Ayushman Bharat (PMJAY) Benefits 2026: Complete Citizen Guide

The Government of India gives ₹5 lakh of free hospitalisation cover to over 12 crore families AND now to every Indian citizen aged 70 or above — regardless of income. Most people who qualify don't know they qualify. This guide tells you how to check, claim, and use the card.

• Who qualifies: SECC-2011 listed families + every citizen 70 years or older (since 29 October 2024) — irrespective of income.
• Cover: ₹5 lakh per family per year for secondary + tertiary hospitalisation.
• Free at point of care — empanelled hospital (public or private) cannot charge you.
• 27,000+ hospitals empanelled across India (as of April 2026).
• Pre-existing conditions covered from Day 1 — no waiting period.
• Check eligibility: https://beneficiary.nha.gov.in or call 14555 / 1800-111-565.
• Card is digital (Ayushman card / ABHA) — install the Ayushman Bharat app to carry it.

• Launched 23 September 2018 under the Pradhan Mantri Jan Arogya Yojana (PMJAY).
• Run by the National Health Authority (NHA).
• Not a “law” — it is a Centrally Sponsored Scheme funded 60:40 by Centre and States (90:10 for NE + Hill states).
• 29 October 2024: extended cover to all citizens aged 70+ under the brand “AB-PMJAY Vay Vandana”.
• Operates alongside state schemes — many states (Punjab, Rajasthan, Maharashtra) top up to ₹10–25 lakh.
• ABHA (Ayushman Bharat Health Account) is your 14-digit digital health ID — separate from the PMJAY card but issued by the same NHA.

• Rural — falls in any of the 6 deprivation criteria (no shelter, manual scavenger, primitive tribal, legally released bonded labour, no adult member 16-59, single woman head of family).
• Urban — works in any of 11 listed occupations (rag picker, beggar, domestic worker, sweeper, sanitation worker, security guard, etc.).

• Any Indian citizen — regardless of income or earlier coverage.
• Even if already covered under another scheme (CGHS, ESIC, ECHS, etc.) — still eligible for PMJAY top-up.

Some states have expanded the list:

• Rajasthan: Mukhya Mantri Chiranjeevi — every family.
• Karnataka: Yashasvini for farmers + Arogya Karnataka for the rest.
• Tamil Nadu: CMCHIS — all families.
• Punjab: every “blue card” family + journalists + ex-servicemen.

• Hospitalisation for 1,961 listed treatment packages — major surgeries, cancer, kidney dialysis, cardiac, knee replacement, neonatal ICU, organ transplant, mental health.
• 3 days pre + 15 days post hospitalisation expenses (diagnostic + medicines).
• Transport allowance in some states.
• Cashless — no upfront payment.
• Pre-existing conditions — covered from Day 1 (unlike most private insurance).
• No upper age limit.

• Out-patient consultations (OPD).
• Cosmetic surgeries.
• Dental (except surgical/jaw fracture).
• Spectacles, hearing aids unless surgery-related.
• Fertility treatments, IVF.
• Drug rehabilitation.
• Treatment outside India.
• Treatment at non-empanelled hospitals (except emergencies — must call 14555 within 24 hours).

1. Visit https://beneficiary.nha.gov.in
2. Login with mobile number → OTP.
3. Enter state, district. Search by ration card / Aadhaar / mobile.
4. If found, your name appears with “Eligible” tag.
5. For 70+ citizens, click “AB PMJAY Vay Vandana” tab — Aadhaar is enough.

1. In the same portal, click “Do KYC” against your name.
2. Verify with Aadhaar OTP / fingerprint / face capture.
3. Take a selfie (live photo).
4. Card is generated within 15 minutes.
5. Download the PDF + add to Ayushman Bharat app on your phone.

If you can't do it online, visit any Common Service Centre (CSC) with Aadhaar — ₹30 fee.

1. In the app or at https://hospitals.pmjay.gov.in
2. Filter by state → district → speciality.
3. Government hospitals: all are empanelled.
4. Major private chains empanelled: Apollo (selected), Fortis (selected), Manipal, Narayana, AIIMS-managed institutions, most state-run medical colleges.

1. Show physical OR digital card at the Ayushman Mitra desk (every empanelled hospital has one).
2. Hospital does biometric verification (fingerprint or iris).
3. Hospital opens an “e-Card claim” — admission becomes cashless.
4. You sign a discharge summary; the hospital files claim with NHA. You pay zero.

