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+{{htmlmetatags>metatag-keywords=(Ayushman Bharat, PMJAY, Ayushman card 2026, ABHA, free health insurance India, Ayushman Bharat 5 lakh, mera-pmjay, eligibility, hospital list, senior citizen 70 plus)
+metatag-description=(Ayushman Bharat (PMJAY) Benefits 2026: Complete Citizen Guide - verified citizen guide on RTI Wiki, India's independent Right to Information reference. Updated 2026.)}}
+====== 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.**
+===== Quick Answer =====
+  * **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.
+===== What the Law / Scheme Says =====
+  * 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.
+===== Who is Eligible =====
+==== Category 1: Listed in SECC-2011 (rural OR urban) ====
+  * **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.).
+==== Category 2: Aged 70 or above (since 29 October 2024) ====
+  * 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.
+==== Category 3: State extensions ====
+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.
+===== What is Covered =====
+  * **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**.
+===== What is NOT Covered =====
+  * 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).
+===== Step-by-Step: How to Get and Use Your Card =====
+==== Step 1 — Check eligibility ====
+  - Visit https://beneficiary.nha.gov.in
+  - Login with mobile number → OTP.
+  - Enter state, district. Search by ration card / Aadhaar / mobile.
+  - If found, your name appears with "Eligible" tag.
+  - For **70+ citizens**, click "AB PMJAY Vay Vandana" tab — Aadhaar is enough.
+==== Step 2 — Generate the card (KYC) ====
+  - In the same portal, click "Do KYC" against your name.
+  - Verify with Aadhaar OTP / fingerprint / face capture.
+  - Take a selfie (live photo).
+  - Card is generated within 15 minutes.
+  - 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.
+==== Step 3 — Find an empanelled hospital ====
+  - In the app or at https://hospitals.pmjay.gov.in
+  - Filter by state → district → speciality.
+  - Government hospitals: **all** are empanelled.
+  - Major private chains empanelled: Apollo (selected), Fortis (selected), Manipal, Narayana, AIIMS-managed institutions, most state-run medical colleges.
+==== Step 4 — At admission ====
+  - Show **physical OR digital card** at the **Ayushman Mitra desk** (every empanelled hospital has one).
+  - Hospital does **biometric verification** (fingerprint or iris).
+  - Hospital opens an "**e-Card claim**" — admission becomes cashless.
+  - You sign a **discharge summary**; the hospital files claim with NHA. **You pay zero**.
+==== Step 5 — If hospital demands payment ====
+  - **Refuse politely** and ask for the Ayushman Mitra.
+  - Call **14555** (toll-free) immediately — they call the hospital.
+  - File a complaint via **Mera-PMJAY** in the app.
+  - Or write to: **[email protected]**.
+===== Documents You Need =====
+  * **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).
+===== Penalties for Hospital Misuse =====
+  * **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.
+===== State-by-State Top-up =====
+| State | Extra cover above ₹5 lakh |
+| Rajasthan | ₹25 lakh (Chiranjeevi) |
+| Karnataka | ₹5 lakh extra (Yashasvini farmers) |
+| Tamil Nadu | ₹5 lakh extra (CMCHIS) |
+| Maharashtra | ₹10 lakh (MJPJAY) |
+| Andhra Pradesh | ₹25 lakh (NTR Vaidya Seva) |
+| Telangana | ₹10 lakh (Aarogyasri) |
+| Punjab | ₹5 lakh (Sarbat Sehat Bima) |
+| Kerala | ₹5 lakh (KASP) |
+| Delhi | NIL (Delhi has its own DSGS) |
+===== Common Mistakes =====
+  * **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.
+===== FAQs =====
+==== I am 72, ex-government employee, on CGHS. Can I still get an Ayushman card? ====
+Yes. From October 2024, every 70+ citizen gets an additional ₹5 lakh under PMJAY Vay Vandana, **on top of** any other scheme.
+==== My ration card says BPL. Am I automatically eligible? ====
+Not automatically — eligibility is based on the SECC-2011 list, not BPL ration card. Check on https://beneficiary.nha.gov.in.
+==== Can NRIs get the card? ====
+No. PMJAY is for Indian residents only. The 70+ extension also requires residency proof.
+==== I lost my Ayushman card. What do I do? ====
+Card is digital — re-download from the app or beneficiary portal. There is no "physical replacement" charge.
+==== My family has 6 members. Each gets ₹5 lakh? ====
+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.
+==== When does the year reset? ====
+On 1 April every year (financial year basis).
+==== Can I use my card outside my home state? ====
+Yes — it's portable across India. Any empanelled hospital nationwide accepts it.
+==== Hospital is asking for "advance" — is this allowed? ====
+No. Refuse and call **14555** immediately. The hospital is in breach.
+===== Quick Checklist =====
+  * [ ] 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
+===== Sources =====
+  * [[https://nha.gov.in|National Health Authority]]
+  * [[https://beneficiary.nha.gov.in|Beneficiary portal — eligibility check]]
+  * [[https://hospitals.pmjay.gov.in|Empanelled hospital finder]]
+  * [[https://pmjay.gov.in/sites/default/files/2024-10/PMJAY-VayVandana-Guidelines.pdf|Vay Vandana 70+ extension guidelines, Oct 2024]]
+  * Helpline: **14555** / **1800-111-565**
+===== 🔗 Related Guides =====
+  * [[:rti-for-pension-delay|RTI for pension delay — getting EPF/NPS dues]]
+  * [[:rti-for-aadhaar-update-stuck|RTI for Aadhaar update stuck]]
+  * [[:apply-senior-citizen-card-2026|Senior Citizen Card — apply, benefits]]
+  * [[:cyber-crime-complaint-india|Cyber crime complaint — if hospital does fraud]]
+{REVIEWED}
+===== Visual / Infographic prompts =====
+  * **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.
+==== SVG icon prompts (use any AI image gen) ====
+  - Minimal medical cross with '₹5 LAKH' inscribed inside.
+  - Senior citizen icon (white hair) with shield labelled '70+'.
+  - Hospital building outline with 'cashless' badge.
+==== Feature image prompt ====
+//Realistic photo of a senior Indian citizen receiving treatment at an empanelled hospital, doctor smiling, no money exchange visible.//
+{{tag>ayushman-bharat pmjay healthcare government-schemes citizen-rights senior-citizens}}
+===== See also =====
+  * [[https://righttoinformation.wiki/rare-disease-treatment-50-lakh-government-aid-india|Rare disease treatment: how to claim up to Rs 50 lakh government aid]]