Ayushman Bharat (PM-JAY)

What Ayushman Bharat PM-JAY Is

Ayushman Bharat PM-JAY (Pradhan Mantri Jan Arogya Yojana) is the government's health insurance programme for low-income families. Launched in September 2018, it covers hospitalisation costs up to ₹5 lakh per family per year at any empanelled public or private hospital — cashless, with no paperwork at the hospital counter.

It's the world's largest government-funded health insurance scheme by coverage. Over 70 crore Indians from the bottom 40% of the population are eligible, and the list of who qualifies is determined by the Socio-Economic Caste Census (SECC) data and state government lists — you don't apply for it, you check whether you're already on the beneficiary list.

In 2023, the scheme was expanded to cover all senior citizens aged 70 and above, regardless of income — under the Ayushman Vaya Vandana component.

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Who Is Covered

PM-JAY doesn't have a formal application process in the traditional sense. Coverage is determined by:

For families under 70: Your family must appear in the SECC 2011 database under certain deprivation categories, OR be on your state government's health insurance list. States like Tamil Nadu (CM Comprehensive Health Insurance), Karnataka, Maharashtra have integrated their own schemes with PM-JAY.

For senior citizens (70+): Any Indian citizen aged 70 or above is eligible, regardless of their family's income or SECC status. They can enrol and get an Ayushman card through their nearest hospital or Common Service Centre (CSC).

No income ceiling for 70+ coverage. Even if you're a middle-class family, your parents/grandparents aged 70+ can be enrolled.

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What's Covered

Category	Coverage
Cover per family per year	₹5 lakh
Family size	No cap — entire family is covered
Age limit	No age limit
Pre-existing conditions	Covered from Day 1
Hospitalisation (secondary)	Yes — general ward surgery, maternity, etc.
Hospitalisation (tertiary)	Yes — cancer, cardiac surgery, kidney transplant, neurosurgery, etc.
Day-care procedures	Yes — over 1,400 procedures listed
Ambulance charges	Yes (limited)
Follow-up care	15 days post-hospitalisation follow-up included

Over 1,949 medical packages are covered, ranging from cataract surgery to bone marrow transplants.

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What's NOT Covered

• Outpatient (OPD) consultations and medicines
• Fertility treatments
• Cosmetic procedures
• Drug rehabilitation
• Self-inflicted injuries
• Injuries from war/riots

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How to Check If You're a Beneficiary

1. Visit beneficiary.nha.gov.in
2. Enter your mobile number and OTP
3. Search by name, Ration Card number, or SECC data
4. Or call 14555 (PM-JAY helpline)
5. Or visit any empanelled hospital — they can check on the spot

If your name is on the list, you'll be issued an Ayushman card (also called PM-JAY card or Golden Card). Carry this to any empanelled hospital for cashless treatment.

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How Treatment Works

1. Walk into any empanelled hospital (public or private) with your Ayushman card and Aadhaar
2. The hospital's PM-JAY desk verifies your eligibility on the portal
3. You're admitted — no deposit, no upfront payment for covered procedures
4. Hospital directly claims reimbursement from the government

The key is using an empanelled hospital. Non-empanelled hospitals will charge you normally. You can search for empanelled hospitals near you on the NHA portal or call 14555.

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Senior Citizens (70+) — Enrolment Process

If you or a family member is 70 or older and not yet enrolled:

1. Visit the nearest Common Service Centre (CSC) or empanelled hospital
2. Carry Aadhaar card
3. OTP verification completes the enrolment
4. Ayushman card generated immediately or within a few days

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State-Wise Variations

Some states top up the ₹5 lakh cover with their own state scheme:

• Tamil Nadu: CM Comprehensive Health Insurance (₹5 lakh top-up for certain categories)
• Andhra Pradesh: YSR Aarogyasri (integrated with PM-JAY)
• Kerala: Karunya Health Scheme (integrated)
• West Bengal, Delhi, Odisha: Have their own schemes and may have partial or no integration

Check with your state health authority if you're in a state with its own health scheme.

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Common Questions

I'm not in SECC data — can I still get covered? Not under the standard PM-JAY eligibility. However, if you're 70+, you qualify under Ayushman Vaya Vandana regardless. Some states also have their own expanded lists.

Can I use PM-JAY at a private hospital? Yes — but only at empanelled private hospitals. Search for the nearest empanelled hospital at pmjay.gov.in or call 14555.

Is the ₹5 lakh limit per person or per family? Per family per year. All members of an eligible household share the ₹5 lakh limit.

Do I need to renew the Ayushman card every year? No. The card is valid as long as you're a beneficiary. However, re-verification of eligibility may happen periodically.

I was treated last month and paid from my pocket — can I claim reimbursement? PM-JAY does not reimburse costs incurred at non-empanelled hospitals or for OPD treatment. Cashless treatment at empanelled hospitals is the only route.

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Official Links

NHA Beneficiary Portal	beneficiary.nha.gov.in
PM-JAY Helpline	14555
Empanelled Hospitals Search	pmjay.gov.in