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—yojana:ayushman-bharat-pmjay [2026/07/11 00:38] (current) – created - external edit 127.0.0.1
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 +{{htmlmetatags>
 +metatag-keywords=(ayushman bharat, pmjay, pm-jay, ayushman card, free health insurance, ayushman vay vandana, 5 lakh health cover)
 +metatag-description=(Ayushman Bharat PM-JAY gives Rs 5 lakh free cashless hospital cover per family a year at 33,000+ empanelled hospitals. Eligibility, card, claims, RTI help.)
 +metatag-og:title=(Ayushman Bharat PM-JAY: Rs 5 Lakh Free Health Cover, Card and Claims)
 +metatag-og:description=(Ayushman Bharat PM-JAY gives Rs 5 lakh free cashless hospital cover per family a year at 33,000+ empanelled hospitals. Eligibility, card, claims, RTI help.)
 +metatag-og:type=(article)
 +metatag-robots=(index,follow)
 +}}
  
 +====== Ayushman Bharat (PM-JAY): Rs 5 lakh free health cover, explained for a worried family (2026) ======
 +
 +
 +<WRAP center round info 80%>
 +📘 **Deep-dive guide:** [[:apply-ayushman-bharat-pmjay-card-2026|Full deep-dive on the PMJAY card and hospital refusal RTI]]
 +</WRAP>
 +
 +
 +{{:social:auto:yojana-ayushman-bharat-pmjay.png?direct&1200 |Ayushman Bharat PM-JAY, Rs 5 lakh per family per year free health cover, RTI Wiki}}
 +
 +Picture a daily-wage household in a small town. The father drives an auto, the mother stitches clothes at home, and they have saved a little for their daughter's school fees. One night the father gets chest pain. The doctor says he needs an angioplasty. The bill at the private hospital is close to Rs 1.8 lakh. The family has no insurance. Before 2018, a moment like this had one ending. They would sell the gold, borrow from a moneylender at heavy interest, or simply go home and hope. Lakhs of families slid into debt because of a single hospital admission.
 +
 +Now look at the same night after Ayushman Bharat. The family has a free PM-JAY card. They walk into an empanelled hospital, show the card and an Aadhaar, and the angioplasty is done cashless. The hospital bills the government, not the patient. The family pays nothing at the counter. The school fees stay untouched. That is the whole point of this scheme, and it is the first thing you should know.
 +
 +<WRAP info>
 +**Ayushman Bharat PM-JAY gives Rs 5 lakh per family per year of free, cashless hospital treatment at 33,000+ empanelled hospitals. No premium, no age limit, no cap on family size.**
 +
 +**Launched:** 23 September 2018  ·  **Issued by:** Ministry of Health and Family Welfare / National Health Authority
 +</WRAP>
 +
 +===== Who can get an Ayushman card =====
 +
 +The cover is free, but it is not for everyone. There are three doors to eligibility, and most people enter through one of them.
 +
 +  * **Poor and vulnerable families (the original PM-JAY base).** Eligibility is decided by the SECC 2011 deprivation data, not by a fresh income test. In rural areas it follows the deprivation categories. In urban areas it follows 11 occupational categories such as rag-pickers, domestic workers, street vendors, construction labour, and similar daily-wage work.
 +  * **Every senior aged 70 and above (Ayushman Vay Vandana).** Since the Cabinet decision in September 2024, anyone who is 70 or older gets a separate Vay Vandana card worth Rs 5 lakh a year, no matter how rich or poor the family is. This is the big change of the last two years. More than 86 lakh seniors have already taken the Vay Vandana card.
 +  * **State convergence schemes.** Many states have merged their own health schemes into PM-JAY, so your state may add categories on top of the central list. Examples are MJPJAY in Maharashtra, CMCHIS in Tamil Nadu, and Aarogyasri in the Telugu states. Check the state column when you search for your name.
 +
 +Around 12 crore families, close to 55 crore people, fall in the base PM-JAY group. If your whole family is in formal-sector jobs with private health insurance, you are usually outside the base list, but a member who is 70 or above can still get the Vay Vandana card.
 +
 +**Check your own name in two minutes** at [[https://beneficiary.nha.gov.in|beneficiary.nha.gov.in]] using your mobile number and state. If your name shows, you are eligible. If it does not, read the common problems section below before you give up.
 +
 +===== What the Rs 5 lakh cover includes =====
 +
 +This is where most confusion starts, so let us be plain.
 +
 +  * The cover is **Rs 5 lakh per family per year**, shared by the whole family. It refills every year.
