• Rural: Families covered under SECC-2011 deprivation criteria (one or more of D1-D5, D7) — kutcha house, no adult earning member, SC/ST, manual scavenger family, landless household dependent on manual labour, etc.
• Urban: 11 occupational categories — ragpicker, beggar, domestic worker, street vendor, construction/sanitation worker, security guard, sweeper, plumber, electrician, washerman, transport worker etc. — plus families recorded under those categories in SECC-2011.
• Automatic addition (post-2018): Families covered under earlier RSBY (Rashtriya Swasthya Bima Yojana), ASHA workers, and Anganwadi workers/helpers.
• 2024-2026 expansion: Families of all senior citizens aged 70+ are now covered under the Ayushman Bharat Vay Vandana add-on — see that scheme.
• Not eligible: Income-tax payers, government employees, professionals, families with ≥2-wheeler+land, or income above the SECC threshold.

Three free ways:

1. Online: beneficiary.nha.gov.in → “Am I Eligible” → enter mobile, OTP, then state and either Aadhaar / ration card / family ID / mobile to search the SECC list.
2. Mobile app: “Ayushman Bharat” app (Android) → “Check Eligibility” — same flow, faster.
3. Helpline: Call 14555 or 1800-111-565 — they verify against SECC.
4. CSC / hospital empanelment desk: Visit any nearby Common Service Centre or any empanelled hospital — they have access to the BIS (Beneficiary Identification System).

If your name appears, proceed to apply for the card. If it doesn't, see “What to do if you're missing from SECC” below.

• Self-service: beneficiary.nha.gov.in → “Beneficiary” tab → log in with mobile OTP → “Generate New Ayushman Card” → upload Aadhaar, take a live selfie, e-KYC. Card downloads as PDF immediately.
• CSC: Free at the official CSC counter. Bring Aadhaar + a passport-size photo (or get one clicked there).
• Hospital PMJAY desk: Empanelled hospitals must enrol you on the spot if you turn up with eligibility proof.

The PVC printed card costs ₹30 from CSC. The PDF download is free and works at every hospital.

• Hospital list: hospitals.pmjay.gov.in → state → district → speciality. There are 30,000+ empanelled hospitals (about 60% private, 40% government).
• Mobile app: “Ayushman Bharat” → “Find Hospital” → uses your GPS.
• Save 2-3 nearby empanelled hospitals to your phone contacts along with their PMJAY desk number — this is critical in an emergency.

1. Show your Ayushman card (PDF or PVC) at the PMJAY/Arogya Mitra desk.
2. The desk verifies you on the TMS (Transaction Management System) using your card and Aadhaar biometric.
3. The hospital files a pre-authorisation with the State Health Agency. Approval is usually within hours.
4. You receive fully cashless treatment — no advance, no deposit, no payment at discharge.
5. The hospital gets reimbursed by the State Health Agency / National Health Authority directly.

If the hospital asks you to pay anything, even informally, that is a violation of empanelment terms.

• Call 14555 — log a complaint, get a docket number.
• Email mis[at]pmjay.gov.in with hospital name, your card number, date of refusal, and what they demanded.

The State Health Agency (SHA) is the implementation body — it has a designated PIO. The Public Authority is also the National Health Authority (NHA), 9th Floor, Tower-1, Jeevan Bharati Building, Connaught Place, New Delhi — for cross-state and central queries.

[Your full name]
[Address]
[Mobile] · [Email]
[Date]

To,
The Public Information Officer
State Health Agency — Ayushman Bharat PM-JAY
[State Health Department, address]

Subject: Application under RTI Act, 2005 regarding refusal of cashless treatment / PMJAY card technical failure

Sir/Madam,

Under Section 6(1) of the Right to Information Act, 2005, I, [Name], holder of Ayushman Bharat PMJAY card number [card number] (Aadhaar last 4 digits XXXX), respectfully request the following information:

1. The reason recorded in TMS for the failure of my card on [date] at [hospital name, full address] when I sought cashless treatment for [procedure / diagnosis].

2. The text of the empanelment agreement / SLA between SHA and [hospital name] insofar as it covers (a) the obligation to provide cashless treatment to a presented PMJAY card-holder and (b) penalties for refusal.

3. The number of complaints received by SHA against [hospital name] in the last 12 months under PMJAY and the action taken on each, including any de-empanelment or warning.

