The Centre has so far issued over 42 crore Ayushman cards, providing free healthcare coverage to around 12 crore vulnerable families under the flagship Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (AB-PMJAY).
Over the years, the Centre kept tweaking the eligibility guidelines for the PM-JAY to bring more and more citizens under the scheme.
Initially, the government launched the scheme for beneficiaries from vulnerable sections of society, with beneficiary families identified from the Socio-Economic Caste Census (SECC) of 2011.
In January 2022, the scheme was expanded to touch the beneficiary base of 12 crore families. Many of the states and Union Territories (UTs) implementing the AB-PMJAY further expanded the beneficiary base at their own cost under the scheme using non-SECC data sources (including National Food Security Act, state-specific datasets).
Last year in March, the eligibility criteria under the scheme were further relaxed to bring around 37 lakh Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs), Anganwadi Helpers (AWHs) and their families under the scheme’s fold.
Ayushman scheme opened for senior citizens above 70
The biggest announcement since the launch of the scheme was made last year on 29th October 2024. The government expanded AB-PMJAY to provide free treatment benefits of up to Rs 5 lakh per year to over 6 crore senior citizens aged 70 years and above, belonging to 4.5 crore families, irrespective of their socio-economic status.
Since the scheme was initially launched in a limited manner, covering citizens based on social vulnerability and other socio-economic conditions, there is still confusion about whether government retirees with a CGHS (Central Government Health Scheme) card can avail benefits under the PM-JAY or not.
Govt pensioners with CGHS card too are covered under PM-JAY
Pensioners retired from state and central government jobs, irrespective of their age, are fully eligible to get registered under the Ayushman scheme. The only condition is that they should use either the Ayushman scheme or their existing government healthcare scheme like CGHS or ECHS.
What is the limit set for CGHS beneficiaries under the AB-PMJAY scheme?
Like other families, CGHS beneficiary families too are eligible for Rs 5 lakh health coverage on a family floater basis. In case of families with parents above 70 years of age, this limit goes up to Rs 10 lakh (Rs 5 lakh to be availed separately by senior citizens in the family).
Following FAQs on the health ministry portal bring further clarity:
Q. I am a retired government employee above 70 years old and have a CGHS card. Can I also enrol myself in this scheme?
Answer: Yes, you are eligible. However, as per government rules, citizens who benefit from any other government health scheme must choose either their existing scheme benefits or those under AB PM-JAY. This means if you have CGHS, you must choose between CGHS and Ayushman Bharat PM-JAY, as benefits from both schemes cannot be availed simultaneously.
Q. If my parents opt for AB PM-JAY and surrender their current government health scheme, is there any provision to switch back to their previous government health insurance scheme?
Answer: No, once your parents choose the AB PM-JAY scheme and surrender their existing government health insurance, they cannot switch back. This is a one-time option and cannot be reversed.
What is Pradhan Mantri Jan Arogya Yojana (PM-JAY)?
Ayushman Bharat Yojana is the largest health assurance scheme in the world, providing a health cover of Rs 5 lakhs per family per year for secondary and tertiary care hospitalization to over 12 crores poor and vulnerable families (approximately 55 crore beneficiaries) that form the bottom 40% of the Indian population.
Key features of PM-JAY
-PM-JAY provides a cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation across public and private empanelled hospitals in India.
-Over 12 crore poor and vulnerable entitled families (approximately 55 crore beneficiaries) are eligible for these benefits.
-PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
-PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.
-It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
-There is no restriction on the family size, age or gender. All pre–existing conditions are covered from day one.