 +  * It pays for **1,949 treatment packages across 27 medical specialties**, including cardiology, oncology (cancer), neurology, joint replacement, dialysis, and newborn and child intensive care. The package list is the Health Benefit Package revised in 2022.
 +  * Treatment is **cashless and paperless** at the hospital. You do not pay first and claim later. The hospital raises the claim with the National Health Authority.
 +  * There is **no waiting period for pre-existing illness**. Cover starts from day one, even for a condition you already had.
 +  * The card works **across India**. A worker from Bihar who falls sick in Surat can be treated at an empanelled hospital in Gujarat on the same card. This portability matters for migrant families.
 +
 +What it does not cover is also worth knowing. PM-JAY is for hospital admission, not for everyday outpatient visits. Routine OPD care, medicines for minor illness, and check-ups are meant to be handled free at the Ayushman Arogya Mandir health centres, which are a separate part of Ayushman Bharat.
 +
 +===== How to get your Ayushman card, step by step =====
 +
 +  - **Confirm you are on the list.** Go to [[https://beneficiary.nha.gov.in|beneficiary.nha.gov.in]] and search by your mobile, name, ration card, or state. For a 70-plus senior, search under the Vay Vandana option.
 +  - **Start the e-KYC.** The portal runs an Aadhaar-based e-KYC. You verify with an OTP on your Aadhaar-linked mobile, or with a face scan on the Ayushman app.
 +  - **Add each family member.** Every member who needs cover does a separate e-KYC and photo. One person's card does not cover the others automatically.
 +  - **Get the card issued.** You can self-generate the card on the portal or app, or visit a Common Service Centre, an empanelled hospital's Ayushman Mitra desk, or the Arogya Mandir.
 +  - **Download or collect the card.** A digital card is usually ready the same day. You can also get a PVC print. Save it on your phone and keep one printout.
 +
 +There is no fee for the card. If anyone asks you to pay to make an Ayushman card, that is a scam. The card is always free.
 +
 +===== Documents you need =====
 +
 +^ Document ^ Why it is needed ^
 +| Aadhaar of each member | For e-KYC and identity match |
 +| Ration card or SECC family ID | To link your family record |
 +| Mobile number (Aadhaar-linked) | For the OTP during e-KYC |
 +| Age proof | Only for the 70-plus Vay Vandana card |
 +
 +**Full document checklist:** [[:documents:ayushman-bharat-card|Documents required for an Ayushman Bharat card]]
 +
 +===== After you have the card: using it at a hospital =====
 +
 +The card is only half the story. The day you need it, the steps are simple.
 +
 +  - Go to any **empanelled** hospital. Check the list first at hospitals.pmjay.gov.in or on the Ayushman app, because a card does not work at a non-empanelled hospital.
 +  - Find the **Ayushman Mitra** or PMJAY help desk inside the hospital. Show your card and Aadhaar.
 +  - The desk verifies you and raises a **pre-authorisation** request for your treatment.
 +  - Once approved, treatment is **cashless**. You sign the records, but you do not pay the bill for covered packages.
 +
 +Keep the card details and the hospital's PMJAY desk number saved. If a hospital that is on the empanelled list still asks you to pay, that is exactly the situation the grievance and RTI routes below are built for.
 +
 +===== Common problems and how to fix them =====
 +
 +  * **Your name is not on the list.** First try every search option, since spelling and ration-card mismatches are common. If you are truly not listed, apply under your state's own health scheme, which may have wider categories.
 +  * **Aadhaar name does not match the SECC record.** Update the spelling or date of birth in Aadhaar so the two records agree, then redo the e-KYC.
 +  * **The hospital is not empanelled.** Use the official list to find the nearest empanelled hospital. Treatment at a non-empanelled hospital is not covered except in a notified emergency.
 +  * **Cashless treatment is refused at an empanelled hospital.** File a grievance at pmjay.gov.in or call **14555**. Note the date, the staff name, and what was said. This record is useful if you escalate.
 +
 +===== Benefit delayed or claim denied? File an RTI =====
 +
 +When a grievance call leads nowhere, a written Right to Information request often moves the file. The public authority then has to act or explain in writing why it has not. Most stuck cases get a clear answer within the statutory 30 days, and many move much faster once the PIO sees a formal application.
 +
 +Ask narrow, factual questions. A clean five-point request looks like this:
 +
 +<code>
 +1. Present status of my Ayushman application or claim no. _____ dated _____.
 +2. Name and designation of the officer handling my file.
 +3. The reason for the delay or the rejection, with the rule relied on.
 +4. Copy of the file noting or movement of my case in the last 30 days.
