Pradhan Mantri Jan Arogya Yojana (PMJAY):
Transforming Healthcare in India

Pradhan Mantri Jan Arogya Yojana
(PMJAY): Transforming Healthcare in India

The Pradhan Mantri Jan Arogya Yojana or PM-JAY is one of the largest government-funded health insurance schemes in the world. The Pradhan Mantri Jan Arogya Yojana also known as Ayushman Bharat was launched on 23rd September 2018 in Ranchi, Jharkhand by the Hon’ble Prime Minister of India, Shri Narendra Modi.
  As one of the leading plans that help to bring quality healthcare services to as many people as possible, this flagship scheme has made the vision a reality for millions of Indians. Let’s pay closer attention to how this scheme changes healthcare.

What Is Pradhan Mantri Jan Arogya Yojana (PMJAY)?

The Ayushman Bharat consists of two massive parts one of which part is the Pradhan Mantri Jan Arogya Yojana (PMJAY) is a health insurance plan of India. Also known as Ayushman Bharat Yojana aids the insurance cover of  ₹5 lakh per family for secondary and tertiary care in hospitals  with the help of an ABHA card. It is primarily oriented toward the socially vulnerable population, therefore it encompasses the needs of people irrespective of their ability to pay for the healthcare facilities.

The Ayushman Bharat scheme has been moving effectively so far and till 1st November 2024, 8,19,73,363 people availed of the benefit, changing the Indian healthcare scenario.

In that regard, the Ayushman Bharat Digital Mission (ABDM) is a government scheme launched on 27 September 2021. It is useful in scaling up PMJAY as a combined and integrated health information program.

Subsequently, the Ayushman Bharat scheme added a new category, the Ayushman Vay Vandana Card, launched on October 29, 2024. It offers ₹5 lakh free health coverage to senior citizens 70 years and above irrespective of caste and economic status. It enhances the reach and effectiveness that Ayushman Bharat has brought to the Indian health sector.

What is Ayushman Bharat Digital Mission (ABDM)?

Ayushman Bharat Digital Mission was launched by the Prime Minister via video conferencing in which Shri Mansukh Mandaviya, Union Minister of Health & Family Welfare, Dr. Bharati Pravin Pawar, Minister of State for Health and Family Welfare and other dignitaries were present.

The Ayushman Bharat Digital Mission will ensure the integration of digital health solutions of hospitals across the country with each other. The mission will not only make the processes of hospitals easier but also make life easie

It helps incorporate numerous other facilities such as digital consultation, consent of patients regarding sharing their records with the concerned medical practitioners, etc. Through this scheme of work, old medical records cannot go missing since all records will be computerised and well-documented

ABDM scheme has many components and the primary one is the ABHA Card or Ayushman Bharat Health Account which offers a personal identification number to the person. This e-card allows the citizens to retain and determine the information regarding their health and offer that information to healthcare givers. 

By integrating PMJAY with the ABHA Card, ABDM improves and streamlines the structure, efficiency, and processes of the Indian healthcare system.

How ABDM Enhances PMJAY

Here’s how ABDM strengthens PMJAY:

  • ABHA Card: The users may have an opportunity to generate an Ayushman Bharat Health Account (ABHA ID), useful for the safe storage of medical information.
  • Improved Transparency: It also effectively deals with the problem of fake claims and ensures timely provision of benefits
  • Seamless Healthcare Access: A person has an empanelled ID number for managing such records related to the treatments done in various empanelled hospitals.
  • Interoperability: ABDM connects the hospitals, the health care providers and the insurance platforms to enable the PMJAY through a paperless environment .

Key Features of Ayushman Bharat Yojana

Here are the characteristics of this systemic change that seeks to bring the necessary
improvement for its beneficiaries.

Here are the characteristics of this systemic change that seeks to bring the necessary improvement for its beneficiaries.

1

ABHA ID

It is designed to uniquely identify individuals, authenticate their identity, and link their health records across various systems and stakeholders, ensuring this is done only with the patient's informed consent. As of December 18, 2024, a total of 71,61,90,805 ABHA IDs have been generated.

2

National Health Claims Exchange (NHCX)

A digital platform designed to streamline and standardise insurance claims processing within the healthcare sector. NHCX allows for effective communication between insurers, healthcare providers, and the beneficiaries resulting in faster and efficient processing of claims.

