Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY)

What Is Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)?

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a government-funded health assurance scheme in India. It helps eligible families access covered hospital treatments without facing the full cost of hospitalisation themselves.

Under the scheme, eligible families receive up to ₹5 lakh per family per year for specified secondary and tertiary care hospitalisation. The benefit is available through government and private hospitals empanelled under PM-JAY, subject to approved treatment packages and scheme rules.

The scheme is administered by the National Health Authority (NHA), working with State Health Agencies. This guide explains PM-JAY eligibility, health benefits, coverage for senior citizens aged 70 and above, Ayushman Card services, hospital treatment and official assistance channels.

Ayushman Bharat Benefits: How Much Health Cover Is Available?

Eligible PM-JAY families receive an annual health cover of ₹5 lakh on a family-floater basis. This means the available annual limit is shared by eligible family members. It is not a separate ₹5 lakh allowance for each person.

Depending on the approved medical package, PM-JAY may cover:

1. Specified secondary and tertiary care hospitalisation.
2. Approved surgical and medical procedures.
3. Doctor and hospital charges associated with covered treatment.
4. Medicines, diagnostic tests and other services included in the approved package.
5. Eligible expenses for up to three days before hospitalisation and up to 15 days after discharge, as provided under the applicable package.
6. Covered treatment for pre-existing medical conditions.

Benefits are generally provided on a cashless basis at empanelled hospitals. However, not every medical service is covered. Routine outpatient consultations, medicines purchased independently and unrelated expenses should not be assumed to be included.

Patients should confirm that their treatment is covered under an approved PM-JAY package and available at the selected hospital.

Ayushman Bharat Coverage for Senior Citizens Aged 70 and Above

In 2024, the Government of India expanded AB PM-JAY coverage to Indian senior citizens aged 70 years or above, regardless of their income. Eligible senior citizens can receive a distinct Ayushman Vay Vandana Card.

The amount and arrangement of cover depend on whether the senior citizen's family is already covered under PM-JAY.

Senior Citizens in Families Already Covered by PM-JAY

If a family already benefits from PM-JAY, eligible members aged 70 or above can receive an additional annual top-up cover of up to ₹5 lakh. This additional cover is reserved for the eligible senior citizens and is not shared with family members below 70.

The existing PM-JAY family cover continues to operate according to the applicable rules.

Senior Citizens in Families Not Previously Covered by PM-JAY

Indian citizens aged 70 or above can also qualify for the senior-citizen benefit even when their families were not previously covered by PM-JAY.

In these cases, eligible senior citizens receive up to ₹5 lakh in annual coverage on a family basis. Each senior citizen does not automatically receive an independent ₹5 lakh limit.

What If a Senior Citizen Already Has Health Insurance?

According to the National Health Authority's guidance, eligible people aged 70 or above can receive PM-JAY coverage even if they have private health insurance or are covered under the Employees' State Insurance scheme.

Different rules apply to certain existing government health schemes, such as CGHS, ECHS and Ayushman CAPF. Senior citizens covered by such schemes may have to choose between their existing scheme and AB PM-JAY.

Important: NHA guidance indicates that changing from an existing government health scheme to PM-JAY can be a one-time, irreversible choice. Review the official conditions carefully before switching.

Who Is Eligible for Ayushman Bharat PM-JAY?

General PM-JAY eligibility has primarily been based on deprivation and occupational criteria from the Socio-Economic Caste Census (SECC) 2011. State-specific eligibility expansions and other applicable government provisions may also affect coverage.

Having a low income or a ration card does not automatically guarantee that a person is included. Eligibility needs to be checked against the applicable beneficiary database and scheme rules.

Rural Families

In rural areas, eligibility may include households identified under specified deprivation criteria. These can relate to housing conditions, landless manual labour and other social or economic circumstances recorded in the relevant beneficiary data.

The precise criteria are defined by the government. Not every rural household or agricultural worker automatically qualifies.

Urban Families

In urban areas, eligibility can be based on specified occupational categories, including certain domestic workers, construction workers, sanitation workers and other categories of informal-sector workers identified under the scheme.

Eligibility depends on the applicable database and government criteria, not merely on having a particular occupation.

Citizens Aged 70 Years or Above

Indian citizens aged 70 or above are eligible under the special senior-citizen expansion regardless of income, subject to identity, age and other required verification.

