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
- 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: 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
- Helpline: 14555 / 1800-111-565
🔗 Related Guides
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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.