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AB-PMJAY
Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana
NationwideFamilyCentralCentral Sector SchemeMinistry Of Health & Family WelfareOpen since 2018-09-23
myScheme’s own wording, reproduced in full. Where it is thin, that is the finding, and the completeness checks are below.
What this is
AB PM-JAY is a health insurance scheme for low-income families in rural and urban areas. The scheme aims to provide affordable healthcare facilities to the Poor. It is the largest health assurance scheme in the world which aims at providing a health cover of ₹5,00,000/- per family per year.
In detail
The scheme “Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana” implemented by the National Health Authority (NHA) under Ministry of Health and Family Welfare, Government of India, aims to provide cashless hospitalisation coverage of ₹5,00,000 per family per year to poor and vulnerable families for secondary and tertiary healthcare services. It was launched on 23rd September 2018 in Ranchi, Jharkhand, by the Hon’ble Prime Minister of India.
"Ayushman Bharat" is an attempt to move from a sectoral and segmented approach to health service delivery to a comprehensive need-based health care service. This scheme aims to undertake path-breaking interventions to holistically address the healthcare system (covering prevention, promotion, and ambulatory care) at the primary, secondary, and tertiary levels. Ayushman Bharat adopts a continuum of care approach, comprising two interrelated components, which are -
- Health and Wellness Centres (HWCs): The scheme aims to provide comprehensive primary healthcare services, including maternal and child health, non-communicable disease care, free essential drugs, and diagnostics, close to people’s homes. The centres promote preventive healthcare and healthy behaviours to reduce the risk of chronic diseases.
- Pradhan Mantri Jan Arogya Yojana (PM-JAY): The second component under Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojna or PM-JAY as it is popularly known. It aims to provide cashless health insurance coverage of up to ₹5,00,000 per family per year for secondary and tertiary hospitalization to poor and vulnerable families.
Who qualifies
> Rural Beneficiaries
Out of the total seven deprivation criteria for rural areas, PM-JAY covered all such families who fall into at least one of the following six deprivation criteria and automatic inclusion(Destitute/ living on alms, manual scavenger households, primitive tribal group, legally released bonded labour) criteria:
- Only one room with kucha walls and kucha roof
- No adult member between ages 16 to 59
- Households with no adult male member between ages 16 to 59
- Disabled member and no able-bodied adult member
- SC/ST households
- Landless households deriving a major part of their income from manual casual labour
- Automatically includedHouseholds without shelter
- Destitute/ living on alms,
- Manual scavenger families,
- Primitive tribal groups,
- Legally released bonded labour.
> Urban Beneficiaries
For urban areas, the following 11 occupational categories of workers are eligible for the scheme:
- Ragpicker
- Beggar
- Domestic worker
- Street vendor/ Cobbler/hawker / other service provider working on streets
- Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and other head-load worker
- Sweeper/ Sanitation worker/ Mali
- Home-based worker/ Artisan/ Handicrafts worker/ Tailor
- Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller
- Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter
- Electrician/ Mechanic/ Assembler/ Repair worker
- Washer-man/ Chowkidar
What you get
> Financial Health Insurance Cover:
- Annual Hospitalization Coverage: Cashless coverage up to ₹5,00,000/- per family per year.- Comprehensive Treatment Costs: Covers consultation, medicines, diagnostics, surgery, ICU, implants, accommodation, and food.- Pre and Post Hospitalization Support: Covers 3 days pre-hospitalization and 15 days post-hospitalization expenses.- Treatment Complication Coverage: Covers complications arising during treatment.
> Coverage Features:
- Pre-Existing Disease Coverage: Covers all pre-existing diseases from day one.- No Family Size Limit: No restriction on age, gender, or family size.- Nationwide Portability: Benefits available across India in empanelled hospitals.- Wide Procedure Coverage: Covers approximately 1,929 medical procedures.
Who is excluded
- Those who own a two, three, or four-wheeler or a motorized fishing boat.
- Those who own mechanized farming equipment.
- Those who have Kisan cards with a credit limit of ₹50,000/-.
- Those employed by the government.
- Those who work in government-managed non-agricultural enterprises.
- Those earning a monthly income above ₹10,000/-.
- Those owning refrigerators and landlines.
- Those with decent, solidly built houses.
- Those owning 5 acres or more of agricultural land.
