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Health & Insurance Schemes in India 2026

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

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· 2026/04/19 05:02

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/yearAyushman 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)

  1. You don't apply in advance — you check eligibility at https://beneficiary.nha.gov.in.
  2. If listed, do KYC (Aadhaar OTP + selfie) at any CSC or self-service. Card generated in 15 minutes.
  3. Save the digital card in Ayushman Bharat app.
  4. At hospital admission: show card + biometric (fingerprint / iris).
  5. 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

  1. Visit https://esanjeevani.in (or download app).
  2. Login with mobile + Aadhaar OTP.
  3. Pick state → district → speciality.
  4. Token allotted. Wait time: 5–30 minutes.
  5. Doctor calls back via video (or audio if low bandwidth).
  6. Prescription generated digitally, sent to your phone.
  7. 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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