Securing lives, strengthening India: The journey of Ayushman Bharat

However, this demographic advantage can be derailed due to the lack of adequate health infrastructure and health financing. In a developing nation like India, access to affordable and quality healthcare is an absolute necessity.

Every year, about 55 million Indians are pushed into poverty due to catastrophic health expenditures, according to a World Health Organization report. In a country aiming to emerge as one of the biggest economies of the world, such financial vulnerability undermines both social and economic progress. Health-related poverty not only affects a single individual or family but also impacts national productivity and development.


This is precisely where government backed health insurance schemes like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) become critical. Such schemes provide a safety net to millions and help make the country stronger. Let us dive into how AB-PMJAY has created a real impact on the ground.

What is covered? AB-PMJAY is a family floater scheme that offers a wide coverage for over 1900 procedures encompassing various costs related to the treatment, including surgeon charges, fee of the physician, ICU charges, diagnostic services to name a few.

Pre-hospitalisation expenses up to 3 days and post-hospitalisation expenses up to 15 days are also covered. One standout feature of the scheme is that it covers all pre-existing ailments from day one, which means the policy does not have a waiting period. The beneficiary can go to any empanelled public or private hospital across the country to receive cashless treatment.

Effect at the grassroots level: Launched in 2018, AB-PMJAY is probably one of the biggest health insurance schemes in the world that provides a coverage of INR 5 lakh per family for secondary and tertiary care hospitalisation. Targeting the bottom 40% of India's population, the scheme truly aimed to make health insurance more accessible in the country.

It covers over 12 crore families or roughly 55 crore individuals. According to the Economic Survey 2024-25, more than 36 crore Ayushman cards have been issued as of January 2025. The scheme has resulted in savings exceeding ₹1.25 lakh crore in out-of-pocket expenditures for families.

Further expansion: To expand the benefits of the scheme, the central government has taken some decisive measures focused on senior citizens. Now all senior citizens over the age of 70 are covered up to INR 5 lakh under the scheme, irrespective of their socio-economic background. This step aims to cover about 4.5 crore families, including 6 crore senior citizens.

One notable point is that senior citizens who were covered under AB-PMJAY will receive an additional top-up cover of INR 5 lakh. This top-up amount is specifically designated for the senior citizen, and cannot not be utilised by members below the age of 70.

A shining example of collaborative efforts: The success of AB-PMJAY is a testament to the collaborative efforts between the governments and insurance companies. Since the scheme operates through a mix of insurance and trust models, it allows states to choose the implementation mode that best suits their infrastructure. This has resulted in efficient administration and adaptability across diverse regions.

Talking about insurers, not only they help in efficient claims management of the scheme, but their expertise in underwriting and actuarial assessments helps optimise fund allocation and sustainability of the scheme. They also play a pivotal role in preventing fraud through robust systems and analytics.

Insurers act as crucial operational partners, ensuring seamless execution across different geographies. Ultimately, their collaboration with government bodies strengthens the backbone of the scheme.

As we commemorate Ayushman Bharat Diwas, it's crucial to acknowledge the strides made so far in taking health insurance to those who need it the most. The success of the scheme shows what phenomenal results can be achieved when governments and insurers join hands.

But we must remember this is just the beginning. As India aims to become a $5 trillion economy, health insurance must reach every citizen, as it will substantially reduce out-of-pocket expenses. Resultantly, people will have more money to spend on products and services, further boosting the economy in the right direction.

Adequate health insurance offers a life of dignity and secures a better tomorrow for every citizen. The journey ahead is long, but with focused efforts, compassion, and commitment, we can build a healthier and stronger nation.

(The author is MD & CEO, Bajaj Allianz General Insurance)

(Disclaimer: Recommendations, suggestions, views, and opinions given by experts are their own. These do not represent the views of the Economic Times)