How to Check Ayushman Bharat Eligibility Online

To check whether your family is included in the scheme, use the official NHA Beneficiary Portal.

1. Open beneficiary.nha.gov.in.
2. Select the beneficiary login or relevant eligibility service displayed on the portal.
3. Complete the required mobile number and OTP verification.
4. Select your state and the applicable scheme, where prompted.
5. Search the beneficiary records using the information requested.
6. Review the available family and eligibility details.

If no matching record appears, do not assume that every application option is closed. Check whether another eligible category or applicable state scheme is available, and contact the official support service for clarification.

Eligibility information may also be available through the official Ayushman App, an authorised assistance centre or an Ayushman Mitra help desk at an empanelled hospital.

How to Apply for an Ayushman Card

The Ayushman Card helps establish the identity of an eligible beneficiary for accessing covered PM-JAY services. It is not the same as purchasing a health insurance policy or submitting an open application that guarantees approval.

For the general scheme, the process generally involves finding an eligible beneficiary record and completing the required identity verification.

1. Visit the official NHA Beneficiary Portal or use the official Ayushman App.
2. Log in using the authentication process displayed.
3. Search for the relevant beneficiary or family record.
4. Review the name, age and other identity details.
5. Complete Aadhaar-based e-KYC or another officially supported verification process.
6. Follow any instructions for approval or additional verification.
7. Download the Ayushman Card when it becomes available.

The exact process may differ depending on beneficiary category and the features available on the portal. Completing e-KYC does not guarantee coverage if the applicant does not meet the eligibility rules.

How to Download an Ayushman Card

If your Ayushman Card has been issued, you can look for the card download option through the official beneficiary services.

1. Open beneficiary.nha.gov.in.
2. Complete the required beneficiary login and verification.
3. Find your beneficiary record.
4. Check the card status.
5. Download the card if the option is available.
6. Keep the card safely for use when accessing covered hospital services.

If the card is not available, check whether identity verification, approval or another requirement is pending. Use official support channels rather than an unauthorised website or agent.

Which Treatments Are Covered Under Ayushman Bharat?

PM-JAY provides access to specified hospital treatment packages for eligible beneficiaries. These include a range of secondary and tertiary healthcare procedures, subject to current package definitions and hospital availability.

Examples of treatment areas that may have approved packages include:

1. Cardiac and cardiovascular procedures.
2. Selected cancer-related treatments.
3. Orthopaedic and surgical procedures.
4. Specified medical and surgical treatment for serious illnesses.
5. Other approved procedures included in the applicable health benefit package.

Listing a treatment category does not mean every procedure within that category is automatically covered. Package eligibility, pre-authorisation requirements and hospital capabilities must be confirmed.

PM-JAY primarily supports specified hospitalisation services. Some defined day-care procedures may also be covered, but general outpatient care should not be assumed to be free under PM-JAY.

How to Find an Ayushman Bharat Empanelled Hospital

PM-JAY benefits are available through participating government and private hospitals that have been empanelled under the scheme.

Not every hospital in India participates in PM-JAY, and an empanelled hospital may not provide every treatment package.

To find a participating hospital:

1. Visit the official PM-JAY Hospital Portal or use the hospital search facility linked from the current official portal.
2. Select the relevant state and district.
3. Review the listed hospitals.
4. Confirm whether the required treatment package is provided.
5. Contact the hospital's Ayushman Mitra desk before visiting, when practical.

PM-JAY includes portability of benefits. Eligible beneficiaries may be able to receive covered treatment at empanelled hospitals outside their home state, subject to scheme rules.

How to Get Cashless Treatment Using an Ayushman Card

When a beneficiary requires covered hospital treatment, the hospital's PM-JAY assistance team generally helps verify eligibility and process the required approval.

1. Choose an empanelled hospital that offers the required treatment.
2. Carry your Ayushman Card, if issued, and an accepted identity document.
3. Visit the Ayushman Mitra or PM-JAY assistance desk.
4. Complete beneficiary identity and eligibility verification.
5. Allow the hospital to confirm the appropriate treatment package and any required authorisation.
6. Receive covered treatment on a cashless basis according to the applicable scheme rules.

