Ayushman Bharat (PM-JAY) – Eligibility, Benefits & How to Apply
Your step-by-step guide to India’s flagship government health insurance scheme offering cashless treatment up to ₹5 lakh per family per year.
1) Overview: What is Ayushman Bharat PM-JAY?
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) is India’s largest publicly funded health insurance program. It provides cashless hospitalization for eligible families at empaneled public and private hospitals across the country. Coverage is offered on a family-floater basis so any member can use the insured amount based on need.
Objective
Protect low-income and vulnerable households from catastrophic medical expenses and improve access to quality secondary & tertiary care.
Coverage Amount
Up to ₹5,00,000 per family per year, cashless at point of care in empaneled hospitals.
Who Runs It
The National Health Authority (NHA) with State Health Agencies (SHAs) implement the scheme pan-India.
2) Key Features
- Cashless & Paperless: Treatment is cashless at empaneled hospitals; claims are settled directly with the hospital.
- No Age or Family Size Limit: All members of eligible families are covered with no cap on the count or age.
- Pre-existing Conditions Covered: Illnesses existing before enrollment are covered from day one.
- Wide Procedure List: 1,900+ procedures across major specialties, including catastrophic care.
- National Portability: Cardholders can avail services in any empaneled hospital across India.
- Pre & Post Hospitalization: Typically up to 3 days before and 15 days after hospitalization (diagnostics & medicines related to the case).
3) Eligibility Criteria
PM-JAY primarily targets economically vulnerable households identified through government databases (e.g., SECC/NFSA lists) as per the scheme design. States can extend coverage using local criteria via state-specific variants.
| Aspect | Details |
|---|---|
| Beneficiary Base | Low-income/vulnerable families identified in official lists (e.g., SECC). States may add more categories under state schemes. |
| Family Definition | Family-floater policy; no cap on number of members or age of members. |
| Income Proof | Not required at the hospital; eligibility is pre-identified in the government database. |
| Geography | Implemented nationwide with portability across states at empaneled hospitals. |
| How to Verify | Use the official “Am I Eligible” tool online, helpline 14555, or visit a CSC/Ayushman Helpdesk. |
4) Benefits & Coverage
| Benefit Category | What You Get |
|---|---|
| Coverage Amount | Up to ₹5,00,000 per family per year (family-floater). |
| Hospitalization Type | Secondary & tertiary care (planned & emergency), cashless at empaneled hospitals. |
| Pre/Post Hospitalization | Pre (typically up to 3 days) and post (typically up to 15 days) expenses related to the covered procedure. |
| Procedures | 1,900+ packages (cardiac, oncology, nephrology/dialysis, ortho, neuro, burns, NICU/PICU, etc.). |
| Inclusions | Room charges, ICU/OT charges, surgeon/doctor fees, implants, medicines, investigations, consumables, diagnostics. |
| Exclusions (Common) | Routine OPD unless linked to an admitted case; non-medical expenses; services outside package norms. |
| Portability | Yes, pan-India within the empaneled network. |
5) Empaneled Hospitals & Portability
All district government hospitals and thousands of public/private hospitals are empaneled under PM-JAY. Beneficiaries can choose the nearest suitable empaneled facility. Your Ayushman card is valid nationwide, enabling treatment outside your home state as well.
- Find hospitals via the Ayushman mobile app or official website’s hospital locator.
- Seek the Ayushman Mitra helpdesk inside the hospital for verification & admission support.
6) How to Check Eligibility & Get the Ayushman Card
- Check Eligibility Online: Visit
mera.pmjay.gov.in or
beneficiary.nha.gov.in.
Use “Am I Eligible” and search by mobile/name/ID. - Call Helpline: Dial 14555 for assistance (eligibility, nearest hospital/CSC).
- Visit a CSC: Go to the nearest Common Service Centre. Carry your ID (Aadhaar/Ration Card). They will check eligibility and generate your Ayushman e-card via e-KYC.
- At Hospital: If eligible and needing admission, the hospital’s Ayushman Mitra will verify and help you get admitted cashlessly.
7) Documents Needed
- ID Proof: Aadhaar, Ration Card, or any accepted government photo ID.
- Mobile Number: For OTP/e-KYC and communication.
- State-specific Proofs (if asked): As per local SHA/CSC guidelines for linking family details.
8) Frequently Asked Questions
Does PM-JAY cover pre-existing diseases?
Yes. Pre-existing conditions are covered from day one for eligible beneficiaries.
Can I use PM-JAY in private hospitals?
Yes, if the private hospital is empaneled under PM-JAY. Check the official hospital list or ask at the hospital helpdesk.
Is OPD covered?
Routine OPD is generally not covered. However, diagnostics/medicines linked to a covered inpatient episode are included within pre/post-hospitalization limits.
What if my name is not in the list but I am poor?
Visit your local health authorities/CSC to understand options under state schemes or to raise a grievance. Eligibility is database-driven, and states sometimes extend coverage via their own criteria.
Do I need a physical card?
An e-card is sufficient. Hospitals verify you digitally via the Ayushman system.
9) Useful Official Links
- Official Portal: pmjay.gov.in
- Am I Eligible: mera.pmjay.gov.in
- Beneficiary Services: beneficiary.nha.gov.in
- 24×7 Helpline: 14555
