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 (PMJAY)
- Available to: SECC-listed families + every Indian citizen aged 70+ since 29 Oct 2024
- Free online doctor: e-Sanjeevani (24×7, 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, 24×7)
- Stuck or denied? 🪄 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's category
List of schemes in this category
Hospitalisation cover
- 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 — 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 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 24×7). 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.
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Related categories
Sources
- Helplines: 14555 · 1800-111-565 · 104
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Last reviewed: 3 May 2026.