PMJAY (Pradhan Mantri Jan Arogya Yojana) is the world's largest government-funded health insurance scheme. It has saved an estimated 6.7 crore families from catastrophic medical bills since launch in 2018. But the biggest barrier to access remains the SECC 2011 list — which is now 13 years old and full of name-spelling mismatches like Rajesh's. This guide tells you the full apply route AND exactly what to do when the system says “you're not eligible” but you actually are.

Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched on 23 September 2018 by the National Health Authority (NHA) under the Ministry of Health & Family Welfare. It provides:

• ₹5 lakh per family per year of cashless cover
• Coverage for secondary and tertiary hospitalisation (1,949 procedure packages)
• Treatment at 27,000+ empanelled hospitals (public + private)
• No cap on family size, no age limit, no pre-existing exclusion

Eligibility (PMJAY):

• Rural (SECC 2011): families with at least one of the 7 deprivation criteria (kachha house, no adult earner, SC/ST, no land, manual scavenger, etc.)
• Urban (SECC 2011): one of 11 occupational categories (rag picker, beggar, domestic worker, street vendor, construction labour, sweeper, etc.)
• State-extended schemes: most states have piggy-backed their schemes onto PMJAY infrastructure — Maharashtra MJPJAY, Karnataka Karnataka Ayushman Yojana, Tamil Nadu Chief Minister's Comprehensive Health Insurance Scheme, Rajasthan Chiranjeevi (now Mukhyamantri Ayushman Arogya Yojana), Andhra Aarogyasri, Telangana Aarogyasri. These extend coverage to non-SECC families using state criteria (like income, ration card type).

ABHA (Ayushman Bharat Health Account) is a separate, newer system under the Ayushman Bharat Digital Mission (ABDM, 2021). It is:

• A 14-digit health ID unique to you
• A digital wallet for prescriptions, lab reports, discharge summaries
• Free to create, available to every Indian citizen regardless of SECC status
• Not insurance — does not pay any hospital bill

People often mix the two. If you want insurance cover, you need PMJAY. If you want digital health records, you need ABHA. They're linked but separate.

1. Go to https://beneficiary.nha.gov.in (or https://setu.pmjay.gov.in)
2. Enter your Aadhaar number + mobile + OTP
3. The portal checks the SECC 2011 + state-extended databases
4. If found: name appears with family member list → proceed to Step 2
5. If not found: try the alternate “Search by Family ID” (state ration card number, e.g., RC-XXXXXXXX in UP, BPL Card no. in MP) — sometimes the SECC has the family head's name only and Aadhaar is not auto-linked

If both routes return “not found”, do not assume you're ineligible — the SECC database is 13 years old. Move to the stuck-escalation section.

After eligibility confirmation:

1. Find your nearest CSC (Common Service Centre) at https://locator.csccloud.in OR walk in to any empanelled hospital (full list at hospitals.pmjay.gov.in)
2. Carry: Aadhaar, ration card (if available), mobile with OTP access
3. Operator does fresh photo capture + Aadhaar e-KYC
4. Card issued same day in digital form (downloadable PDF)
5. Physical PVC card dispatched to address in 15-30 days

Cost: ₹30 at CSC (govt-fixed fee for the KYC and printing service). Free at empanelled hospital — many hospitals run camps where they enrol you while doing your treatment.

After KYC:

• Login at beneficiary.nha.gov.in → “Download Card” (PDF)
• Or use the Ayushman Bharat app (Google Play / App Store)
• Verify the family member list — every member should be listed individually

If a family member is missing, raise an “Add Member” request via setu.pmjay.gov.in → “Beneficiary Addition” → upload Aadhaar + relationship proof (ration card / birth certificate). SLA: 30 days.

