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Difficulty: MediumSocial Sector Initiatives, Welfare Schemes, and Social Security Architecture

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) serves as a cornerstone of India's healthcare social security architecture by offering secondary and tertiary care hospitalization coverage. Which of the following statements regarding the structural design and eligibility criteria of AB-PMJAY are correct?

  1. It provides a health cover of up to ₹5 lakh per family per year for hospitalization without any ceiling on family size, age, or gender.Answer
  2. B
    The entire financial burden is borne 100% by the Central Government across all States and Union Territories as a Central Sector Scheme.
  3. Target beneficiary identification is based on specified occupational and socio-economic deprivation criteria mapped from the Socio-Economic Caste Census (SECC) 2011.Answer
  4. D
    Pre-existing medical conditions are mandatorily excluded from coverage during the initial two years of policy enrollment.

Answer

The correct statements are that AB-PMJAY provides ₹5 lakh health insurance per family per year without caps on size or age, and beneficiary identification is derived from the deprivation and occupational criteria of SECC 2011.
The statements highlighting the ₹5 lakh annual family cover with no cap on family size or age, alongside beneficiary selection grounded in SECC 2011 deprivation and occupational metrics, accurately describe AB-PMJAY's social security framework.

Step-by-Step Solution

1
Analyze financial coverage and demographic restrictions
AB-PMJAY provides a cashless cover of ₹5 lakh per family annually for secondary and tertiary care, explicitly omitting any restriction on family size, gender, or age.
Ensuring coverage for larger families and elderly dependents is vital for comprehensive social safety nets.
2
Examine the funding mechanism between Centre and States
AB-PMJAY operates as a Centrally Sponsored Scheme rather than a 100% Central Sector Scheme. The cost is shared between the Centre and State Governments.
Health is a State subject under the Seventh Schedule, requiring shared fiscal and operational responsibilities.
3
Verify beneficiary identification source and pre-existing condition rules
Beneficiaries are automatically identified via SECC 2011 deprivation criteria. Furthermore, pre-existing diseases are covered from the very first day without any waiting period.
Immediate coverage of pre-existing illnesses prevents out-of-pocket medical expenditure traps for vulnerable households.

Key Concept

Ayushman Bharat PM-JAY Architecture, Beneficiary Entitlement, and Fiscal Sharing
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Topics

Social Sector Initiatives, Welfare Schemes, and Social Security Architecture