Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is India's government-funded health insurance scheme that provides up to ₹5 lakh per family per year for hospitalisation at empanelled public and private hospitals across the country — completely free for eligible families. Understanding who is eligible, what is covered, and how to actually use the scheme can save families lakhs in medical expenses.

What Is Ayushman Bharat PMJAY?

Launched in September 2018, Ayushman Bharat PMJAY is the world's largest government-funded health protection scheme, covering approximately 55 crore (550 million) beneficiaries from India's bottom economic strata — around 12 crore (120 million) families.

The scheme provides:

• ₹5 lakh per family per year in hospitalisation coverage
• Cashless treatment at over 29,000 empanelled hospitals (public and private)
• Coverage for 1,926+ medical and surgical procedures across all major specialties
• No pre-exclusion for pre-existing conditions — if you are eligible, all conditions are covered from day one
• Coverage for all family members — no cap on family size

Key point: PMJAY is a hospitalisation scheme, not an OPD scheme. It covers in-patient treatment (admission for at least one night), day-care procedures, and surgeries — not outpatient consultations or diagnostic tests done without admission.

Who Is Eligible for Ayushman Bharat?

Rural Eligibility (Deprived Rural Households)

Eligibility for rural households is based on the Socio-Economic Caste Census (SECC) 2011 data. Rural families are automatically eligible if they meet any of the following deprivation criteria:

• Only one room with kutcha (temporary) walls and roof
• No adult member in the family aged 16–59 years
• Female-headed household with no adult male member aged 16–59
• Household with a disabled member and no able-bodied adult
• SC/ST households
• Landless households earning primarily through manual casual labour

Additionally, rural families in the following occupational categories are included:

• Beggars and those surviving on charity
• Manual scavengers
• Primitive tribal groups
• Legally released bonded labourers

Urban Eligibility (Occupational Category)

Urban households are eligible based on occupation. Covered occupational groups include:

• Rag pickers
• Domestic workers
• Street vendors, cobblers, hawkers, and pavement dwellers
• Construction workers, plumbers, masons, electricians, painters
• Washermen, rickshaw pullers
• Home-based artisans
• Sweepers, sanitation workers
• Transport workers (drivers, helpers, conductors)
• Shop workers, assistants, delivery boys, attendants
• Security guards, coolies, and other head-load workers

Expanded Coverage Under AB-PMJAY 2.0

As of 2024–25, the Government of India expanded PMJAY coverage to include all senior citizens above 70 years of age — regardless of income — with an additional top-up of ₹5 lakh per year. This means elderly individuals from all income groups, not just BPL families, are now eligible under this specific senior citizens expansion.

Several states have also expanded PMJAY through their own state-level add-ons (MSBY in Maharashtra, Dr. YSR Aarogyasri in Andhra Pradesh, Aarogyasri in Telangana, Mukhyamantri Amrutum in Gujarat, etc.) with varying additional coverage.

How to Check PMJAY Eligibility

Method 1: Online at pmjay.gov.in

1. Visit pmjay.gov.in
2. Click "Am I Eligible?"
3. Enter your mobile number and OTP
4. Enter your state, name, ration card number, or mobile number as prompted
5. The portal will confirm whether your family is on the beneficiary list

Method 2: PMJAY Helpline

Call 14555 (toll-free, 24x7) — the national PMJAY helpline can verify your eligibility and assist with scheme queries.

Method 3: At Ayushman Mitra Desk

Visit any empanelled government or private hospital. Every empanelled hospital is required to have an Ayushman Mitra (helpdesk) who can verify your eligibility using your Aadhaar number and assist with card issuance.

Method 4: Common Service Centres (CSCs)

PM-JAY cards can be issued at any government Common Service Centre (Jan Seva Kendra). Bring your Aadhaar card and ration card.

What Does Ayushman Bharat Cover?

The scheme covers 1,926 medical and surgical procedures under health benefit packages (HBPs) across the following specialties:

Major Procedure Categories Covered

What Is Also Covered

• 3 days of pre-hospitalisation expenses (diagnostic tests, consultations done before admission that led to the hospitalisation)
• 15 days of post-hospitalisation follow-up expenses
• Medical transport for referred transfers between hospitals
• ICU/ICCU charges
• Implant costs (stents, prosthetics, IOLs for cataract)

What Is NOT Covered

• Outpatient (OPD) consultations
• Diagnostic tests done without hospitalisation
• Cosmetic procedures
• Fertility treatment and IVF
• OPD medications (only inpatient medications are covered)
• Alcohol/drug de-addiction (except the ABDM mental health program)
• Self-inflicted injuries

How to Use the Ayushman Bharat Card at a Hospital

Using the scheme is straightforward once you are verified as a beneficiary:

Step 1: Visit any empanelled hospital — public or private. Find the Ayushman Mitra desk (typically near the main reception or admission counter).