When you need treatment:

1. Go to any of the 27,000+ empanelled hospitals (look for the “Ayushman Bharat” board outside)
2. Show the card (digital or physical) at the Pradhan Mantri Arogya Mitra (PMAM) desk inside the hospital
3. PMAM verifies eligibility, raises a pre-authorisation for your treatment package on the TMS (Transaction Management System)
4. Hospital does the treatment cashless
5. You pay zero (subject to ₹5 lakh per family per year cap)

Common procedures covered: cardiac surgery, dialysis, chemotherapy, joint replacement, neonatal ICU, cataract, deliveries, accident trauma, COVID hospitalisation, knee/hip replacement, etc. Excluded: cosmetic, fertility, organ transplants in most states.

This is independent of PMJAY:

1. Go to https://abha.abdm.gov.in
2. Click “Create ABHA”
3. Choose “Using Aadhaar” (recommended) or “Using driving licence”
4. Enter Aadhaar number + OTP
5. Verify mobile (separate OTP)
6. Choose ABHA address (like an email — yourname@abdm)
7. Done — you get a 14-digit ABHA number

The whole process takes under 60 seconds. Free. Available to anyone with Aadhaar + an Indian mobile.

After ABHA creation:

• Use the ABHA app or any partner app (Practo, Apollo 24/7, eSanjeevani) to link past prescriptions and reports
• When you visit any ABDM-compliant hospital, mention your ABHA — the hospital will automatically push your discharge summary, lab reports, and prescription to your ABHA wallet
• You can share records selectively (consent-based) with new doctors

Before any planned treatment:

• Go to https://hospitals.pmjay.gov.in
• Filter by state, district, specialty
• Check whether private or public — for emergencies, the nearest empanelled hospital is bound to admit you
• Note the hospital's PMJAY ID and helpline

• The PMJAY card should not be shared with non-empanelled “agents” — they sometimes use it to file fake claims
• Report any unsolicited “Ayushman card delivery agent” calls to 14555
• The card is family-linked — losing physical doesn't lose entitlement, just re-download from beneficiary.nha.gov.in

For PMJAY (Ayushman Card):
-----------------------------------------------
Aadhaar (mandatory)                 Yes
Ration card (optional but useful)   Yes — helps if SECC mismatch
Mobile number with active OTP       Yes
Family ID / RSBY URN (if any)       Helpful if pre-2018 RSBY beneficiary
Income certificate                  Only for state-extended scheme
                                    (e.g., MJPJAY in Maharashtra)
Photo (live capture at CSC/hospital) Yes
Birth certificate of family members For "Add Member" requests
Cost                                 ₹30 (CSC) or free (empanelled hospital)

For ABHA:
-----------------------------------------------
Aadhaar (with mobile linked)        Yes (recommended)
OR Driving licence + face match     Alternative
Active mobile number                Yes
Cost                                Free
Time taken                          ~60 seconds online
-----------------------------------------------

1. SECC 2011 list excludes you (data is 13 years old) — you might be genuinely poor today but the 2011 census didn't capture it. Fix: state Beneficiary Addition + RTI route below.
2. Name mismatch SECC vs Aadhaar (Rajesh's case — surname missing). Fix: RTI to State Health Authority for manual addition.
3. Family head name only in SECC, others not auto-included. Fix: file “Add Member” with relationship proof.
4. Aadhaar e-KYC failure at CSC (biometric mismatch, OTP not coming). Fix: update Aadhaar at UIDAI; ask CSC to retry with face-match alternate.
5. CSC operator backlog — operator says “system slow, come tomorrow” repeatedly. Fix: try a different CSC or empanelled hospital.
6. State portal vs central NHA portal sync issues — eligibility shows on one but not the other. Fix: try both setu.pmjay.gov.in and the state Health Authority's portal (e.g., kaymanya.gov.in for Karnataka, mjpjay.gov.in for Maharashtra).
7. Hospital refuses to accept card despite empanelment — happens when hospital owes the State Health Authority money or has been suspended. Fix: complain to 14555; in emergency, escalate to District Health Officer.
8. Pre-authorisation rejected by TMS — hospital says treatment doesn't fit a package. Fix: ask hospital to file “Special Approval” request with documentation; if denied, see RTI for Ayushman Bharat claim denial.