If an empanelled hospital asks for payment for a covered, authorised package or refuses assistance without a clear explanation, contact the official PM-JAY helpline or grievance service.

The scheme's cashless feature applies to covered treatment under its rules. It should not be interpreted as a promise that every possible hospital expense will be paid.

Documents Required for an Ayushman Card

Depending on the beneficiary category and verification process, the following documents or details may be useful:

1. Aadhaar or another officially accepted identity verification method.
2. An active mobile number for applicable OTP-based services.
3. Family or ration card details, if requested.
4. Information that matches the beneficiary database.
5. Age and identity verification for senior citizens aged 70 or above.
6. Any additional records requested by the authorised agency.

The exact requirements should be checked through the current official beneficiary portal. Applicants should not assume that a particular paper document is mandatory unless the official process requires it.

Ayushman Card vs ABHA Card: What Is the Difference?

The Ayushman PM-JAY Card and the ABHA number serve different purposes.

1. Ayushman PM-JAY Card: Relates to beneficiary identification and access to covered services under PM-JAY for eligible individuals.
2. ABHA Number: An Ayushman Bharat Health Account identifier used within India's digital health ecosystem to support health record access and sharing with appropriate consent.

Having an ABHA number does not automatically mean you are entitled to ₹5 lakh of PM-JAY coverage. PM-JAY eligibility must be established separately.

Frequently Asked Questions About Ayushman Bharat PM-JAY

1. How much health cover does Ayushman Bharat provide?

General PM-JAY provides eligible families with up to ₹5 lakh per year on a family-floater basis for covered hospital treatment packages.

2. Can anyone get an Ayushman Card?

No. General PM-JAY eligibility depends on applicable government criteria and beneficiary records. A separate expansion covers Indian senior citizens aged 70 or above regardless of income.

3. Are people aged 70 or above eligible regardless of income?

Yes. Indian citizens aged 70 or above can qualify under the senior-citizen expansion irrespective of income, subject to applicable verification requirements.

4. Does every family member receive a separate ₹5 lakh limit?

No. Standard PM-JAY coverage is shared by eligible family members. Specific additional top-up provisions apply to eligible senior citizens aged 70 or above in families already covered by PM-JAY.

5. Can I use my Ayushman Card at any private hospital?

No. The hospital must be empanelled under the scheme, and the relevant treatment must be available within an approved package.

6. Does PM-JAY cover routine OPD visits?

PM-JAY mainly covers specified hospitalisation and certain approved day-care procedures. Routine outpatient consultations are not automatically covered.

7. Can I get covered treatment in another state?

Yes. Eligible beneficiaries may access covered treatment at participating hospitals in other states under the scheme's portability provisions.

8. Is an ABHA card the same as an Ayushman PM-JAY card?

No. ABHA is a digital health identifier. An Ayushman PM-JAY card is associated with identification of eligible PM-JAY beneficiaries.

9. What is the Ayushman Bharat helpline number?

The national PM-JAY helpline number is 14555. Beneficiaries can also seek assistance through authorised hospital help desks and official NHA services.

10. What if my name is missing from the beneficiary list?

Check your details using the official beneficiary portal and confirm whether another applicable beneficiary category or state scheme is available. Contact the official helpline for assistance. Do not pay an agent who claims to guarantee eligibility.

11. Can senior citizens keep their existing government health scheme and also use PM-JAY?

Certain government health scheme beneficiaries may be required to choose between their existing scheme and AB PM-JAY. The NHA has warned that switching from some government schemes to PM-JAY is a one-time decision that cannot be reversed. Review the official rules before choosing.

Official Ayushman Bharat Websites and Support

For eligibility checks, beneficiary verification, Ayushman Card services and hospital information, use official government resources.

1. PM-JAY Official Website: pmjay.gov.in
2. National Health Authority: nha.gov.in
3. NHA Beneficiary Portal: beneficiary.nha.gov.in
4. Hospital Information: PM-JAY Hospital Portal
5. National Helpline: 14555
6. Official Senior-Citizen Guidance: NHA Senior Citizen FAQs

Disclaimer: e-Sarkari Yojna is an independent informational website. It is not operated by the Government of India or the National Health Authority. Scheme eligibility, benefits, package availability and verification requirements may change. Always confirm final details using official government sources before applying or sharing personal information.