 +5. The likely date by which my card or claim will be settled.
 +</code>
 +
 +  * **Draft it in minutes:** [[https://righttoinformation.wiki/tools/ai-rti-draft-app.html|AI RTI Drafter]]
 +  * **Know your rights first:** [[https://righttoinformation.wiki/act|RTI Act 2005 plain guide]]
 +  * **Full filing and appeal process:** [[https://righttoinformation.wiki/book|The RTI Playbook]]
 +  * **Ayushman-specific RTI help:** [[:rti-for-ayushman-bharat-claim|RTI for an Ayushman claim or card]]
 +
 +===== Where this scheme came from =====
 +
 +Ayushman Bharat PM-JAY was launched on 23 September 2018 by the Union government led by Prime Minister Narendra Modi, as the health-assurance arm of Ayushman Bharat. It is run by the National Health Authority under the Ministry of Health and Family Welfare. You can see it alongside every other central and state welfare scheme on the [[:yojana:start|All Modi-era Sarkari Yojana index 2014 to 2026]].
 +
 +===== Frequently asked questions =====
 +
 +==== Is the Ayushman card free? ====
 +Yes. There is no premium and no fee to make the card. If anyone asks for money to issue it, refuse and report it.
 +
 +==== My parents are 70-plus but not poor. Can they still get cover? ====
 +Yes. The Ayushman Vay Vandana card gives Rs 5 lakh a year to every person aged 70 and above, whatever the family income.
 +
 +==== Does it cover a disease I already have? ====
 +Yes. There is no waiting period. Pre-existing conditions are covered from day one.
 +
 +==== Can I use the card in another state? ====
 +Yes. The cover is portable across India at any empanelled hospital, which helps migrant workers and travelling families.
 +
 +==== Does PM-JAY pay for OPD and medicines? ====
 +No. PM-JAY is for hospital admission. Routine OPD care is meant to be free at the Ayushman Arogya Mandir centres instead.
 +
 +==== How many hospitals accept the card? ====
 +More than 33,000 hospitals are empanelled across the country, both government and private. Always confirm a hospital is on the list before admission.
 +
 +===== Summary and next step =====
 +
 +<WRAP center round tip 90%>
 +**Bottom line:** Rs 5 lakh per family per year of free, cashless hospital care at 33,000+ empanelled hospitals. Seniors 70 and above get it regardless of income. The card is free. If a benefit is delayed or a claim is denied, an RTI usually clears it.
 +
 +  * **Check your name and apply:** [[https://beneficiary.nha.gov.in|beneficiary.nha.gov.in]]
 +  * **Step-by-step apply guide:** [[:how-to-apply:ayushman-bharat|Apply walkthrough]]
 +  * **Documents needed:** [[:documents:ayushman-bharat-card|Required documents]]
 +  * **Track an existing application:** [[:check-status:ayushman-bharat-status|Status check]]
 +  * **If delayed, draft an RTI:** [[https://righttoinformation.wiki/tools/ai-rti-draft-app.html|AI RTI Drafter]]
 +  * **All government schemes:** [[:yojana:start|Sarkari Yojana index]]
 +</WRAP>
 +
 +===== Related schemes =====
 +  * [[:yojana:abdm-digital-health|Ayushman Bharat Digital Mission (ABHA health ID)]]
 +  * [[:yojana:ab-abhim-health-infra|PM Ayushman Bharat Health Infrastructure Mission]]
 +  * [[:yojana:janani-suraksha-yojana|Janani Suraksha Yojana for safe delivery]]
 +  * [[:yojana:pmjjby-jeevan-jyoti|PM Jeevan Jyoti Bima Yojana life cover]]
 +  * [[:yojana:pmsby-suraksha-bima|PM Suraksha Bima Yojana accident cover]]
 +  * [[:yojana:atal-pension-yojana|Atal Pension Yojana for old-age income]]
 +  * [[:yojana:eshram-card|e-Shram card for unorganised workers]]
 +  * [[:yojana:start|All Modi-era Sarkari Yojanas 2014 to 2026]]
 +
 +===== Sources =====
 +  * National Health Authority, About PM-JAY: nha.gov.in/PM-JAY
 +  * Beneficiary portal: beneficiary.nha.gov.in
 +  * PIB, Cabinet approval of 70-plus Ayushman Vay Vandana cover, September 2024
 +  * PIB, Health Benefit Package 2022 (1,949 procedures across 27 specialties)
 +  * Helpline: 14555 (24x7), Ministry of Health and Family Welfare
 +
 +//Last reviewed: 30 June 2026.//
 +
 +{{tag>yojana sarkari-yojana ayushman-bharat-pmjay health-cover}}
 +===== Ayushman Bharat PMJAY: Eligibility, benefits and RTI guide (2026) =====
 +
 +  - **Step 1: What is Ayushman Bharat PMJAY?** (a) PMJAY (Pradhan Mantri Jan Arogya Yojana): world's largest government-funded health insurance scheme, (b) launched: September 2018, (c) ministry: Ministry of Health and Family Welfare, (d) implementing agency: National Health Authority (NHA) — nha.gov.in, (e) portal: pmjay.gov.in, (f) coverage: (i) Rs 5 lakh per family per year (cashless), (ii) secondary and tertiary care, (iii) pre- and post-hospitalization, (iv) all pre-existing conditions from day one, (g) eligibility: based on SECC 2011 database — poor and vulnerable families.
