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+{{htmlmetatags>metatag-keywords=(health schemes India, ayushman bharat, PMJAY, e-Sanjeevani, government health insurance, free hospitalization India, 5 lakh health cover, telemedicine India)
+metatag-description=(Health & Insurance Schemes in India 2026 - verified citizen guide on RTI Wiki, India's independent Right to Information reference. Updated 2026 with latest.)}}
+====== Health & Insurance Schemes in India 2026 ======
+**Healthcare in India is unaffordable for most — a single hospital admission can wipe out years of savings. Government schemes now cover the cost: **₹5 lakh free hospitalisation** under Ayushman Bharat (every 70+ citizen since Oct 2024), **free online doctor consultations** under e-Sanjeevani, and **state top-ups** that take cover up to ₹25 lakh in some states.**
+===== Quick Answer =====
+  * **₹5 lakh free hospital cover/year** → [[:ayushman-bharat-benefits-2026|Ayushman Bharat (PMJAY)]]
+  * **Available to**: SECC-listed families + **every Indian citizen aged 70+** since 29 Oct 2024
+  * **Free online doctor**: [[:e-sanjeevani|e-Sanjeevani]] (24x7, government-run)
+  * **27,000+ empanelled hospitals** nationwide (public + private)
+  * **Pre-existing conditions covered Day 1** (no waiting period)
+  * **Helpline**: **14555** / **1800-111-565** (toll-free, 24x7)
+  * **Stuck or denied?** [[https://righttoinformation.wiki/tools/ai-rti-draft-app.html|🪄 Free RTI in 60 sec]] → 30-day reply mandatory.
+===== Who should read this page =====
+  * **Anyone with a family member aged 70+** — automatic eligibility regardless of income
+  * **SECC-2011 listed households** — long-standing PMJAY beneficiary base
+  * **Frequent doctor visitors** who can't afford private fees — e-Sanjeevani is free
+  * **People living in tier-2/3 cities** with limited specialist access — telemedicine reaches everyone
+  * **Pregnant women, mothers** — additional schemes (PMMVY, JSY) under [[:women-social-welfare-schemes-india|Women's category]]
+===== List of schemes in this category =====
+==== Hospitalisation cover ====
+  * **[[:ayushman-bharat-benefits-2026|Ayushman Bharat — Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)]]** — ₹5 lakh per family per year for secondary + tertiary care. 1,961 treatment packages. Cashless at empanelled hospitals.
+  * **AB-PMJAY Vay Vandana** (October 2024 expansion) — extends ₹5 lakh cover to **every citizen aged 70+ regardless of income**, on top of any existing scheme.
+  * **State top-ups**:
+    * Rajasthan **Mukhya Mantri Chiranjeevi** — ₹25 lakh extra
+    * Karnataka **Yashasvini** (farmers) — ₹5 lakh extra
+    * Tamil Nadu **CMCHIS** — ₹5 lakh extra
+    * Maharashtra **MJPJAY** — ₹10 lakh extra
+    * Andhra Pradesh **NTR Vaidya Seva** — ₹25 lakh extra
+    * Telangana **Aarogyasri** — ₹10 lakh extra
+    * Punjab **Sarbat Sehat Bima** — ₹5 lakh extra
+    * Kerala **KASP** — ₹5 lakh extra
+==== Telemedicine + OPD ====
+  * **[[:e-sanjeevani|e-Sanjeevani]]** — government's free telemedicine. **Covers OPD** which Ayushman Bharat doesn't. 100M+ consultations done. Available in 22 Indian languages. Doctors are real (not chatbots).
+==== Maternal & child health ====
+  * **Janani Suraksha Yojana (JSY)** — cash assistance for institutional delivery (₹1,400 rural / ₹1,000 urban for BPL women).
+  * **PM Matru Vandana Yojana** — ₹6,000–12,000 for pregnant + lactating mothers. See [[:pm-matru-vandana-yojana|full guide]].
+==== Senior citizen health ====
+  * **National Programme for Health Care of the Elderly (NPHCE)** — free OPD + medicines at District Hospitals. 60+ priority.
+  * **Rashtriya Vayoshri Yojana** — free aids/appliances (walking sticks, hearing aids, dentures) for BPL seniors.
+===== How Ayushman Bharat actually works (citizens get this wrong) =====
+  - **You don't apply** in advance — you check eligibility at https://beneficiary.nha.gov.in.
+  - If listed, **do KYC** (Aadhaar OTP + selfie) at any **CSC** or self-service. **Card generated in 15 minutes.**
+  - **Save the digital card** in **Ayushman Bharat app**.
