West Bengal signed an MoU with the National Health Authority on 8 June 2026 to implement Ayushman Bharat PM-JAY, becoming the 36th State/UT; Swasthya Sathi beneficiaries will be merged into the national network for cashless secondary and tertiary care up to ₹5 lakh per family with interstate portability.
State Adoption and Integration
- 36th State/UT: West Bengal’s MoU completes adoption of PM-JAY across all States and Union Territories.
- Scheme Integration: Existing Swasthya Sathi beneficiaries to be migrated into the central PM-JAY database and empanelment network.
- Portability: Beneficiaries eligible for cashless treatment at any empanelled public or private hospital nationwide.
Entitlement and Clinical Scope
- Cover: Up to ₹5 lakh per eligible family per year for secondary and tertiary hospitalisation.
- Procedure Range: Over 1,900 procedures across 24 super‑speciality fields (oncology, neurosurgery, cardiovascular etc.).
- Continuity: Pre‑existing conditions covered from day one; pre‑hospitalisation diagnostics up to 3 days; post‑hospitalisation expenses for 15 days.
- Exclusions: OPD, cosmetic surgery, fertility treatment, rehabilitation programmes and standalone diagnostic tests.
Funding and Governance
- Funding Ratios: Centre–State split typically 60:40; Northeastern states, Jammu & Kashmir, Himachal Pradesh and Uttarakhand 90:10; Union Territories without legislatures 100% central funding.
- Administrative Bodies: National Health Authority (apex) and State Health Agencies (implementation and hospital empanelment).
Beneficiary Identification
- Selection Basis: Objective SECC‑2011 deprivation and occupational criteria used for initial household selection.
- Rural Deprivation: Single‑room kucha houses, landless manual labour, female‑headed no adult male 16–59, SC/ST households.
- Urban Occupational Clusters: Street vendors, domestic workers, construction labour, ragpickers, sanitation and transport workers.
Senior Citizens (70+) Vertical
- Universal Coverage: All persons aged 70+ covered irrespective of income or family status.
- Card and Modalities: Ayushman Vay Vandana Card; isolated top‑up for 70+ within PM‑JAY families; distinct family cover if the family is otherwise uncovered.
- Service Options: 70+ retain choice to remain in CGHS/ECHS/CAPF or shift to PM‑JAY; PM‑JAY can operate parallel to private insurance/ESI.
IASPOINT Booster Facts
- Launch Date: PM‑JAY launched 23 September 2018 as part of Ayushman Bharat (alongside Health and Wellness Centres).
- Model: Centrally sponsored, entitlement‑based national health assurance programme with centralised medical benefit package and state implementation.