3

Health Facility Registry (HFR)

A list of healthcare organisations that exist in the country. As per the latest records dated December 18, 2024, a total of 543,821 healthcare professionals have been registered.

4

Wide NHealthcare Professionals Registry (HPR)

An online registry that connects all healthcare providers including traditional medicine in India.

5

Privacy and Security

Protects one’s Personal Health Information.

6

Interoperability

Enables the easy transfer of data from one system to the other.

7

Unified Health Interface (UHI)

It makes health services delivery convenient between patients and healthcare providers.

Differences Between PMJAY and ABDM

It is crucial to comprehend that both the existing PMJAY and the ABDM are parts of the Ayushman Bharat programme, yet they
both engage in revolutionising the health service delivery system in India.
While PMJAY aims for financial risk protection of healthcare treatment, ABDM created a digital health technology
platform to ease the delivery of healthcare facilities.

The table below highlights the key differences between PMJAY and ABDM across various parameters:

ParameterPMJAYABDM
ObjectiveOffers monetary support for health treatments.Creates a digital framework for healthcare delivery.
NatureHealth insurance scheme.Technology-driven healthcare initiative.
Coverage₹5 lakh per family per year for hospitalisation.Computerised storage and retrieval of the client’s medical records.
Eligibility CriteriaServes the Below Poverty Line (BPL), Above Poverty Line (APL), and Economically Weaker Sections (EWS), among other categories.Anyone with a valid Aadhaar card can access digital health services.
Implementation FocusCashless treatment at hospitals.Interoperability and digital infrastructure.
Technology IntegrationEnables cashless treatment at empanelled hospitals.Provides a platform to integrate health data securely.

Benefits of Ayushman Bharat Digital Mission

Here are the key benefits of Ayushman Bharat Digital Mission:

How to Register for Ayushman Bharat Digital Mission

To register for the Ayushman Bharat Digital Mission (ABDM) and to create your ABHA ID
(Ayushman Bharat Health Account), follow these simple steps:

To register for the Ayushman Bharat Digital Mission (ABDM) and to create your ABHA ID (Ayushman Bharat Health Account), follow these simple steps:

  1. Visit the Official ABDM Website
    • Go to the official website: https://abdm.gov.in/
    • You could also use the ABHA App which can be downloaded on the Google Play Store or on the App Store.
  2. Generate Your ABHA ID

    You can generate your ABHA ID using one of the following methods

    a. Using Aadhaar Card

    • Click on the “Create ABHA ID” option.
    • Click on Aadhaar and then type the Aadhaar number
    • Confirm the OTP received by your registered mobile number.
    • Input your basic identification information including name, date of birth and gender
    • Your unique ABHA ID will be created and promptly provided to you

    b. Using Mobile Number

    • Click on the “Create ABHA ID” option.
    • Select Mobile Number and enter your contact details.
    • Confirm with the OTP received on your mobile number.
    • Additional information must be provided including, name, date of birth as well as gender.
    • This way your ABHA ID will be created successfully.
  3. Download Your ABHA Card
    • After registration people can download their ABHA Card which comprises the Health ID number.
    • This card will also enable you to securely save, store and share your health records with the health care providers
  4. Visit Your Nearest Health Facility
    • ABHA ID can also be registered at the hospitals, clinics or other health facilities that are part of ABDM.
      Documents Required for Registration:
    • Aadhaar Number (optional but preferred)
    • Mobile Number (linked to Aadhaar)

      • By following these steps, individuals can easily create their ABHA ID and become a part of India’s digital health ecosystem.

Ayushman Bharat Health Insurance for Senior Citizens and Its Integration with ABDM

The Ayushman Bharat Yojana stratifies the elderly specifically due to more extended benefits provided under PMJAY insurance. However, it operates as a senior citizen health insurance scheme by the Government of India under which senior citizens can get financial assistance during health breakdown.

In India, digital support in healthcare for senior citizens has been strengthened under the Ayushman Bharat Digital Mission (ABDM), especially with initiatives like the Ayushman Bharat Health Account (ABHA).