Step 2: Show your Aadhaar card and state that you wish to use the PMJAY benefit. The Ayushman Mitra will verify your eligibility in real-time using the NHA portal.

Step 3: Once verified, your treatment is pre-authorised by the hospital. You are admitted as a cashless patient — no payment is required at any stage (including surgery, ICU, or implants) for covered procedures.

Step 4: After discharge, the hospital directly claims reimbursement from the NHA/state health agency. You receive a summary of the claim.

Important: Keep a copy of your pre-authorisation letter and discharge summary — these are your records of what was claimed under PMJAY.

Understanding PMJAY Empanelled Hospitals

Not all hospitals accept PMJAY. You must use an empanelled hospital — one registered with the National Health Authority to provide PMJAY services.

To find empanelled hospitals near you:

1. Visit pmjay.gov.in → "Find Hospital"
2. Search by state, district, and specialty required
3. Check whether the hospital is currently "active" — empanelment can be suspended for quality violations

Major hospital chains including Apollo, Fortis, Narayana Health, Care Hospitals, and Yashoda are empanelled in many states. All government hospitals and government medical college hospitals are automatically empanelled.

How to Keep PMJAY Claim Documents Organised in Ayu

Every PMJAY hospitalisation generates important documents that you should keep permanently:

Pre-hospitalisation documents:

• Diagnostic reports that led to admission
• Referral letter (if transferred from another hospital)
• Pre-authorisation letter from the hospital

During hospitalisation:

• Patient registration / UHID number from the hospital
• Implant or stent specifications (for cardiac or orthopaedic procedures)

At discharge:

• Discharge summary (the most important document)
• Final PMJAY claim summary (how much was claimed on your behalf)
• Medicines at discharge and follow-up instructions

Storing these in Ayu ensures:

• You have a permanent record of what procedure was done and when — essential for follow-up appointments
• You can share these with a specialist for a second opinion
• In case of complications after discharge, the treating doctor has the complete record
• If a similar hospitalisation is needed in future, the previous discharge summary helps the new hospital understand your history

Organise your PMJAY and medical records securely in Ayu

Frequently Asked Questions

Q: Is Ayushman Bharat only for BPL families?

The scheme primarily targets families in the bottom 40% of India's economic strata based on the SECC 2011 database. However, as of 2024, all senior citizens aged 70 and above are now eligible regardless of income, as per the expanded AB-PMJAY 2.0. Several states have also extended coverage beyond SECC criteria under their own state health schemes.

Q: Can a family member who lives in a different state from the card use the benefit?

Yes. PMJAY is portable across India. A beneficiary from Bihar can use their PMJAY card for treatment at an empanelled hospital in Mumbai or Delhi. This is one of the scheme's most important features, particularly for migrant workers.

Q: My family's name is on the ration card but not appearing on the PMJAY portal. What should I do?

PMJAY eligibility is based on the SECC 2011 data — not the current ration card. If your name was in the SECC 2011 survey, you are eligible. If you have a new ration card issued after 2011 or are from a newly formed household, you may not be on the list. Contact the state health agency or Ayushman Mitra for grievance resolution. Many states periodically update their beneficiary lists.

Q: Does PMJAY cover dialysis for kidney failure?

Yes, but with some limitations. A specified number of dialysis sessions per year are covered under PMJAY health benefit packages. For patients needing long-term (maintenance) dialysis, additional coverage may be available under state scheme top-ups or through the government's Pradhan Mantri National Dialysis Programme (PMNDP), which provides free dialysis at government hospitals.

Q: Can I use PMJAY for treatment in a private hospital of my choice?

Only at empanelled private hospitals. Not all private hospitals participate in PMJAY. Check the NHA portal's hospital finder to confirm whether a specific hospital is empanelled before visiting.

Q: What happens if the hospital charges extra despite me having an Ayushman card?

PMJAY beneficiaries should receive treatment at zero cost for covered procedures. If a hospital charges above the PMJAY package rates or demands additional payments for covered procedures, you can:

• File a complaint with the Ayushman Mitra at the hospital
• Call the PMJAY toll-free number 14555
• File a complaint on the NHA grievance portal at pmjay.gov.in

Q: Does PMJAY cover mental health treatment?

Under the Ayushman Bharat Digital Mission's mental health integration, several mental health conditions are covered for inpatient treatment at empanelled facilities. This includes acute psychiatric conditions requiring hospitalisation. The Govt of India's National Mental Health Program (NMHP) and the Manodarpan initiative also support outpatient mental health care.

References

1. National Health Authority, Government of India. Pradhan Mantri Jan Arogya Yojana. https://pmjay.gov.in/
2. National Health Authority. PMJAY Operational Guidelines. https://pmjay.gov.in
3. National Health Authority. PMJAY Beneficiary and Hospital Data. https://pmjay.gov.in/about/pmjay