Ayushman Bharat - Health Insurance Scheme

Ayushman Bharat, formally known as Pradhan Mantri Jan Arogya Yojana (PM-JAY), is India's largest government-funded health insurance scheme launched in 2018 to provide financial protection to poor and economically vulnerable households. The scheme covers approximately 50 crore people identified through SECC (Socio Economic and Caste Census) data and includes additional beneficiaries from unorganized sector workers and frontline workers. Each eligible family receives free hospitalization coverage up to Rs. 5 lakhs per family per year, with no individual limit per family member. Coverage includes secondary and tertiary care hospitalization, pre-hospitalization expenses (up to 3 days before admission), and post-hospitalization expenses (up to 14 days after discharge). Enrollment is free; the government bears the full premium cost. Beneficiaries receive a Ayushman card (golden card) that can be used at any of the 32,000+ empaneled hospitals across India (both government and private). Treatment under the scheme is cashless; patients need not pay directly at hospitals. Beneficiary status can be verified on the PMJAY portal (pmjay.gov.in) or state-specific portals using name or phone number. Coverage includes expenses for accommodation, medicines, diagnostic tests, and doctor consultation during hospitalization. Exclusions include outpatient care, wellness programs, and cosmetic treatments. A critical pitfall: beneficiary status must be verified before hospitalization to avoid payment disputes; many cardholders face service refusals due to unclear eligibility records. Additionally, not all hospitals listed on the portal may have beds available or may decline Ayushman patients.