Ministry of Health and Family Welfare

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

(AB-PMJAY)

Posted On: 23 JUL 2021 5:01PM by PIB Delhi

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was launched on 23rd
September 2018. The salient features of AB-PMJAY are:

1. AB-PMJAY is the world’s largest Government funded health assurance scheme.

2. AB-PMJAY provides health assurance of up to Rs.5 Lakh per family per year for secondary
and tertiary healthcare hospitalizations.

3. AB-PMJAY is a completely cashless and paperless scheme.

4. The benefits under AB-PMJAY are portable across the country.

5. There is no cap on family size, or age or gender.

6. The beneficiary families under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana
(AB-PMJAY) have been identified from the Socio Economic Caste Census (SECC) of 2011 on the
basis of select deprivation and occupational criteria across rural and urban areas. Details are as
below:

Detailed list of criteria for eligibility under AB-PMJAY as per SECC 2011

Automatically included:

Households without shelter

Destitute/ living on alms
Manual scavenger families
Primitive tribal groups
Legally released bonded labour

Deprivation criteria in rural area:

D1: Only one room with kucha walls and kucha roof

D2: No adult member between age 16 to 59

D3: Female headed households with no adult male member between age 16 to 59

D4: Disabled member and no able-bodied adult member

D5: SC/ST households

D7: Landless households deriving major part of their income from manual casual labour

Occupational criteria in urban area:

i. Rag picker
ii. Beggar

iii. Domestic worker

iv. Street vendor/ Cobbler/hawker / Other service provider working on streets

v. Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie

and other head-load worker

vi. Sweeper/ Sanitation worker / Mali

vii. Home-based worker/ Artisan/ Handicrafts worker / Tailor

viii. Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/

Rickshaw puller
ix. Shop worker/ Assistant/ Peon in small establishment/ Helper/ Delivery assistant / Attendant/

Waiter
x. Electrician/ Mechanic/ Assembler/ Repair worker/Washer-man/ Chowkidar

7. The number of eligible beneficiaries under SECC 2011 is 10.74 crore (50 crore people). 33
States/UTs implementing AB-PMJAY have further expanded the coverage of the scheme to
include 13.44 crore families (65 crore people).

8. AB-PMJAY is being implemented in all States and UTs barring West Bengal, NCT of Delhi
and Odisha.

9. The scheme is implemented across the country through a three-tier model. National
Health Authority, an attached office of the Ministry of Health and Family Welfare with full
functional autonomy, is the apex body implementing AB-PMJAY across the country. For effective
implementation of AB-PMJAY at States/UTs level, State Health Agencies (SHAs) have been
established. District Implementation Units (DIUs) have been set up for ensuring on-ground
coordination between scheme stakeholders and for smooth implementation.

10. AB-PMJAY is completely funded by the Government and costs are shared between Central
and State Governments in the ratio as per the extant directives issued by Ministry of Finance.

11. The States/UTs have been provided with the flexibility to implement the scheme in the
operational model best suited to the local conditions. Thus, AB-PMJAY is being implemented in
Insurance mode, Mixed mode and Trust mode.
As regards procedure involved, AB-PMJAY is an entitlement-based scheme. All the eligible
beneficiary families are covered from day one of the implementation of the scheme in the
States/UTs. AB-PMJAY does not require enrolment. However, beneficiary verification
process is being undertaken to verify the genuineness of the beneficiary. Ayushman cards
are issued to all eligible beneficiaries as part of this process to ensure easy availing of
health benefits.

Targets are not fixed for AB-PMJAY as the scheme operates on the basis of beneficiary
demand for healthcare services. All the eligible beneficiaries of the implementing
States/UTs are entitled for free healthcare services under the scheme from the day of
launch of the scheme.

A total of 1.96 crore hospital admissions worth Rs. 24,315 crores have been authorized
through a network of approximately 23,000 Empanelled Health Care Providers (EHCPs).

