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Ayushman Bharat (PMJAY) Benefits 2026: Complete Citizen Guide

Ayushman Bharat 2026: ₹5 lakh free hospitalisation cover for eligible families + every citizen aged 70+. Check eligibility, get card, find empanelled hospital, claim benefits.

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

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

Step 2 — Generate the card (KYC)

  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.

Step 3 — Find an empanelled hospital

  1. Filter by state → district → speciality.
  2. Government hospitals: all are empanelled.
  3. Major private chains empanelled: Apollo (selected), Fortis (selected), Manipal, Narayana, AIIMS-managed institutions, most state-run medical colleges.

Step 4 — At admission

  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.

Step 5 — If hospital demands payment

  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: grievance@nha.gov.in.

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