+  - At hospital admission: show card + biometric (fingerprint / iris).
+  - Hospital does **cashless billing** — you pay **₹0**.
+==== If hospital demands money ====
+  * **Refuse** politely.
+  * Ask for the **Ayushman Mitra desk** (every empanelled hospital has one).
+  * Call **14555** (toll-free 24x7). They call the hospital directly.
+  * File complaint via **Mera-PMJAY** in the app.
+===== How e-Sanjeevani works =====
+  - Visit **https://esanjeevani.in** (or download app).
+  - Login with mobile + Aadhaar OTP.
+  - Pick state → district → speciality.
+  - Token allotted. Wait time: 5–30 minutes.
+  - Doctor calls back via **video** (or audio if low bandwidth).
+  - Prescription generated digitally, sent to your phone.
+  - **You pay ₹0**.
+===== Common mistakes =====
+  * **Going to non-empanelled hospital** thinking Ayushman covers — it doesn't (except verified emergencies).
+  * **Not doing KYC** — name in eligibility list ≠ active card. KYC is required.
+  * **Hiding pre-existing conditions** — counter-productive. PMJAY covers them Day 1; lying delays admission.
+  * **Believing private agents who charge for "Ayushman card"** — card is **100% free**. Anyone charging is a fraud.
+  * **Skipping helpline 14555** — it's free, fast, English/Hindi/regional.
+===== FAQ =====
+==== I'm 72 and on CGHS. Can I still get Ayushman Bharat? ====
+**Yes** — since October 2024, every citizen 70+ gets ₹5 lakh PMJAY cover **on top of** any existing scheme. Use whichever is better in any given admission.
+==== Does Ayushman Bharat cover OPD / consultations? ====
+**No** — only secondary + tertiary hospitalisation. For OPD, use **e-Sanjeevani** (free, online). District Hospitals also have free OPD.
+==== Is Ayushman Bharat available in every state? ====
+**33 of 36 states/UTs** signed on. Delhi (has its own Delhi Government Scheme), Odisha (Biju Swasthya), West Bengal (Swasthya Sathi) — these states have **their own programs** which work similarly.
+==== What does pre-existing condition mean? ====
+A medical condition you had **before** card activation. PMJAY covers all pre-existing conditions from Day 1 (no waiting period) — unlike most private health insurance.
+==== I lost my Ayushman card. What do I do? ====
+Card is **digital** — re-download from beneficiary.nha.gov.in or the app. **No 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 (1 April).
+==== Hospital is asking for advance payment. What do I do? ====
+**Refuse** + call **14555** + file complaint via Mera-PMJAY app. Empanelled hospital cannot demand cash from PMJAY beneficiary; doing so violates their MoU.
+==== Can I use PMJAY outside my home state? ====
+**Yes** — fully portable across India. Any empanelled hospital in any state accepts your card.
+===== All RTI Wiki tools =====
+  * 🪄 **[[https://righttoinformation.wiki/tools/ai-rti-draft-app.html|AI RTI Drafter]]**
+  * 🎤 **[[https://righttoinformation.wiki/tools/awaaz-rti.html|AwaazRTI]]**
+  * 🌐 **[[https://righttoinformation.wiki/intelligence/citizen-360.html|Citizen 360]]** — find local hospitals + civic services
+===== Related categories =====
+  * [[:government-schemes-india-2026|🏛 Top schemes — pillar guide]]
+  * [[:financial-support-schemes-india|💰 Financial Support]]
+  * [[:women-social-welfare-schemes-india|👩 Women & Social Welfare]]
+  * [[:home-remedies-common-illnesses-india|🌿 Home remedies — common illnesses]]
+  * [[:digital-arrest-scam-india|⚠ Digital arrest scam (health-fraud variant)]]
+===== Sources =====
+  * [[https://nha.gov.in|National Health Authority — PMJAY official]]
+  * [[https://beneficiary.nha.gov.in|Beneficiary portal — eligibility check]]
+  * [[https://hospitals.pmjay.gov.in|Empanelled hospital finder]]
+  * [[https://esanjeevani.in|e-Sanjeevani — official]]
+  * [[https://www.mohfw.gov.in|Ministry of Health & Family Welfare]]
+  * Helplines: **14555** · **1800-111-565** · **104**
+{REVIEWED}
+//Last reviewed: 3 May 2026.//
+{{tag>health-schemes ayushman-bharat pmjay e-sanjeevani 2026 senior-citizens}}