State wise details of Ayushman-cards issued, authorized hospitals admissions by count and
amount under AB-PMJAY and schemes converged with AB-PMJAY are as follows:

State/UT Ayushman Authorized Value of

cards Hospital Admissions authorized
issued # hospital
admissions
(in Rs)

Andaman and
Nicobar 33,844 651 16,011,653
Islands

Andhra
Pradesh* 11 1,245,956 35,454,214,219

Arunachal
Pradesh 22,726 1,812 31,559,579

Assam
12,420,824 252,251 3,749,546,919

Bihar
6,869,237 287,389 2,770,023,718

Chandigarh
63,524 11,406 81,696,009
Chhattisgarh
13,240,939 1,551,997 15,108,847,365

Dadra and
Nagar Haveli 416,028 67,444 455,095,733
| Daman and
Diu

Goa
21,867 10,282 331,417,452

Gujarat
7,641,318 2,426,337 36,636,319,474

Haryana
2,616,418 290,815 3,588,146,295

Himachal
Pradesh 1,075,101 96,035 1,077,353,995

Jammu and
Kashmir 4,794,200 200,034 1,860,995,910

Ladakh
93,516 1,615 18,187,716

Jharkhand
8,992,890 867,385 8,767,034,692

Karnataka
9,782,602 1,581,386 17,576,957,813

Kerala
6,621,730 2,478,238 19,135,502,001

Lakshadweep
1,636 1 1,800

Madhya
Pradesh 24,791,352 853,881 12,140,065,052

Maharashtra
7,162,216 479,528 12,416,017,419
Manipur
313,634 36,759 453,214,817

Meghalaya
1,655,716 287,303 2,210,910,884

Mizoram
356,647 55,878 576,271,260

Nagaland
258,083 19,194 277,952,667

Puducherry
250,454 6,184 31,688,824

Punjab
7,021,511 756,583 8,631,451,965

Rajasthan* -
1,336,147 7,809,870,450

Sikkim
36,667 4,012 37,808,637

Tamil Nadu
24,727,508 3,102,787 38,240,413,903

Tripura
1,255,479 99,404 670,014,773

Uttar
Pradesh 14,189,874 769,531 7,965,274,653

Uttarakhand
3,973,158 308,192 3,960,546,591

West -
Bengal@ 17,636 170,981,470

Undefined&
762,296 122,244 903,192,165
 Note:
* - Details of individual beneficiary card holders are not available for Rajasthan and Andhra
Pradesh
# - Total Ayushman cards data also includes 4.68 Crore beneficiary cards issued by State using
State IT systems
@ - West Bengal was initially implementing the scheme. On 10th January 2019, the State
Government decided to withdraw from the implementation of the scheme

& - State related information for some transactions is not available as certain implementation
data had been shared offline

The funds allocated for the scheme for the current financial year 2021-22 are Rs. 6400 crore.

Following the onset of Covid-19, AB-PMJAY provided valuable support to the healthcare
ecosystem by ensuring that beneficiary registration process was kept active and empanelled
hospitals continued to provide services to the scheme beneficiaries. However, there was a
noticeable impact on the uptake of the scheme on account of factors such as restriction of
mobility, restrictions on elective surgeries, reluctance from scheme beneficiaries to visit
hospitals due to fear of infection and designation of public facilities as dedicated COVID centres.
During the period from 01stMarch 2020 –19thJuly 2021, a total of approx. 1.05 crore hospital
admissions worth approx. Rs. 11,862 crore have been authorized under AB-PMJAY.

As on 20.07.2021, a total of 16.14 crore Ayushman cards have been issued to the scheme
beneficiaries.

AB-PMJAY provides services only for inpatient treatment, therefore, only hospitals providing
inpatient services are empanelled under this scheme.

Accordingly, NHA has developed guidelines for empanelment of hospitals under the scheme. The
empanelment of hospitals under AB-PMJAY is done for general treatment and for treatment
under particular speciality. The guidelines for empanelment of hospitals under AB-PMJAY can be
accessed on PMJAY website. (https://pmjay.gov.in/sites/default/files/2020-06/Empanelment-and-
De-empanelment-guidelines.pdf )

Since the empanelment of hospitals under AB-PMJAY is primarily done by the respective
State/UT Governments, flexibility has been provided to the State/UT Governments to modify the
empanelment criteria based on local requirements including supply and demand.

