PM-JAY: Healthcare for India’s Vulnerable

PM-JAY: Expanding Healthcare Coverage for India’s Poorest and Most Vulnerable

The Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a health insurance initiative aimed at providing free healthcare access to India’s poorest 40% of the population, covering nearly 12 crore households. This initiative targets beneficiaries identified through the Socio-Economic Caste Census (SECC) 2011, which categorizes households based on deprivation and occupational criteria, ensuring the inclusion of those who are socio-economically vulnerable.

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Coverage for Rural and Urban Beneficiaries

For rural beneficiaries, PM-JAY includes families that meet at least one of six specific deprivation criteria or fall under automatic inclusion categories:

D1: One-room houses with kucha (mud) walls and roof.
D2: No adult member between ages 16-59.
D3: No adult male member between ages 16-59.
D4: Disabled member and no able-bodied adult.
D5: Scheduled Caste/Tribe (SC/ST) households.
D7: Landless households deriving income mainly from manual casual labor.
Automatic inclusion: Destitute individuals, households of manual scavengers, primitive tribal groups, and legally released bonded laborers.

For urban beneficiaries, eligibility is determined based on occupation, covering 11 categories of workers, such as ragpickers, domestic workers, street vendors, construction laborers, and sanitation workers, among others.

State Flexibility and Convergence

States are encouraged to align their health insurance schemes with PM-JAY. They may use their own databases if they already provide broader coverage than the SECC, provided that eligible SECC households are also included. The goal is to converge existing state schemes with PM-JAY, improve the consistency of coverage, and offer national portability of care. This convergence aims to standardize health insurance across states, expand accessibility to hospital services, reduce out-of-pocket expenses, and meet healthcare needs, especially for catastrophic illnesses.