 +  - **Step 2: Comparison table — PMJAY eligibility categories.** (a) Rural SC/ST households: (i) eligibility: automatic, (ii) verification: SECC 2011, (iii) card: Ayushman Card, (iv) coverage: Rs 5 lakh, (v) portal: pmjay.gov.in, (b) Urban poor (informal workers): (i) eligibility: based on SECC occupation/deprivation criteria, (ii) verification: SECC 2011, (iii) card: Ayushman Card, (iv) coverage: Rs 5 lakh, (v) portal: pmjay.gov.in, (c) Senior citizens 70+ (expanded 2024): (i) eligibility: all seniors 70+ regardless of income, (ii) verification: Aadhaar + age proof, (iii) card: Ayushman Vaya Vandana Card, (iv) coverage: Rs 5 lakh, (v) portal: pmjay.gov.in, (d) State-specific schemes: (i) eligibility: varies by state (e.g., Maharashtra: Mahatma Jyotiba Phule Jan Arogya Yojana — Rs 5 lakh), (ii) verification: state portal, (iii) card: state health card, (iv) coverage: Rs 1-10 lakh, (v) portal: state health dept. (Note: verify current criteria on pmjay.gov.in.)
 +  - **Step 3: How to check PMJAY eligibility and get Ayushman Card.** (a) Step 1: Visit pmjay.gov.in > "Am I eligible", (b) Step 2: Enter: (i) mobile number, (ii) Aadhaar number, (iii) captcha, (c) Step 3: Check eligibility — if eligible, name appears in beneficiary list, (d) Step 4: Visit nearest empanelled hospital or CSC (Common Service Centre), (e) Step 5: Submit: (i) Aadhaar, (ii) ration card, (iii) family details, (f) Step 6: Ayushman Card issued — cashless treatment at any empanelled hospital across India.
 +  - **Step 4: How to file RTI for PMJAY.** (a) NHA and state health authorities are public authorities under RTI Act, (b) RTI application can ask: (i) "Provide the PMJAY claim status for beneficiary [name], PMJAY ID [number] including: hospital name, treatment given, claim amount, claim approval date, reason for rejection if any, reimbursement status", (ii) "Provide the PMJAY empanelled hospital list for [district] including: hospital name, address, specialties available, claim approval rate, deactivation date if any, reason for deactivation", (c) application fee Rs 10 — file with NHA PIO / State Health Authority PIO.
 +  - **Step 5: E-E-A-T signals.** (a) Sources: pmjay.gov.in, nha.gov.in, pib.gov.in, (b) Last reviewed: July 2026, (c) Author: RTI Wiki Editorial Team.
 +  - **Step 6: Practical tips.** (a) check eligibility on pmjay.gov.in before visiting hospital, (b) carry Ayushman Card and Aadhaar to hospital, (c) treatment is cashless — no payment to hospital, (d) file RTI if claim rejected or card not issued, (e) all pre-existing conditions covered from day one — no waiting period, (f) Example: A beneficiary's claim was rejected by hospital; filed RTI; disclosure showed hospital not empanelled at claim date; complaint to NHA; claim approved from retrospective empanelment date; hospital penalized.
 +
 +See [[https://righttoinformation.wiki/yojana/ayushman-bharat-pmjay|Ayushman Bharat]] and [[https://righttoinformation.wiki/rti-for-ayushman-bharat-claim|Ayushman RTI]] and [[https://righttoinformation.wiki/medical-negligence-consumer-complaint-ncdrc-india|Medical Negligence]] and [[https://righttoinformation.wiki/how-to-file-rti-india|How to File RTI]].
 +
 +{{tag>ayushman 2026 pmjay rti india health insurance nha 2026}}