4. A copy of the file noting on my complaint registered on [date] with docket number [helpline reference], including the present status and the dealing officer's name and designation.

5. Please also state whether and when my pre-authorisation request, if filed by the hospital, was approved or rejected, and the reason.

I enclose the prescribed fee of Rs. 10/- by [IPO / Court Fee Stamp / cash receipt].

Yours faithfully,
[Signature]
[Name]

File a First Appeal under §19(1) to the Mission Director of the State Health Agency. Cite §7(1) of the RTI Act for the missed deadline. If that also fails, escalate to the State Information Commission.

The SECC-2011 list is closed for new entries. But three workarounds:

• Categorial inclusion — If you're an ASHA, Anganwadi worker/helper, BOCW (construction worker) cardholder, NFSA priority household (PHH) cardholder, or PMAY-G beneficiary, your family is auto-added.
• State convergence — Many states (TS, AP, MH, RJ, KA, KL, TN) run state-funded health insurance schemes (Aarogyasri, MJPJAY, Mahatma Phule, BSY, Vajpayee Arogyashree, KASP, CMCHIS) layered on top of PMJAY — check your state portal.
• Senior citizens 70+ are automatically eligible irrespective of SECC since 2024. See Ayushman Vay Vandana.

• Confusing PMJAY card with ABHA. ABHA is the digital health ID for storing records — does not give insurance. Ayushman Bharat PMJAY is the cashless-treatment scheme. They share branding but are separate. Get both for full benefit.
• Paying ANY money at an empanelled hospital. Empanelled hospitals are barred from collecting registration fees, advance, OT charges, or “premium room” upgrades for PMJAY patients. If they ask, refuse and call 14555.
• Not carrying Aadhaar. TMS biometric verification needs Aadhaar at the hospital. Carry it.
• Choosing a non-empanelled hospital in emergency. Cashless only works at empanelled hospitals. In a true emergency, treatment at a non-empanelled hospital is not reimbursable except under specific state addons.
• Card with old name/address. Get the card re-generated after marriage / address change. Mismatches at TMS verification fail the cashless flow.

• Save the PMJAY hospital empanelment number for hospitals near you — both home and office — to your phone before any emergency.
• The pre-authorisation is often where delays happen. If the hospital says “approval pending”, call 14555 and quote your card + Aadhaar — they can escalate within 2-4 hours.
• For elective surgery, get the pre-auth confirmed in writing from the hospital before admission.
• 70+ senior citizens in your family are auto-eligible since 2024 even if the family is excluded from SECC. Apply separately under Vay Vandana.

Q. Can I use the card outside my home state? Yes — PMJAY is portable across India. Treatment at an empanelled hospital in any state is covered.

Q. Does the ₹5 lakh apply per person or per family? Per family per year. Pooled — one member can use the entire ₹5 lakh, or it can be split across multiple members.

Q. Are out-patient (OPD) consultations covered? No. PMJAY covers secondary and tertiary hospitalisation (admission of 24 hours+). OPD is excluded except for some day-care procedures (chemotherapy, dialysis).

Q. Can I be added if I missed the SECC? Through categorial inclusion (ASHA, Anganwadi, NFSA-PHH, BOCW, PMAY-G) or via state-funded extensions. Direct addition to SECC is not currently possible.

Q. The hospital wants ₹500 for “registration”. Pay or refuse? Refuse. Empanelled hospitals must waive all registration and consultation charges for PMJAY patients. Call 14555 if pressed.

The PMJAY card has saved over 7 crore Indian families from catastrophic medical debt since launch. The two real-world failure modes are eligibility-list gaps (use the categorial routes) and hospital-side refusal (use 14555 + RTI). When the hospital refuses, the RTI to the State Health Agency forces a written reason in 30 days and triggers an inquiry that often de-empanels the offender. That is what makes the right enforceable.

• Apply for ABHA digital health ID
• Ayushman Vay Vandana — 70+ cover
• Apply for BPL ration card
• All scheme helplines

• National Health Authority — pmjay.gov.in operational guidelines (Rev. 2024)
• Beneficiary Identification System — beneficiary.nha.gov.in
• Hospital empanelment guidelines, NHA, 2023
• RTI Act, 2005 §§6, 7, 19

Last reviewed: 27 April 2026.