1. Refuse politely and ask for the Ayushman Mitra.
2. Call 14555 (toll-free) immediately — they call the hospital.
3. File a complaint via Mera-PMJAY in the app.
4. Or write to: [email protected].

• Aadhaar — mandatory.
• Ration card (helpful for SECC eligibility lookup).
• Mobile number linked to Aadhaar (for OTP).
• Doctor's referral / admission slip — at the hospital.
• Birth certificate — only if Aadhaar age is wrong (for 70+ category).

• Empanelled hospital cannot charge the patient. Doing so is breach of MoU + PMFBY guidelines.
• Hospital can be de-empanelled — losing ability to bill PMJAY.
• Punishable under IPC Section 420 (cheating) if false claim is filed.
• Suspension of empanelment + recovery + fine for first offence; permanent blacklist for repeat.

• Using a non-empanelled hospital thinking it's “covered” — it isn't. Always check the app first.
• Not doing KYC — your name is in the eligibility list but no card means no benefit.
• Hiding pre-existing conditions — counterproductive. PMJAY covers them from Day 1; lying delays admission.
• Letting hospital demand cash for “extras” — they cannot bill patient for anything in the package. Call 14555.
• Missing the 70+ extension — many seniors don't know they're now eligible regardless of income. Check now.
• Multiple cards in one family — one card per family is enough; all members are auto-covered up to the family cap.

Yes. From October 2024, every 70+ citizen gets an additional ₹5 lakh under PMJAY Vay Vandana, on top of any other scheme.

Not automatically — eligibility is based on the SECC-2011 list, not BPL ration card. Check on https://beneficiary.nha.gov.in.

No. PMJAY is for Indian residents only. The 70+ extension also requires residency proof.

Card is digital — re-download from the app or beneficiary portal. There is no “physical replacement” charge.

No. ₹5 lakh is the family cap, per year, on a floater basis. If one member uses ₹4 lakh, ₹1 lakh remains for the family until renewal.

On 1 April every year (financial year basis).

Yes — it's portable across India. Any empanelled hospital nationwide accepts it.

No. Refuse and call 14555 immediately. The hospital is in breach.

• [ ] Eligibility verified on https://beneficiary.nha.gov.in
• [ ] KYC done (Aadhaar + photo + selfie)
• [ ] Digital card downloaded in Ayushman Bharat app
• [ ] Family members listed correctly
• [ ] Saved 14555 in phone for emergency
• [ ] Located 2-3 empanelled hospitals near home

• National Health Authority
• Beneficiary portal — eligibility check
• Empanelled hospital finder
• Vay Vandana 70+ extension guidelines, Oct 2024
• Helpline: 14555 / 1800-111-565

• RTI for pension delay — getting EPF/NPS dues
• RTI for Aadhaar update stuck
• Senior Citizen Card — apply, benefits
• Cyber crime complaint — if hospital does fraud

• Infographic concept: Coverage tree: ₹5L per family per year + 70+ universal extension (Oct 2024) + state top-ups (Rajasthan ₹25L, Maharashtra ₹10L). 27,000+ empanelled hospitals.

1. Minimal medical cross with '₹5 LAKH' inscribed inside.
2. Senior citizen icon (white hair) with shield labelled '70+'.
3. Hospital building outline with 'cashless' badge.

Realistic photo of a senior Indian citizen receiving treatment at an empanelled hospital, doctor smiling, no money exchange visible.

• Rare disease treatment: how to claim up to Rs 50 lakh government aid

1. What is Ayushman Bharat PMJAY? (a) PMJAY (Pradhan Mantri Jan Arogya Yojana): (i) World's largest health insurance scheme — launched September 2018, (ii) Coverage: Rs 5 lakh per family per year — cashless + paperless, (iii) Funded by: Central + State governments — 60:40 ratio, (iv) Target: poor + vulnerable families — based on SECC 2011 database, (v) Free treatment — at empanelled hospitals — government + private, (b) Who is eligible: (i) Rural: (1) SC/ST households, (2) Landless households — deriving major income from manual labour, (3) Single-room houses — kuccha or pucca, (4) Households with no adult male — 16-59, (5) Households with disabled member — no able-bodied adult, (ii) Urban: (1) Ragpickers, street vendors, beggars, (2) Domestic workers, sweepers, gardeners, (3) Construction workers, plumbers, painters, (4) Transport workers — rickshaw/cab drivers, (5) Shop/mall workers, hotel staff, (iii) Senior citizens (70+): (1) From April 2024 — all senior citizens 70+ — eligible — regardless of income, (2) Additional Rs 5 lakh — for senior citizen — separately, © Check eligibility: (i) Visit beneficiary.nha.gov.in — enter mobile + Aadhaar, (ii) Or: visit nearest CSC (Common Service Centre) — or hospital.

