Pradhan Mantri Jan Aarogya Yojana

A serious illness can wipe out a poor family's savings. Pradhan Mantri Jan Aarogya Yojana, also called PMJAY or Ayushman Bharat, exists to stop that from happening.

It targets poor and deprived rural families. It also covers some groups of urban workers. A family is eligible if it appears in a specific government list, called the SECC 2011 database. Once listed, every member of that family is covered. There is no limit on family size, age or gender.

The promise is simple. If a covered family member is hospitalised, the family pays nothing for the treatment.

Three features carry the real weight of this scheme, and the workbook states each plainly:

1. Eligibility comes from the SECC 2011 database. All members of an eligible family listed there are automatically covered — there is no separate application to prove eligibility once the family appears in that database.
2. No restriction on family size, age or gender — unlike a typical private health policy, a large family is not charged more, and no member is excluded for being too old or too young.
3. Pre-existing conditions are covered from day one of the policy, and the benefit covers pre- and post-hospitalisation expenses.

Treatment can be taken at public or empanelled private hospitals across the country, and the workbook states plainly that no money needs to be paid by the family for that treatment. It gives no specific sum-insured figure per family in this booklet.

The Yadav family — seven members across three generations, listed in the SECC 2011 database — is automatically covered under PMJAY, with no separate premium to pay and no restriction because of their family size.

When the grandmother, who already had a diagnosed heart condition before the policy existed, needs hospitalisation, the treatment is still covered — the workbook states pre-existing conditions are covered from day one of the policy, unlike many private health policies that impose a waiting period.

The family goes to an empanelled private hospital rather than a government one, and — exactly as the workbook states — pays nothing for the treatment itself.

Chapter 9 (Government Schemes for Various Savings and Investment Options) lists PMJAY-Ayushman Bharat as the third of the basic insurance schemes, after PMSBY and PMJJBY. Expect a question on the SECC 2011 eligibility database and on the day-one coverage of pre-existing conditions, which is unusual compared with typical health insurance.

• Eligibility is drawn from the SECC 2011 database, not from an income certificate applied for separately.
• No restriction on family size, age or gender — a question suggesting an age cap or a per-member limit is testing whether you know this is absent.
• Pre-existing conditions are covered from day one — this is the opposite of the waiting period typical of private health insurance, and a favourite point of contrast.
• The workbook gives no sum-insured figure for PMJAY in this booklet.