Role of ABDM and ABHA for Senior Citizens

Ayushman Bharat Digital Mission merges senior citizen health insurance with a digital platform to
provide better access. Through ABHA, senior citizens can:

Ayushman Bharat Digital Mission merges senior citizen health insurance with a digital platform to provide better access. Through ABHA, senior citizens can:

  • Store and Access Health Records: Personal details, medicines, diagnostic reports, details about surgeries & discharge summaries can be saved and the same can be disclosed to specific doctors without hassle.
  • Efficient Claims Processing: ABDM makes the claims process digital and helps senior citizens get their insurance claims settled much faster.
  • Uninterrupted Healthcare Access: : ABHA ensures faster and less cumbersome treatment, through empanelled hospitals, making treatment accessible to elderly citizens.
  • Teleconsultations: Elderly individuals can access remote healthcare services through eSanjeevani, India's National Telemedicine Service, which aims to achieve Universal Health Coverage (UHC). It offers easy access to doctors and specialists via smartphones or by visiting the nearest Ayushman Bharat Health & Wellness Centre

How Does PMJAY Benefit Senior Citizens Aged 70+?

According to this scheme, every senior citizen who is 70 years and older will be able to get
benefits from this scheme regardless of their socio-economic status.

According to this scheme, every senior citizen who is 70 years and older will be able to get benefits from this scheme regardless of their socio-economic status.

The cover under the scheme extends to all costs for the following parts of the treatment:

For many elderly Indians, this is only possible because of the PMJAY scheme

Eligibility Criteria and Documents Required for the PMJAY Scheme

To avail medical insurance for senior citizens in India under Ayushman Bharat, the following criteria must be met:


Eligibility:

According to this scheme, every senior citizen who is 70 years and older will be able to get benefits regardless of their socio-economic status.

Required Documents:

The other acceptable identification was an

  1.  Aadhaar card for verification.
  2. Voter ID or senior citizen ID
  3. Family income certificate

This relatively simple scheme allows senior citizens in India to obtain proper medical care that decreases out-of-pocket expenses. Health insurance for the elderly in India has not seen such easy access

The connectivity of PMJAY with the ABDM ensures that elder people in India receive efficient, affordable and quality healthcare services. The elderly would also be able to use the ABHA card to get easy access to records, fast passage of treatments and easy claims which will also assist in reducing the burden of having to go for treatment.

PM-JAY Health Packages

The PMJAY scheme covers 1,929 medical procedures  including surgeries, diagnostics, and follow-up. These packages aim to offer solutions to healthcare needs that are core today but also accessible. Examples include:


  • Cardiac surgeries
  • Chemotherapy and Radiation treatments for cancer patients
  • Emergency trauma care

Consumers can consult with the empanelled hospitals to know more about the details of the packages, in order to be provided the ultimate treatment under the scheme

Hospital Empanelment Under Ayushman Bharat

Empanelled hospitals are the backbone of the Ayushman Bharat scheme, providing quality healthcare services to beneficiaries.

List of Empanelled Hospitals

Over 25,000 government & private hospitals of states across India are included in the PMJAY scheme. These are selected hospitals to ensure that they offer the best quality in treating patients. Examples include:


  • All the AIIMS institutions across the country.
  • Government health care available at the state level.
  • Top independent multi-speciality hospitals.

The complete list of empanelled hospitals is listed here.

How to Find an Empanelled Hospital

Beneficiaries can easily locate an empanelled nearby hospital using the PMJAY registration online portal or mobile app. Steps include:


  • Open the PMJAY website
  • Type in your state, district, hospital type, nearby hospital name, and empanelment type, and then select the appropriate speciality.
  • Click "Search"
  • You will be provided with the details of the hospital.

This feature allows the beneficiaries to check the hospital whenever a need arises.

Enhancing Healthcare Access with PMJAY and ABDM

Pradhan Mantri Jan Arogya Yojana is complemented by ABDM which is a tech-enabled outreach program. It offers a complete framework to advance healthcare arrangements and services, decrease claim complexity, and improve data sharing, and protection. ABDM remains the health record aggregator, supports telemedicine sessions, and assists in reducing the complexity of health services, for both givers and takers. Using state-of-the-art technologies, extensive hospitalisation, and inclusive health connect,Ayushman Bharat Yojana shall emerge as a ray of hope for families, especially those with senior members. If you are a fortunate one then start your Ayushman card registration today to explore the top Ayushman card benefits .