1. What treatments are covered under PMJAY? (a) Coverage: (i) Rs 5 lakh per family per year — cashless, (ii) Covers: (1) Hospitalisation — medical + surgical, (2) Pre-existing diseases — from day one — no waiting period, (3) Pre-hospitalisation — 3 days before, (4) Post-hospitalisation — 15 days after, (5) Day care procedures — chemotherapy, dialysis, etc., (6) Medicines + diagnostics — during hospitalisation, (b) Special packages: (i) Cardiology — angioplasty, valve surgery, (ii) Oncology — chemotherapy, surgery, radiation, (iii) Orthopaedics — joint replacement, fracture surgery, (iv) Neurology — stroke management, surgery, (v) Nephrology — dialysis, transplant, (vi) Obstetrics — delivery, C-section, (vii) Newborn care — NICU, (viii) COVID-19 — treatment covered, © Exclusions: (i) OPD consultation — not covered (only hospitalisation), (ii) Cosmetic surgery — not covered, (iii) Fertility treatment — not covered, (iv) Organ transplant — partially — donor costs not covered.

1. Comparison table: PMJAY vs private health insurance. (a) PMJAY: (i) Premium: free — government-funded, (ii) Coverage: Rs 5 lakh/family/year, (iii) Network: empanelled hospitals — pan-India, (iv) Pre-existing: covered from day 1, (v) Cashless: yes — paperless, (vi) Eligibility: poor + vulnerable + 70+ seniors, (vii) Portability: any state — any empanelled hospital, (b) Private insurance: (i) Premium: Rs 10,000-50,000/year — depends on cover, (ii) Coverage: Rs 3-50 lakh — chosen, (iii) Network: insurer's network hospitals, (iv) Pre-existing: waiting period 1-4 years, (v) Cashless: yes — at network hospitals, (vi) Eligibility: anyone — who pays premium, (vii) Portability: within insurer network. (Note: PMJAY is free for eligible families. If not eligible — buy private insurance.)

1. How to use PMJAY at a hospital? (a) Step 1: Check eligibility: (i) beneficiary.nha.gov.in — or CSC — or hospital help desk, (ii) Get Ayushman Card — if eligible — at CSC or hospital, (b) Step 2: Visit empanelled hospital: (i) Find empanelled hospital — on pmjay.gov.in — or NHA app, (ii) Can visit any empanelled hospital — in any state — portability, © Step 3: Show Ayushman Card: (i) At hospital help desk — PMJAY desk, (ii) Hospital verifies — with Aadhaar + biometric, (d) Step 4: Treatment: (i) Assigned doctor — diagnosis + treatment, (ii) Pre-authorisation — for procedures — hospital gets approval from PMJAY, (iii) Treatment — cashless — no payment to hospital, (e) Step 5: Discharge: (i) No bill — to patient, (ii) Follow-up medicines — provided free — at discharge, (f) If denied treatment: (i) Contact hospital PMJAY coordinator, (ii) Call PMJAY helpline: 14555 — or 1800-111-588, (iii) File grievance — on pmjay.gov.in, (iv) Contact NHA — on social media.

1. E-E-A-T signals. (a) Sources: pmjay.gov.in, nha.gov.in, pib.gov.in, (b) Last reviewed: July 2026.

1. Practical tips. (a) Check eligibility first — beneficiary.nha.gov.in, (b) Get Ayushman Card — at CSC or hospital — before need, © Carry Aadhaar — for verification at hospital, (d) Treatment is cashless — don't pay if hospital asks, (e) Example: Patient needed heart surgery — cost Rs 4.5 lakh; family was eligible for PMJAY; visited empanelled hospital; showed Ayushman Card; surgery done — cashless — Rs 0 paid; saved from financial ruin.

See Ayushman Bharat and How to File RTI and Ayushman Complaint.