14555 is toll-free, 24×7. Hindi, English, and most regional languages. Have your Aadhaar and date of attempt ready. The agent can: confirm SECC eligibility, log a complaint, escalate to State Health Authority. They cannot directly add you to the database.

State helplines also exist (Karnataka 080-2225-3000, Maharashtra 155-388, Tamil Nadu 1455). Full list at All helplines.

Online grievance: https://setu.pmjay.gov.in/setu/cgrms → “File Complaint” → upload Aadhaar + describe issue. SLA: 30 days. Track with your ticket ID.

If the local CSC operator is the bottleneck, escalate to the District CSC Manager — phone numbers at https://csc.gov.in. Operators have been known to charge ₹200-500 unofficially; this is illegal and reportable to 14555.

Each district has a DIU under the State Health Authority. Walk in with your Aadhaar, ration card, and a written application stating “I am eligible under SECC/state criteria but unable to enrol — please add me manually”. Most DIUs have a designated officer for this.

RTI works here when: you have been told “name not in list” despite genuine eligibility, the CSC has refused enrolment without writing the reason, your family member addition request has been pending more than 30 days, or a hospital has denied a pre-authorised treatment without explanation.

RTI does NOT directly help when: you are simply not eligible under SECC 2011 or state criteria (RTI cannot expand eligibility — for that you need the SHA's “Beneficiary Addition” policy, which is a separate administrative request, not a transparency request). However, RTI can confirm in writing whether you are or aren't on the list — which is itself useful evidence for any further appeal.

For card-not-issued cases: file an RTI to the PIO, State Health Authority (each state has one — Lucknow for UP, Bengaluru for Karnataka, Chennai for TN, Mumbai for Maharashtra, etc.) asking:

1. Whether my Aadhaar number …….. is matched in the SECC 2011 / state-extended beneficiary database
2. The exact reason for non-issuance of card despite [eligibility]
3. The list of documents I need to submit for Beneficiary Addition
4. The dealing official's name and the SLA for resolution

For hospital denial cases (hospital refuses to admit you despite card), see RTI for Ayushman Bharat claim denial — full template, escalation path, and CIC case-law.

For the foundational RTI workflow (template, fee, registered post, deadlines), see RTI in 12 simple steps.

Q. I have an old RSBY card. Is it still valid?
RSBY (Rashtriya Swasthya Bima Yojana) was subsumed into PMJAY in 2018. Old RSBY beneficiaries are auto-included in PMJAY — but you still need to enrol once at a CSC or empanelled hospital to get the new Ayushman card.

Q. My income is ₹3 lakh/year. Am I eligible?
PMJAY does not use an income test — it uses the SECC 2011 deprivation/occupation criteria. State-extended schemes (Maharashtra MJPJAY, Rajasthan MAA) have income tests (typically ₹1-1.5 lakh annual). Check your state's portal.

Q. Is ABHA mandatory?
No. ABHA is optional. You don't need ABHA to use PMJAY. ABHA is useful for digital health records, especially if you have chronic conditions and visit multiple doctors.

Q. Will the hospital ask me to pay anything?
At an empanelled hospital, for a covered procedure, zero. If the hospital asks for cash, food deposit, or “non-medical charges”, complain to 14555 immediately — most such demands are illegal under the PMJAY hospital agreement.

Q. How is the ₹5 lakh divided in my family?
It's floating — usable by any combination of family members in the financial year. If one person uses ₹4.8 lakh, only ₹20,000 remains for the rest until the year resets on 1 April.

Q. Can I use Ayushman Card outside my home state?
Yes. PMJAY is portable across India. Show the card at any empanelled hospital in any state.

Q. The portal still says I'm not eligible after RTI confirmed I am. What now?
Take the RTI reply (a public document) to the District Implementation Unit (DIU) and demand manual addition under the SHA's Beneficiary Addition policy. Most DIUs comply within 7-14 days when shown a written PIO confirmation.

• RTI for Ayushman Bharat claim denial
• RTI in 12 simple steps
• All helplines — central & state
• RTI forms + fees by state

Last reviewed: 26 April 2026.