The CAG has audited this
1 report tabled
· Comptroller and Auditor General of India
| Report | Kind | Government | Tabled | Read it |
|---|---|---|---|---|
| Report No. 11 of 2023- Performance Audit of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana – Union Government (Civil) National Health Authority Ministry of Health and Family Welfare | Performance | Union | 08 August 2023 | CAG |
That a report exists, and nothing about what it found
This register records which schemes have been audited, which the CAG does not publish
as a list. It does not read, quote or summarise an audit’s conclusions: those are
the CAG’s to publish and the reports are linked above. The match is on the
report’s subject at high similarity and every one was read by eye; the rules that
were tried and rejected are named on /audit.
What the CAG’s reports record
How the scheme was set up, as the Comptroller and Auditor General’s
reports state it, cited to the printed page. Never what an audit found.
| Began | 25 September 2018, as Ayushman Bharat-National Health Protection Mission, later renamed PM-JAY under Government of India | Comptroller and Auditor General of India, Report No. 8 of 2024, Public Health Infrastructure and Management of Health Services, Government of Karnataka, para 7.2, p. 124. |
| Began | September 2018 under Ministry of Health and Family Welfare | Comptroller and Auditor General of India, Report No. 5 of 2024, Performance Audit on Public Health Infrastructure and Management of Health Services, Government of Tamil Nadu, para 7.15, p. 105. |
| Began | September 2018 under Government of India | Comptroller and Auditor General of India, Report No. 3 of 2024, Public Health Infrastructure and Management of Health Services in West Bengal, Government of West Bengal, para 5.8, p. 120. |
| Began | September 2018 named in the report “Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)” under Ministry of Health and Family Welfare | Comptroller and Auditor General of India, Report of 2024, Performance Audit on Public Health Infrastructure and Management of Health Services in Maharashtra, Government of Maharashtra, para 7.21, p. 80. |
| Renamed | September 2018: the Mission was renamed AB-PMJAY (launched 23 September 2018, p9) named in the report “Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)” | Comptroller and Auditor General of India, Report No. 11 of 2023, Performance Audit of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana, Union Government (Civil), National Health Authority, Ministry of Health and Family Welfare, para 1.4, p. 3. |
| Merged into | Rashtriya Swasthya Bima Yojana and Senior Citizen Health Insurance Scheme | Comptroller and Auditor General of India, Report No. 3 of 2024, Public Health Infrastructure and Management of Health Services in West Bengal, Government of West Bengal, footnote 120, p. 120. |
| Funding | fully government funded; cost shared between Central and State Governments named in the report “Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)” under National Health Authority the register’s sources differ: myScheme: Central Sector Scheme; the Union budget lists it as centrally sponsored (the CAG and the budget agree that the cost is shared with the States) | Comptroller and Auditor General of India, Report No. 11 of 2023, Performance Audit of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana, Union Government (Civil), National Health Authority, Ministry of Health and Family Welfare, para 6.2, p. 60. |
| Implemented by | State Agency for Comprehensive Health and Integrated Services (SACHIS) | Comptroller and Auditor General of India, Report No. 8 of 2024, Public Health Infrastructure and Management of Health Services in Uttar Pradesh, Government of Uttar Pradesh, para 1.6, p. 12. |
| Implemented by | United India Insurance Company Limited under Ministry of Health and Family Welfare | Comptroller and Auditor General of India, Report No. 5 of 2024, Performance Audit on Public Health Infrastructure and Management of Health Services, Government of Tamil Nadu, para 7.15, p. 106. |
| Benefit | aims to reduce out-of-pocket health spending and catastrophic health expenditure named in the report “Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)” | Comptroller and Auditor General of India, Report No. 11 of 2023, Performance Audit of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana, Union Government (Civil), National Health Authority, Ministry of Health and Family Welfare, Executive Summary, p. v. |
| Eligibility | Poor families identified from the Socio-Economic Caste Census 2011 under Government of India | Comptroller and Auditor General of India, Report No. 8 of 2024, Public Health Infrastructure and Management of Health Services, Government of Karnataka, para 7.2, p. 124. |
| Eligibility | families included in the Socio-Economic Caste Census, 2011, among others named in the report “Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)” under Ministry of Health and Family Welfare | Comptroller and Auditor General of India, Report of 2024, Performance Audit on Public Health Infrastructure and Management of Health Services in Maharashtra, Government of Maharashtra, para 7.21, p. 80. |