As on 20th July 2021, approx. 23,000 hospitals have been empaneled under AB-PMJAY by various
State/UT Governments. The State/UT wise details of the empaneled hospitals are at Annexure-III.

Under Ayushman Bharat Health and Wellness centre, Government of India is committed to
establish 1,50,000 Health and Wellness Centres (AB-HWCs) by upgrading the Sub Health
Centres (SHCs) and rural and urban Primary Health Centres (PHCs) to bring health care closer to
the community.

As on 20th July 2021, 77,406 AB-HWCs are operational across the country. Details are at Annexure
- IV.
Details of financial assistance provided to States/UTs are at Annexure – V.

AB-PMJAY provides treatment corresponding to a total of 1669 procedures under 26 different

specialties including chronic diseases like Cancer, Diabetes, Heart Disease and other non-
communicable diseases and renal and corneal transplant. The specialty wise breakup of
packages is provided under Annexure – VI.

Chemotherapy and Radiotherapy packages, along with surgical oncology are covered as part of
cancer treatment under the scheme.

Additionally, there is a category of unspecified packages which can be booked for procedures
which are not defined in the Health Benefit Packages (HBPs).

The following measures have been adopted by NHA to offer state-of-the-art healthcare service
delivery under AB-PMJAY

Public hospitals empanelled under AB-PMJAY are reimbursed for treatment provided under the
scheme at par with cost reimbursed to their private sector counterparts. These funds can be
leveraged by such institutions to carry out infrastructural development and establish state-of-
the-art facilities. NHA has issued necessary guidelines and instructions to the SHAs and public
hospitals to encourage the same. Many States have effectively used the funds allotted to public
hospitals for infrastructure upgradation and for providing better amenities to beneficiaries.
A targeted approach is being followed to empanel the top corporate hospitals in the country
under AB-PMJAY.
NHA has partnered with Quality Council of India to develop a quality certification program for
empanelled hospitals. AB-PMJAY quality certifications include Bronze, Silver and Gold Quality
certifications. Hospitals achieving PMJAY Gold, Silver and Bronze certifications are provided
15%, 10% and 5% higher package rates respectively. As on 19th July, 2021 over 200 empanelled
hospitals have been Quality Certified under the scheme.
Further, if an empanelled hospital attains entry level NABH accreditation, it is incentivized by
reimbursing the cost of treatment at a rate which is 10 per cent higher that the standard
package rates. Similarly, a PMJAY empanelled hospital attaining full NABH accreditation is paid
15 percent higher rate.

These incentives have been designed to promote state-of-the-art healthcare service delivery
under AB-PMJAY.

Beneficiary families under AB-PMJAY have been identified from the SECC-2011 database on the
basis of 6 deprivation criteria and 11 occupational criteria across rural and urban areas
respectively. Details are at Annexure – I.
Representations have been received regarding the inclusion of families under AB-PMJAY.
However, the beneficiary database under the scheme has been frozen with the approval of the
Union Cabinet.
At the same time, it may be noted that the 33 States/UTs implementing the scheme have
expanded the scope of AB-PMJAY to include other categories of beneficiaries beyond SECC 2011
at their own cost. As on 20th July, 2021, approximately 13.44 crore beneficiary families are
covered under AB-PMJAY.
With respect to Assam, it may be noted that in addition to AB-PMJAY, the Government is
implementing a local health insurance scheme known as “Atal Amrut Abhiyan” (AAA).

AAA is an enrolment-based scheme, providing insurance coverage of up to Rs. 2 Lakh per year to
every entitled family in the State. Moreover, those families belonging to the APL category with
income between Rs. 1.2 Lakh and 5 Lakh per annum can also avail the benefit of AAA by paying a
nominal premium of Rs. 100/- per year per member. Thus, eligible beneficiaries can avail
services under either of these schemes.

