India now runs two large, separately-growing health-cover systems at once. On one track, the government's Ayushman Bharat PM-JAY has issued over 48.5 crore cards (up from 43.52 crore when this piece was first written) and reached every state and union territory as of June 2026, after West Bengal became the last holdout to join. On the other, private individual health insurance premiums grew nearly 30% in the six months after a September 2025 GST exemption, and international reinsurers are opening branches in GIFT City at a pace that's tripled the sector's local capacity this year. Both are real growth stories. What this piece checks is whether they're actually the same story — whether public scheme coverage and private insurance uptake move together, substitute for each other, or barely touch — using the state-level and research data available, not assumption.
Policy · Insurance · Healthcare Finance
India's Two Tracks of Health Cover, and Where They Actually Meet
1. The public track: PM-JAY's scale, and how states actually run it
Ayushman Bharat PM-JAY offers eligible families up to ₹5 lakh per year in cashless secondary and tertiary care. As of this piece's original reporting, 43.52 crore Ayushman cards had been created nationally, with 12.69 crore cumulative hospital admissions authorised as of 30 June 2026 and over ₹1.92 lakh crore in approved claims. Update, 27 September 2026: by the scheme's 8th anniversary (23 September 2026), the government reported over 48.54 crore Ayushman cards created, 13.25 crore hospital admissions funded (as of 31 August 2026), and ₹2.03 lakh crore in treatment support — roughly 5 crore more cards issued in under three months. Source: organiser.org, ddindia.co.in and thenewsmill.com coverage of the anniversary, citing NHA/government figures. The scheme reached full national coverage in mid-2026: West Bengal, the sole remaining holdout, signed its implementation MoU with the National Health Authority on 8 June 2026, bringing an estimated 1.43 crore families (roughly 6 crore individuals) into the scheme.
What's less visible in the headline numbers is that states don't all run PM-JAY the same way. Most operate in trust mode — the state government directly bears claim risk rather than buying an insurance policy. Four states (Gujarat, Jharkhand, Rajasthan and West Bengal) use a hybrid trust-insurer structure, and Tamil Nadu alone runs a pure insurance-company model. Research comparing the two dominant approaches found the trust model processes claims more slowly and with a higher rejection rate, but costs less per beneficiary enrolled — a real trade-off between claimant experience and fiscal cost, not a case where one model is simply better.
The more important structural fact for this piece: several states don't stop at PM-JAY's ₹5 lakh cap. Tamil Nadu's CMCHIS and Odisha's BSKY both add state-funded coverage on top of the central scheme rather than replacing it, and Rajasthan's Chiranjeevi Yojana goes further still — universal, all-family coverage layered onto the PM-JAY base. This is convergence, not competition: the state schemes assume PM-JAY as a floor and build upward from it.
2. The private track: a real GST-driven acceleration, and a low base
India's insurance penetration — premiums as a share of GDP — sits at 3.7%, well below the 7.3% global average, even after a decade of PM-JAY. But the growth rate has genuinely accelerated on the private side too. The GST Council recommended, and the government implemented from 22 September 2025, a full GST exemption on individual life and health insurance policies (including family floater plans), explicitly framed as supporting an "Insurance for All" goal. The effect shows up directly in premium collection data: individual health insurance premiums (including family floater) grew 29.7% in the October–March 2025-26 period, against 7.0% growth in the same period a year earlier — roughly a fourfold jump in growth rate. Individual life insurance saw a smaller but still real acceleration, 11.2% versus 7.7%. IRDAI subsequently confirmed to the Finance Department that insurers had not raised base premium rates to offset the tax cut — the relief was actually passed through to policyholders, not absorbed.
| Category | Growth, Oct–Mar 2024-25 | Growth, Oct–Mar 2025-26 (post-GST-exemption) |
|---|---|---|
| Individual health insurance (incl. family floater) | 7.0% | 29.7% |
| Individual life insurance | 7.7% | 11.2% |
Source: reported via VATupdate, 4 August 2026, citing a2ztaxcorp.net; the underlying government/IRDAI dataset was not independently located for this piece, so treat this as a secondary-sourced figure consistent with IRDAI's own public confirmation that the exemption's benefit reached policyholders, not a primary-filing citation.
3. The actual linkage: complement, not substitute
The intuitive assumption is that PM-JAY's expansion should crowd out private insurance demand — why buy a policy if the government already covers ₹5 lakh of hospitalisation? The research evidence points the other way. Studies of PM-JAY's effects on hospital-utilisation patterns found that enrollment is associated with a higher, not lower, probability of visiting a private facility — roughly a 4.6 percentage-point increase — and a broader shift in utilisation from public to private hospitals among covered beneficiaries. PM-JAY appears to function as a demand-side subsidy that makes private care newly affordable for beneficiaries who couldn't previously access it, rather than a substitute that displaces private-sector demand once someone already has (or could afford) a private policy.
