Pradhan Mantri Jan Arogya Yojana (PM-JAY)

✦Key Features

• Health insurance coverage of ₹5 lakh per family per year
• Covers 1,929+ medical procedures including surgery, medical, and day-care
• 33,000+ public and private hospitals empanelled across India
• Extended to ALL senior citizens 70+ years irrespective of income (Sep 2024)
• Cashless and paperless access — no enrollment needed at hospital
• ₹1.52 lakh crore saved in out-of-pocket expenses since inception
• Budget FY2025-26: ₹9,406 crore (29% increase from FY2024-25)

✓Eligibility Criteria

• Families identified through Socio-Economic Caste Census (SECC) 2011
• All Scheduled Caste/Scheduled Tribe families
• Rural families meeting deprivation criteria
• Urban families in specific occupational categories

★Benefits

• Free treatment at empanelled hospitals
• Coverage for pre and post-hospitalization expenses
• No restrictions on family size and age
• Pre-existing conditions covered from day one
• Transport allowance for certain procedures

▶Application Process

• Visit any empanelled hospital
• Provide Aadhar number at hospital counter
• Hospital verifies eligibility through PM-JAY portal
• Receive cashless treatment if eligible
• Get PM-JAY Golden Card for future use

₹ Budget Allocation

9406

Funding Ratio (Centre:State): 60:40 (States), 90:10 (NE/Hilly), 100:0 (UTs without legislature)

Historical Context

Launched in September 2018 as part of Ayushman Bharat, based on the NHP 2017 recommendation to provide insurance to the bottom 40% of the population.