National Health Authority has entered into a collaboration with WHO to carry out research and
evaluation studies. In this regard, a study on “Mainstreaming quality in empaneled hospitals
under PMJAY” is being conducted in three States viz. Haryana, Gujarat and Uttar Pradesh.

Annexure – III

State/UT list of empanelled hospitals in AB-PMJAY

State/UT PHC CHC Other Govt. Private Hospitals Total

Hospitals Hospitals

Andaman and Nicobar 3 0 3

Islands

Andhra Pradesh 774 565 1339

Arunachal Pradesh 2 3 35 1 41

Assam 12 15 185 159 371

Bihar 265 152 193 266 876

Chandigarh 1 7 18 26

Chhattisgarh 720 162 133 442 1457

Dadra and Nagar Haveli 0 3 4 0 7

| Daman and Diu
Delhi 32 64 96

Goa 7 6 6 13 32

Gujarat 310 222 1367 530 2429

Haryana 95 81 391 567

Himachal Pradesh 3 35 111 82 231

Jammu and Kashmir 1 44 138 43 226

Ladakh 7 3 0 10

Jharkhand 2 143 130 514 789

Karnataka 2894 542 3436

Kerala 1 33 158 520 712

Lakshadweep 2 4 0 6

Madhya Pradesh 8 277 167 419 871

Maharashtra 296 669 965

Manipur 4 9 46 11 70

Meghalaya 112 27 25 18 182

Mizoram 54 4 31 5 94

Nagaland 34 20 30 14 98

Odisha 30 1 31

Puducherry 4 8 11 23

Punjab 2 133 109 634 878

Rajasthan 2 594 189 785

 Sikkim 10 1 11

Tamil Nadu 1541 1580 3121

Telangana 12 17 29

Tripura 79 22 37 2 140

Uttar Pradesh 19 820 263 1612 2714

Uttarakhand 62 62 101 225

West Bengal 61 7 68

Annexure – IV

Functional Health and Wellness Centres as on 20th July 2021

S.No. STATE Functional HWCs as on 20th July 2021

SHC- PHC- UPHC- TOTAL

HWC* HWC** HWC***

1 Andaman & Nicobar 58 17 5 80

Islands

2 Andhra Pradesh 2,904 1,145 243 4,292

3 Arunachal Pradesh 136 63 4 203

4 Assam 1,539 617 53 2,209

5 Bihar 1,057 1,019 98 2,174

6 Chandigarh 0 28 28

7 Chhattisgarh 2,457 634 45 3,136

8 Dadra & Nagar Haveli 52 8 60

 Daman & Diu 26 4 30

9 Goa 53 54 5 112

10 Gujarat 4,468 1,469 316 6,253

11 Haryana 430 360 100 890

12 Himachal Pradesh 554 497 14 1,065

13 Jammu & Kashmir 915 378 16 1,309

14 Jharkhand 1,378 177 54 1,609

15 Karnataka 3,298 2,166 365 5,829

16 Kerala 1,520 859 93 2,472

17 Ladakh 69 20 89

18 Lakshadweep 0 3 3

19 Madhya Pradesh 5,098 1,124 145 6,367

20 Maharashtra 6,376 1,824 457 8,657

21 Manipur 154 55 2 211

22 Meghalaya 182 78 19 279

23 Mizoram 120 53 8 181

24 Nagaland 168 48 7 223

25 Odisha 316 1,229 90 1,635

26 Puducherry 80 39 2 121

27 Punjab 2,270 328 93 2,691

28 Rajasthan 160 1,957 280 2,397

 29 Sikkim 74 16 1 91

30 Tamil Nadu 3,027 1,381 460 4,868

31 Telangana 1,875 634 223 2,732

32 Tripura 241 33 5 279

33 Uttar Pradesh 6,644 1,656 435 8,735

34 Uttarakhand 536 359 38 933

35 West Bengal 4,041 783 339 5,163

Total 52,276 21,115 4,015 77,406

Delhi does not implement HWC Programme

*- Sub Health Centre Health and Wellness Centre

**- Primary Health Centre Health and Wellness Centre

***- Primary Health Centre Health and Wellness Centre

Annexure – V

Central Release (allocation) for the activity Ayushman Bharat - Health & Wellness Centres
for the FY 2018-19 to 2020-21 (Rupees in crore)

