Ayushman Bharat PM-JAY Scheme
Last Updated
July 2026 Fact Checked By: Schemewala Editorial Team
Quick Summary
| Detail | Information |
|---|---|
| Scheme Name | Pradhan Mantri Jan Arogya Yojana (PM-JAY) |
| Ministry | Ministry of Health and Family Welfare (NHA) |
| Beneficiaries | Poor/Vulnerable families (SECC 2011) + All Senior Citizens 70+ |
| Benefit | ₹5 Lakh per family per year for secondary/tertiary hospital care |
| Toll-Free Helpline | 14555 |
About the Scheme
Ayushman Bharat PM-JAY is the world's largest government-funded healthcare program. It provides a health cover of ₹5 Lakh per family, per year, for secondary and tertiary care hospitalization across public and empaneled private hospitals in India.The biggest misconception is that it is an "apply and get" scheme. You cannot simply buy an Ayushman card. Your eligibility is pre-determined based on the Socio-Economic Caste Census (SECC) 2011 database. However, in a major 2026 update, all senior citizens aged 70 and above are now automatically eligible, regardless of their family income or SECC status.
Benefits & Financial Assistance
- ₹5 Lakh Family Floater: The ₹5 lakh cover can be used by one person for a major surgery, or split among multiple family members throughout the year.
- Pre and Post Hospitalization: It covers up to 3 days of pre-hospitalization and 15 days of post-hospitalization expenses (medicines and diagnostics).
- Zero Cash Rule: All pre-existing diseases are covered from day one. Hospitals cannot ask you for a single rupee. All tests, food, surgery, and bed charges are bundled into the package the government pays the hospital.
Eligibility & Hidden Rules
Who is eligible:
- Families identified under the SECC 2011 database (e.g., households without shelter, destitute, manual scavengers, SC/ST households, landless laborers).
- Senior Citizens 70+ (New rule, irrespective of income).
- Hidden Clause: There is no cap on family size or age. If a family has 10 members, all are covered under the same ₹5 Lakh umbrella.
Actionable Tip - Checking Eligibility: Do not assume you are ineligible just because you don't have a BPL card. Go to the Beneficiary Portal, log in with your mobile number, and search using your Aadhaar or Ration Card number. If your name appears, do your eKYC immediately.
Documents Required
- Aadhaar Card (Mandatory for eKYC).
- Ration Card (Highly recommended to prove family linkage if a new child is born).
- Mobile Number linked to Aadhaar.
Exact Navigation Path: How to Apply / Generate Card
- Go to beneficiary.nha.gov.in.
- Select "Beneficiary Login", enter your mobile number, and authenticate via OTP.
- Select your State, District, and search by "Aadhaar Number".
- If your family details appear, look for the action button marked "eKYC".
- Complete the Aadhaar OTP verification.
- Once approved (usually instantly or within 24 hours), click the "Download Card" button. Save the PDF and print it like an ATM card.
Grievance Redressal (Insider Tips)
Hospitals sometimes illegally demand cash deposits or reject Ayushman patients. Here is exactly what to do:
- Immediate Action: While sitting in the hospital lobby, dial the toll-free number 14555. Inform the operator that "Hospital [Name] is denying cashless treatment under PM-JAY". The central team will immediately contact the hospital's Ayushman Mitra.
- Official Portal: If the issue is not urgent, log a ticket at cgrms.pmjay.gov.in.
- Escalation: Every district has a District Implementation Unit (DIU) and a Chief Medical Officer (CMO). A written complaint to the CMO forces the hospital to reply within 48 hours or face de-empanelment.
Latest Updates (2026)
- Portability: The scheme is now fully portable. If you have a UP Ayushman card, you can get a heart surgery done in a private hospital in Mumbai for free. Just ensure the hospital is "PMJAY Empaneled."
Important Links
| Purpose | Link |
|---|---|
| Check Eligibility & Download | beneficiary.nha.gov.in |
| Search Empaneled Hospitals | hospitals.pmjay.gov.in |
| Register Grievance | cgrms.pmjay.gov.in |
FAQs
The hospital says the "package limit" is over and I have to pay cash. Is this true?
Ask the hospital's "Ayushman Mitra" (the dedicated desk agent) to show you the package blocking on the computer screen. If your ₹5 Lakh limit is intact, the hospital cannot charge you for medicines or tests that exceed their internal cost. Call 14555 immediately if they force you to pay.
Can I use this for OPD (Outpatient) visits for cold and cough?
No. PM-JAY only covers secondary and tertiary care that requires actual hospitalization (admission to a bed).
I don't have my name in the SECC list, but I am poor. How do I get added?
You cannot add your name manually right now. The government relies on the 2011 census and state-specific databases (like Antyodaya Anna Yojana).
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