In a written reply to the Lok Sabha, Union Minister of State for Health, Dr. Prataprao Jadhav, detailed the scope and coverage of the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the world’s largest publicly funded health assurance scheme. The scheme provides a health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization, benefiting 55 crore individuals across 12.34 crore families. Coverage under the scheme is extended to all members of eligible families, regardless of age.

Currently, AB-PMJAY is operational in 33 States and Union Territories, excluding the National Capital Territory of Delhi, West Bengal, and Odisha. There are no plans to extend the scheme beyond its existing beneficiary base or introduce a premium contribution model.

Initially, 10.74 crore beneficiary families were identified based on the 2011 Socio-Economic Caste Census (SECC), using specific deprivation and occupational criteria for both rural and urban areas. In January 2022, the beneficiary base was expanded to 12.34 crore families. States and Union Territories have been granted the flexibility to use additional digitized databases reflecting similar socio-economic conditions to identify beneficiaries. These databases, including Aadhaar-seeded records of poor and vulnerable families, have been used for verification purposes.

Under the scheme, beneficiaries can access cashless treatment at any empaneled public or private hospital across the country. Treatment is provided free of charge based on the hospital’s diagnosis, and claims for reimbursement are submitted by the hospital after discharge.