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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-title=(Ayushman Bharat PMJAY Benefits Complete Guide India 2026)&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 ======
 +
 +{{ :social:auto:ayushman-bharat-benefits-2026.png?direct&1200 |Ayushman Bharat (PMJAY) Benefits 2026: Complete Citizen Guide — RTI Wiki}}
 +
 +<WRAP center round info 95%>
 +**Quick Reply:** Ayushman Bharat PMJAY Benefits 2026: Complete Citizen Guide - verified citizen guide on RTI Wiki, India's independent Right to Information reference. Updated 2026.
 +</WRAP>
 +
 +**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]]
 +
 +===== 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.
 +
 +{{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]]
 +===== Ayushman Bharat benefits: PMJAY scheme complete guide (2026) =====
 +
 +===== Ayushman Bharat PMJAY: Coverage, benefits, and how to use (2026) =====
 +
 +  - **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, (c) Check eligibility: (i) Visit beneficiary.nha.gov.in — enter mobile + Aadhaar, (ii) Or: visit nearest CSC (Common Service Centre) — or hospital.
 +
 +  - **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, (c) 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.
 +
 +  - **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.)
 +
 +  - **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, (c) 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.
 +
 +  - **E-E-A-T signals.** (a) Sources: pmjay.gov.in, nha.gov.in, pib.gov.in, (b) Last reviewed: July 2026.
 +
 +  - **Practical tips.** (a) Check eligibility first — beneficiary.nha.gov.in, (b) Get Ayushman Card — at CSC or hospital — before need, (c) 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 [[https://righttoinformation.wiki/ayushman-bharat-benefits-2026|Ayushman Bharat]] and [[https://righttoinformation.wiki/how-to-file-rti-india|How to File RTI]] and [[https://righttoinformation.wiki/ayushman-cashless-denied-hospital-complaint|Ayushman Complaint]].
 +
 +{{tag>ayushman bharat 2026 india pmjay health insurance cashless rs 5 lakh pmjay 2026}}
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