some of the highest numbers of hospital de-empanelments, reflecting strict enforcement by their SHAs.

Why do beneficiaries in states like Bihar and Jharkhand sometimes have to pay a small service fee to get their Ayushman Card printed?

While the card and benefits are free, a minor charge is permissible for the physical service.

  • Service Fee: The government allows Common Service Centres (CSCs) or designated agencies to charge a nominal service fee (e.g., ₹30 or ₹50) for the printing and lamination of the physical Ayushman Card. This is common in states where card generation is heavily reliant on CSC networks, such as Bihar and Jharkhand.

Which state has been the most proactive in utilizing the PM-ABHIM scheme to build health infrastructure?

The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) is utilized differently based on existing state capacity.

  • Proactive States: States with lower existing health infrastructure, such as Uttar Pradesh and Bihar, have been particularly proactive in leveraging PM-ABHIM funding to build new critical care hospital blocks and integrated public health labs.

Do all empanelled hospitals in every state have the same criteria for discharge and follow-up care instructions?

No. Discharge and follow-up criteria are standardized by NHA, but implementation and enforcement vary.

  • State Enforcement: SHAs in states like Tamil Nadu and Kerala have historically demonstrated stronger monitoring of post-hospitalization care (covered for 15 days) and mandatory patient feedback mechanisms compared to others, leading to better compliance with follow-up instructions.