PMJAY vs ESI — Which Scheme Covers You?
PMJAY (Ayushman Bharat) and ESI (Employees’ State Insurance) are both government health schemes, but they serve completely different populations. Understanding which one covers you — and what benefits each provides — helps you access the right healthcare.
Key Differences
Who is covered: PM-JAY covers economically weaker families identified through SECC 2011 data — approximately 55 crore people. ESI covers organised sector employees earning up to ₹21,000/month and their dependents — approximately 13 crore people.
Funding: PM-JAY is fully government-funded (60% central, 40% state). ESI is contributory — employees pay 0.75% of wages and employers pay 3.25%. ESI functions like employer-employee insurance.
OPD coverage: PM-JAY does NOT cover OPD consultations — only hospitalisation. ESI covers both OPD and IPD, including regular doctor visits, medicines, and diagnostic tests at ESI dispensaries.
Coverage limit: PM-JAY provides ₹5 lakh per family per year. ESI has no upper cap — all medically necessary treatment is covered without a monetary ceiling.
Hospital network: PM-JAY uses empanelled hospitals — both government and private. ESI primarily uses ESI hospitals and dispensaries, with limited empanelled private hospitals.
Additional benefits: ESI provides sickness benefit (paid leave during illness), maternity benefit (26 weeks paid leave), disability benefit, and dependent benefit (pension for family if worker dies). PM-JAY provides only hospitalisation coverage.
Can You Have Both?
If you are an ESI-registered employee, you are typically NOT eligible for PM-JAY. The government considers ESI employees as already covered. However, if your ESI contribution has lapsed (e.g., you lost your job), you may still be in the SECC database and eligible for PM-JAY. Check your eligibility by calling 14555.
Which Has Better Hospitals?
PM-JAY has a larger and more diverse hospital network — over 27,000 empanelled hospitals including major private chains. ESI’s own hospitals are limited to about 155 hospitals and 1,500 dispensaries, though ESIC has been expanding its empanelled private hospital network. For advanced treatments like cardiac surgery, neurosurgery, or cancer treatment, PM-JAY often offers more hospital choices.
Find PM-JAY hospitals: Search all PMJAY empanelled hospitals across India
Disclaimer: PMJAYHospitals.com is an independent directory. For official information, visit pmjay.gov.in or call 14555.