| Rashtriya Swasthya Bima Yojana, replaced by this | ||
|---|---|---|
| Began | 2008, centrally sponsored under Government of India | Comptroller and Auditor General of India, Report No. 4 of 2025, Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana and Pradhan Mantri Awaas Yojana-Gramin, Government of Bihar, footnote 18, para 1.6.1, p. 7. |
| Began | April 2008, for BPL unorganised workers; later subsumed in Ayushman Bharat under Government of India | Comptroller and Auditor General of India, Report No. 4 of 2025, Welfare of Building and Other Construction Workers, Government of Uttar Pradesh, footnote 118, p. 109. |
| Ended | Subsumed in PM-JAY, 2018 | Comptroller and Auditor General of India, Report of 2026, Implementation of Mahatma Gandhi National Rural Employment Guarantee Act, Government of Kerala, para 5.4, p. 43. |
| Benefit | Cashless health insurance of Rs 30,000 a year per family of five under Government of India | Comptroller and Auditor General of India, Report No. 4 of 2025, Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana and Pradhan Mantri Awaas Yojana-Gramin, Government of Bihar, footnote 18, para 1.6.1, p. 7. |
| Rashtriya Swasthya Bima Yojana (RSBY), replaced by this | ||
| Began | 2008; Centrally Sponsored under Ministry of Labour and Employment | Comptroller and Auditor General of India, Report No. 11 of 2023, Performance Audit of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana, Union Government (Civil), National Health Authority, Ministry of Health and Family Welfare, para 6.4.3, p. 66. |
| Merged into | into PMJAY in Jharkhand, September 2018 | Comptroller and Auditor General of India, Report No. 11 of 2023, Performance Audit of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana, Union Government (Civil), National Health Authority, Ministry of Health and Family Welfare, Executive Summary, p. x. |
Found elsewhere in government
Not published on myScheme · carried from another
government source, with the join score shown so it can be disputed
| Budget allocation | ₹9,500 cr for 2026-27
Centrally Sponsored
· Demand No. 46
· matched to budget line “Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PMJAY)”
at 1.0 (strong) |
Union Budget, Expenditure Profile Statement 4A |
What it promises to deliver this year
Outcome Budget 2026-27, Output Outcome Monitoring Framework, p.148 · matched at
1.0 (strong)
| Indicator | Measure | Target 2026-27 |
|---|---|---|
| output 2.1 | Estimated number of | 300.00 |
| output 3.1 | Amount of Claims | 36,000.00 |
| output 4.1 | Total number of Public | 800.00 |
| output 4.2 | Total number of Private | 1,000.00 |
| output 5.1 | % of confirmed fraud | 1.00 |
| outcome 2.1 | % change in number of | 5.00 |
| outcome 3.1 | % change in the number | 5.00 |
| outcome 4.1 | % change in the number | 8.00 |
| outcome 5.1 | Number of | 7.00 |
Indicator wording is the first line of a
wrapped cell in the source PDF; target values are complete. The framework carries
targets and no achieved-versus-promised column, for this scheme or any
other.
Why this is here and not above
myScheme publishes no budget figure for any scheme. This one comes from the Union
Budget Expenditure Profile and is joined by name, so it is shown apart from the
checks and never counted in them. A scheme’s launch date, likewise, exists in
its gazette notification whether or not the portal repeats it. The checks
above ask only whether this portal tells a citizen, which is a different
and narrower question.
Listed by Union BudgetCAG audit reportsDBT BharatmySchemeOutcome Budget
Documentation completeness
8 of 9 checks passed
Checks are about the record,
not about the scheme.
not about the scheme.
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Eligibility published here1568 characters
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Benefit amount published hereamount or quantity stated
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Description more than a name291 characters
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Implementing agency published herenamed
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How to apply published hereoffline mode declared, no URL needed
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Start date published here2018-09-23
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End date published hereno end date recorded, so indefinite by omission
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Stored links well-formedall parse
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Not expired while still listedno end date
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Provenance
Every field above, and where it came from
| schemeName | Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana | myScheme · 2026-10-17 |
| schemeOpenDate | 2018-09-23 | myScheme · 2026-10-17 |
| schemeCloseDate | ... | not published at source |
| nodalMinistryName | Ministry Of Health & Family Welfare | myScheme · 2026-10-17 |
| dbtScheme | True | myScheme · 2026-10-17 |
| achievement data | ... | no source publishes this for any central scheme |