Ayushman Bharat Yojana — ₹5 Lakh Free Health Cover

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is the world's largest government-funded health insurance scheme. Launched in September 2018, it provides free health coverage of ₹5 lakh per family per year to India's most vulnerable population — covering over 50 crore people from approximately 12 crore poor and lower-middle-class families.

What is Ayushman Bharat?#

AB PM-JAY is a health insurance scheme that covers hospitalization expenses up to ₹5 lakh per family per year at empanelled public and private hospitals. The scheme covers:

• Pre and post-hospitalization expenses
• Day care procedures (no overnight stay required)
• Pre-existing diseases from day one
• All family members (no cap on family size)
• Secondary and tertiary care hospitalization

The scheme is entirely funded by the government — beneficiaries pay zero premium.

Who is Eligible?#

Eligibility is based on the Socio-Economic Caste Census (SECC) 2011 database. You are eligible if your family is listed in SECC 2011 under the following categories:

Rural Families (any one criterion)

1. Families with only one room with kuccha walls and roof
2. Families with no adult member between 16–59 years
3. Female-headed households with no adult male member between 16–59 years
4. Families with a disabled member and no able-bodied adult
5. SC/ST households
6. Landless households earning primarily through manual casual labour
7. Families with no literate adult above 25 years

Urban Families (occupational categories)

Rag pickers, beggars, domestic workers, street vendors, construction workers, plumbers, painters, security guards, coolies, sweepers, sanitation workers, home-based workers, artisans, handicraft workers, transport workers, shop workers, and similar occupations.

Additional Coverage (2024 expansion)

• All PMJAY beneficiaries above 70 years of age get additional ₹5 lakh coverage
• Senior citizens (70+) from any income group are now eligible

What is Covered?#

Medical Procedures

Over 1,949 medical and surgical procedures across 27 specialties including:

• Cardiac surgery (bypass, valve replacement)
• Cancer treatment (chemotherapy, radiation, surgery)
• Kidney transplant and dialysis
• Neurosurgery
• Orthopedic procedures (joint replacement)
• Maternity and newborn care
• Mental health treatment
• COVID-19 treatment

What is NOT Covered

• OPD (outpatient) consultations
• Cosmetic procedures
• Fertility treatments
• Drug de-addiction
• Organ transplant (except kidney)

Key Benefits#

1. ₹5 lakh coverage per family per year — covers entire family, no individual cap
2. Cashless treatment — no upfront payment at empanelled hospitals
3. Paperless — Ayushman card or Aadhaar is sufficient
4. Pre-existing diseases covered — from day one, no waiting period
5. 25,000+ hospitals — both public and private empanelled hospitals
6. Portability — use anywhere in India, not just your home state
7. No premium — completely free for beneficiaries

Documents Required#

1. Aadhaar card (primary identification)
2. Ration card (for family verification)
3. Mobile number (for OTP verification)
4. Ayushman card (generated after eligibility verification)

How to Get Your Ayushman Card#

Online

1. Visit pmjay.gov.in or beneficiary.nha.gov.in
2. Click "Am I Eligible"
3. Enter mobile number and OTP
4. Enter Ration Card or name/location details
5. If eligible, download your Ayushman card

At Hospital

1. Visit any empanelled hospital's Ayushman Mitra desk
2. Carry Aadhaar card
3. Ayushman Mitra will verify eligibility and generate your card on the spot

At Common Service Centre (CSC)

1. Visit nearest CSC/Jan Seva Kendra
2. Carry Aadhaar and Ration Card
3. CSC operator will verify and generate card

How to Use Ayushman Bharat for Treatment#

1. Find empanelled hospital: Visit pmjay.gov.in → Hospital Finder, or call 14555
2. Go to Ayushman Mitra desk at the hospital
3. Show Aadhaar/Ayushman card for verification
4. Biometric verification (fingerprint or iris scan)
5. Pre-authorization obtained by hospital from NHA
6. Cashless treatment — hospital bills directly to the scheme
7. Discharge — no payment required for covered procedures

Ayushman Bharat and State Schemes#

Many states have their own health schemes that work alongside or extend PM-JAY:

• Andhra Pradesh: Dr. YSR Aarogyasri
• Tamil Nadu: Chief Minister's Comprehensive Health Insurance
• Karnataka: Arogya Karnataka
• Maharashtra: Mahatma Jyotiba Phule Jan Arogya Yojana

In states with their own schemes, beneficiaries may get combined coverage exceeding ₹5 lakh.

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Frequently Asked Questions#

Frequently Asked Questions#

1. How do I check if I am eligible for Ayushman Bharat?

Visit pmjay.gov.in and click 'Am I Eligible'. Enter your mobile number and OTP, then search by name, Ration Card number, or SECC data. You can also call 14555 to check eligibility.

2. What is the Ayushman card and how do I get it?

The Ayushman card (also called PMJAY card or Golden Card) is your health insurance card. Get it at any empanelled hospital's Ayushman Mitra desk, at a CSC, or download from pmjay.gov.in after eligibility verification.

3. Can I use Ayushman Bharat outside my home state?

Yes. Ayushman Bharat has full portability — you can use it at any empanelled hospital anywhere in India, not just in your home state.

4. Are pre-existing diseases covered from day one?

Yes. Unlike private health insurance, Ayushman Bharat covers all pre-existing diseases from the very first day of enrollment. There is no waiting period.

5. What is the family size limit for Ayushman Bharat?

There is no family size limit. The ₹5 lakh coverage is for the entire family, regardless of how many members. All family members listed in the SECC database are covered.

6. Can I get treatment at a private hospital under Ayushman Bharat?

Yes. Both public and private hospitals empanelled under PM-JAY provide cashless treatment. There are over 25,000 empanelled hospitals across India, including many private hospitals.

7. What happens if my treatment cost exceeds ₹5 lakh?

If treatment costs exceed ₹5 lakh, you must pay the excess amount yourself. Some states have higher coverage limits under their own schemes. You can also use private health insurance to cover the gap.

8. Is Ayushman Bharat available for senior citizens above 70?

Yes. From 2024, all senior citizens above 70 years of age are eligible for Ayushman Bharat, regardless of income. They get an additional ₹5 lakh coverage on top of existing family coverage.

9. How do I find empanelled hospitals near me?

Visit pmjay.gov.in → Hospital Finder, or call 14555. You can search by state, district, specialty, and hospital type to find empanelled hospitals near you.

10. What should I do if a hospital refuses to treat me under Ayushman Bharat?

If an empanelled hospital refuses cashless treatment for covered procedures, call the Ayushman Bharat helpline at 14555 immediately. You can also file a complaint at pmjay.gov.in.