Frequently asked questions

Frequently asked questions

Ayushman Bharat Yojana aims to offer necessary medical amenities to economically weakened families of the Indian population. These PMJAY schemes are restructuring health insurance strategies that emphasise affordability by targeting secondary and tertiary care hospitalisation. It strives to facilitate the adoption of health care insurance for senior citizens. This government scheme for old age persons not only controls emergency health expenditures but also contributes to achieving universal health coverage in India.
Unlike other health insurance policies, Ayushman Bharat Yojana is a government-sponsored insurance scheme that will offer up to ₹ 5,00,000 per family; more importantly, there are no premiums to be paid. It has provisions for pre-existing diseases from the first day it comes into force, making it a proper choice for medical insurance for senior citizens in India . This PMJAY scheme is also cashless, and this has eliminated the use of too many papers during the hospitalisation of beneficiaries. It is also linked to the ABHA card and solves the problem of digital healthcare services.
Yes, the Ayushman Bharat scheme treats all pre-existing diseases from the day they include the patient in their scheme. As for treatments of chronic diseases, for instance, diabetes, hypertension, or cancer, the beneficiaries are free to undergo such treatments without requiring further permission. The PMJAY insurance helps ensure that cash is available for the patient in case the patient has a chronic disease. With proper Ayushman card registration, patients can obtain treatment for pre-existing diseases from hospitals listed under this senior citizen health insurance scheme by the government of India.
The Ayushman Bharat Yojana is valid only in empanelled government and private hospital recognized under the PMJAY scheme. These hospitals deliver cashless services with no paperwork to the beneficiaries. To get information about the empanelled hospitals, you can look into the online directories, or alternatively, you can even verify it with an ABHA card. Non-empanelled hospitals are not allowed to provide benefits under this health insurance for the elderly in India; hence, the facilities that cover health insurance for senior citizens in India are restricted to empanelled hospitals only.
There is no restriction on family size, age, or gender. It is, however, meant for families who fall under the scheme's eligibility criteria. This makes it perfect for health insurance for senior citizens of India, especially those 70 years and above. PMJAY insurance allows for the complete scheduling of insurance without discrimination, thus encouraging universal healthcare among qualified persons.
You can find the status of your Ayushman Bharat card at PMJAY registration online or call the Ayushman Bharat helpline. If you have an ABHA card or a registered mobile number, then use it for verification. This way, you remain informed on your Ayushman card benefits and be in a position to plan out treatments successfully.
Well, the Ayushman Bharat scheme doesn't pay for treatments that have been paid directly by the patient. The scheme operates a cashless system and the procedures at the empanelled hospitals are to be directly settled under the PMJAY scheme. Currently, beneficiaries just have to bring their Ayushman card to the hospital to access services without the need to pay out of pocket.
The PMJAY insurance is planned for economically weaker sections of society and older people as well. The selected beneficiaries are chosen based on data from the Socio-Economic Caste Census (SECC). This makes it an inclusive health insurance for the elderly in India. This health insurance scheme by the government of India can be availed by families coming under the SECC criteria.
For registration for the Ayushman Bharat for senior citizens, one has to provide proof of identity (Aadhaar card), proof of address, and SECC-based eligibility verification. To register for an Ayushman card without any hindrances, please ensure that your documents are updated. The process can be made easier, especially when you link your ABHA card.
No, under Ayushman Bharat Yojana, the enrolment is based on the family and not individual in nature. If your family is listed in the SECC database, then both parents will qualify for it automatically. Everyone will be provided with an individual Ayushman card so as to avail themselves of these benefits under the PMJAY scheme wherever they are identified.
Yes, senior citizens will get personal Ayushman cards even if they are enrolled in a family category. This guarantees the proper delivery of healthcare services under the PMJAY. ABHA cards can also be used to maintain medical records and offer a connection to benefits on the spot.
Yes, cashless treatments can be claimed on the day of enrolment under the Ayushman Bharat Yojana. The scheme begins coverage from the moment one gets the Ayushman card. This feature is especially beneficial for senior citizens needing urgent care, aligning with the goals of medical insurance for senior citizens in India.
If you want to get more people enrolled into the PMJAY beneficiary list, you are required to get your records in the SECC database. Go to your nearest Common Service Centre (CSC) or directly check the PMJAY registration online portal. Make sure all members have valid documents especially an ABHA card to ease the process.
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