That reframes the two tracks: PM-JAY is expanding access for the population that couldn't previously pay for private care at all, while the GST-driven private premium growth is happening among the population that already could, and is now doing so more cheaply. They're not competing for the same household's decision so much as operating on different segments of the same underlying gap — the roughly 43% of India's total health expenditure that NHA 2022-23 still records as out-of-pocket is the space both tracks are separately trying to shrink, from opposite ends of the income distribution.
4. The supply side: reinsurance capacity is arriving specifically for this gap
A less-covered part of the same story is happening on the supply side, in GIFT City. India's International Financial Services Centres Authority (IFSCA) has approved a wave of new reinsurance branches through 2026: International General Insurance (IGI), Singapore Reinsurance Corporation, Santam, Abu Dhabi National Insurance, Eurasia Insurance, Korean Re, Kuwait Re, Peak Re, Saudi Re, Allianz, Generali, Starr International, Qatar Re, Doha Re and Lloyd's have all either received licences or begun operations in GIFT City's insurance offices (IIOs) this financial year, taking the count of active IIOs from roughly 8 to around 24. Several of these entrants have specifically flagged health reinsurance — alongside surety bonds, parametric cover, marine and cyber risk — as an underdeveloped product line they intend to build out in India, precisely because domestic reinsurance capacity for health risk has lagged the growth in both PM-JAY's claim volume and private health premium collection documented above.
That's a genuine structural link between the two tracks this piece has been describing: more reinsurance capacity lowers the cost of writing health risk for both a state's PM-JAY-adjacent scheme and a private insurer's individual policy book, since both ultimately need reinsurance backing to absorb catastrophic claims. It's a capacity story sitting underneath both the public and private demand-side growth already covered, not a third, separate track.
Related on this blog
See also: ABHA: What India's 14-Digit Health ID Actually Does, in the Real Numbers · India Cannot Sell “China-Free” Medicine While Importing 43% of What’s In It · Foreign Capital Found India’s Hospitals — It Is Buying Them, Not Building New Ones
What would fix this
- IRDAI should publish monthly premium growth for individual health (including family floater) and individual life policies in its own statistical release, so that the post-GST-exemption jump from 7.0% to 29.7% can be checked against primary data rather than a secondary tax-news source.
- The National Health Authority should publish, state by state, PM-JAY claim settlement time and rejection rate alongside each state’s operating model — trust, hybrid or insurance, so that the speed-versus-cost trade-off research has found can be tracked from official data every year.
- The National Health Authority should publish PM-JAY admissions split by public and private hospitals for each state annually, so that the shift towards private facilities that studies associate with enrolment can be monitored directly as the scheme reaches all 36 states and UTs.
- The health departments of Tamil Nadu, Odisha and Rajasthan should publish annual beneficiary and claim figures for CMCHIS, BSKY and Chiranjeevi separately from the PM-JAY component, so that how much state top-ups add above the ₹5 lakh floor is measurable.
- IFSCA should publish annual health reinsurance premium written by GIFT City insurance offices, so that whether the roughly 24 active offices actually build the health line several entrants have flagged can be checked, rather than inferred from licence counts.
These are proposals from this blog, not recommendations any agency has adopted.
Sources
- PIB, "Union Health Ministry Releases the National Health Accounts Estimates for India 2022-23," 27 May 2026 — government/out-of-pocket health expenditure shares
- National press coverage of PM-JAY's Ayushman card count, hospital admissions and claims, and West Bengal's 8 June 2026 accession as the 36th state/UT to join AB PM-JAY
- PMC/NCBI, "The trust and insurance models of healthcare purchasing in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in India" — state-level operating model comparison (trust/hybrid/insurance)
- PLOS One and Health Systems & Reform (Tandfonline), research on PM-JAY's effect on private-facility utilisation and hospitalisation patterns
- Department of Financial Services, Ministry of Finance, "Exemption of GST on all Individual Life Insurance and Health Insurance Policies," effective 22 September 2025
- VATupdate, "GST Exemption Boosts Individual Life and Health Insurance Affordability, Premium Growth Surges," 4 August 2026, citing a2ztaxcorp.net — premium growth figures
- Insurance Business Magazine, Reinsurance News, Insurance Journal and Life Insurance International reporting on IFSCA approvals for new GIFT City reinsurance branches through 2026
This article is a policy and market explainer, not investment, insurance-purchasing or medical advice. Figures on scheme enrollment, premium growth and reinsurer entry are current as of their stated reporting dates and will change as both tracks continue to grow; the GST-driven premium growth figures are drawn from a secondary source (VATupdate, citing a2ztaxcorp.net) rather than a primary IRDAI filing located directly for this piece, and should be treated accordingly. Anyone making a decision about a specific insurance policy or a state health scheme should consult the scheme's official portal or a licensed adviser rather than this piece.
About this article: Researched, written and edited by Umashankar Triplicane Dwarakanathan, with AI research assistance; every figure is meant to trace to the primary source cited. See the Editorial Policy for how sourcing, AI use and corrections work.
