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| + | {{htmlmetatags> | ||
| + | metatag-description=(Health & Insurance Schemes in India 2026 - verified citizen guide on RTI Wiki, India' | ||
| + | |||
| + | ====== Health & Insurance Schemes in India 2026 ====== | ||
| + | {{page> | ||
| + | |||
| + | **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, | ||
| + | |||
| + | ===== Quick Answer ===== | ||
| + | |||
| + | * **₹5 lakh free hospital cover/ | ||
| + | * **Available to**: SECC-listed families + **every Indian citizen aged 70+** since 29 Oct 2024 | ||
| + | * **Free online doctor**: [[: | ||
| + | * **27,000+ empanelled hospitals** nationwide (public + private) | ||
| + | * **Pre-existing conditions covered Day 1** (no waiting period) | ||
| + | * **Helpline**: | ||
| + | * **Stuck or denied?** [[https:// | ||
| + | |||
| + | ===== 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 [[: | ||
| + | |||
| + | ===== List of schemes in this category ===== | ||
| + | |||
| + | ==== Hospitalisation cover ==== | ||
| + | |||
| + | * **[[: | ||
| + | * **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 ==== | ||
| + | |||
| + | * **[[: | ||
| + | |||
| + | ==== 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, | ||
| + | |||
| + | ==== 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/ | ||
| + | |||
| + | ===== How Ayushman Bharat actually works (citizens get this wrong) ===== | ||
| + | |||
| + | - **You don't apply** in advance — you check eligibility at https:// | ||
| + | - 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:// | ||
| + | - 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' | ||
| + | * **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 " | ||
| + | * **Skipping helpline 14555** — it's free, fast, English/ | ||
| + | |||
| + | ===== 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/ | ||
| + | |||
| + | ==== 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; | ||
| + | |||
| + | ==== 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:// | ||
| + | * 🎤 **[[https:// | ||
| + | * 🌐 **[[https:// | ||
| + | |||
| + | ===== Related categories ===== | ||
| + | |||
| + | * [[: | ||
| + | * [[: | ||
| + | * [[: | ||
| + | * [[: | ||
| + | * [[: | ||
| + | |||
| + | ===== Sources ===== | ||
| + | |||
| + | * [[https:// | ||
| + | * [[https:// | ||
| + | * [[https:// | ||
| + | * [[https:// | ||
| + | * [[https:// | ||
| + | * Helplines: **14555** · **1800-111-565** · **104** | ||
| + | |||
| + | {REVIEWED} | ||
| + | |||
| + | //Last reviewed: 3 May 2026.// | ||
| + | |||
| + | {{tag> | ||