S. Name of the State/UT Allocation in Allocation in Allocation in

No. 2018-19 2019-20 2020-21

1 Andaman & Nicobar Islands 0.80 0.85 1.16

2 Andhra Pradesh 43.51 52.44 59.38

3 Arunachal Pradesh 8.15 8.59 14.80

4 Assam 68.67 97.60 89.69

5 Bihar 88.50 88.78 119.22

6 Chandigarh 0.71 0.84 1.51

7 Chattisgarh 36.42 65.66 28.08

8 Dadra & Nagar Haveli and 1.13 1.64 2.09

Daman & Diu

9 Delhi - - -

10 Goa 0.79 1.26 0.88

11 Gujarat 44.64 49.98 69.75

12 Haryana 18.45 24.03 29.02

13 Himachal Pradesh 16.08 27.21 25.87

14 Jammu & Kashmir 32.66 38.88 39.27

15 Jharkhand 26.02 75.81 -

16 Karnataka 47.98 54.70 75.51

17 Kerala 18.43 21.65 27.73

18 Lakshadweep 0.18 0.26 0.24

19 Madhya Pradesh 87.74 87.82 140.35

20 Maharashtra 91.27 97.64 138.60

21 Manipur 5.44 9.22 8.06

22 Meghalaya 8.64 12.46 9.17

23 Mizoram 4.03 5.19 5.25

24 Nagaland 5.01 5.34 6.22

25 Orissa 48.34 95.49 77.06

26 Puducherry 14.46 0.22 -

 27 Punjab 19.69 20.39 22.17

28 Rajasthan 83.70 68.64 62.63

29 Sikkim 2.16 1.62 2.71

30 Tamil Nadu 56.41 89.12 82.65

31 Tripura 10.18 13.57 9.27

32 Uttar Pradesh 176.10 330.85 279.52

33 Uttarakhand 19.62 30.31 26.93

34 West Bengal 59.47 61.55 99.44

35 Telangana 46.14 33.70 35.94

36 Ladakh 7.36

Total 1,191.52 1,573.31 1,597.53

Note: 1. The above releases relate to Central Govt. Grants & do not include State share
contribution.

Annexure – VI

Specialty wise breakup of packages and procedures under AB-PMJAY

S. No. Specialty HBP 2.1

Code Packages Procedures

1 Burns Management BM 6 21

2 Cardiology MC 21 27

3 Cardio-thoracic & Vascular SV 35 129

surgery
4 Emergency Room Packages ER 3 4

5 General Medicine MG 81 106

6 General Surgery SG 105 159

7 Infectious Diseases ID 3 3

8 Interventional Neuroradiology IN 10 15

9 Medical Oncology MO 72 264

10 Mental Disorders Packages MM 10 10

11 Neo-natal care Packages MN 10 10

12 Neurosurgery SN 61 94

13 Obstetrics &Gynaecology SO 60 80

14 Ophthalmology SE 41 54

15 Oral and Maxillofacial Surgery SM 14 19

16 Orthopedics SB 74 134

17 Organ & Tissue Transplant OT 1 6

18 Otorhinolaryngology SL 35 79

19 Pediatric Medical management MP 48 67

20 Pediatric surgery SS 19 35

21 Plastic & reconstructive Surgery SP 8 12

22 Polytrauma ST 10 23

23 Radiation Oncology MR 14 46

24 Surgical Oncology SC 80 125

 25 Urology SU 96 146

26 Unspecified Surgical US 1 1

Total 918 1669

The Union Minister of State for Health and Family Welfare, Dr. Bharati Pravin Pawar stated this
in a written reply in the Lok Sabha here today.

****

MV

HFW/PQ/AB-PMJAY/23rdJuly2021/14

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