Healthcare expenses can become a major financial burden when a family faces hospitalization or a serious illness.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a government health assurance scheme designed to provide cashless hospitalization benefits to eligible beneficiaries through empanelled hospitals.
The scheme provides health cover of up to ₹5 lakh per family per year for eligible secondary and tertiary care hospitalization. The benefit is available through empanelled public and private hospitals, with portability across the country.
The scheme has also been expanded to cover all citizens aged 70 years and above, irrespective of their socio-economic status, through the Ayushman Vay Vandana Card.
This Ayushman Bharat PM-JAY Guide 2026 explains eligibility, benefits, the Ayushman Card, hospital treatment, documents, the application process, and important things beneficiaries should know.
This Ayushman Bharat PM-JAY Guide explains the scheme in simple terms, including eligibility, ₹5 lakh health cover, Ayushman Card, hospital treatment, senior citizen benefits, documents and how to use the scheme.
Important: Eligibility and benefits can depend on the beneficiary category, state/UT implementation and applicable government rules. Always verify your status through official PM-JAY/NHA channels before relying on the information for treatment.
Ayushman Bharat PM-JAY Guide: What You Need to Know
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a government-funded health assurance scheme launched in September 2018.
Its main purpose is to provide financial protection against major hospitalization expenses for eligible poor and vulnerable families.
Under the core PM-JAY beneficiary framework, eligible families receive health cover of up to ₹5 lakh per family per year for covered secondary and tertiary hospitalization.
The scheme uses a network of empanelled government and private hospitals. Eligible beneficiaries can receive cashless treatment for covered packages at these hospitals.
The scheme also provides portability, meaning an eligible beneficiary can use PM-JAY benefits at an empanelled hospital outside the home state, subject to the applicable scheme process.
What does ₹5 lakh cover mean?
The ₹5 lakh amount is an annual family-level health cover for eligible PM-JAY families.
It is not a ₹5 lakh cash payment to the beneficiary.
Instead, the scheme pays for eligible covered healthcare packages at empanelled hospitals, subject to the applicable package, rules and available coverage.
The official NHA material describes the benefit as cashless coverage for hospitalization and applicable day-care procedures, along with related pre- and post-hospitalization expenses.
Important points
| Feature | PM-JAY |
|---|---|
| Annual cover | Up to ₹5 lakh per family |
| Type | Government health assurance |
| Main coverage | Secondary and tertiary hospitalization |
| Treatment | Covered packages/procedures |
| Hospital type | Empanelled public and private hospitals |
| Payment | Cashless for covered services |
| Portability | Available across India |
| Family size | No general restriction under the core PM-JAY framework |
| Pre-existing diseases | Covered from day one under the scheme framework |
The National Health Authority’s beneficiary materials state that there is no restriction on family size, age or gender under the core PM-JAY framework, and that pre-existing conditions are covered from day one.
Who is eligible for Ayushman Bharat PM-JAY?
This is one of the most important points to understand.
For the original PM-JAY beneficiary base, eligibility is linked primarily to identified poor and vulnerable households using government beneficiary databases and specified deprivation/occupational criteria. NHA documentation refers to eligible households identified through the Socio-Economic Caste Census (SECC) deprivation and occupational criteria, along with specified automatically included categories and certain legacy RSBY families.
The beneficiary base has subsequently been expanded for specific groups.
Major beneficiary categories include:
- Eligible poor and vulnerable families identified under PM-JAY criteria
- ASHA workers and their families
- Anganwadi Workers and their families
- Anganwadi Helpers and their families
- All citizens aged 70 years and above, irrespective of socio-economic status, under the 70+ expansion
The government expanded AB PM-JAY in 2024 to include approximately 37 lakh families of ASHAs, Anganwadi Workers and Anganwadi Helpers.
The 70+ expansion provides coverage to senior citizens aged 70 years and above irrespective of income or socio-economic status.
Important
Being an Indian citizen does not automatically mean that everyone below age 70 is eligible for the core PM-JAY benefit.
Eligibility needs to be verified through the official beneficiary system.
If you want to understand the eligibility rules in more detail, read our Ayushman Bharat PM-JAY Eligibility 2026.
If you are looking for other government benefits you may qualify for, use our Government Scheme Finder 2026 to explore schemes based on your profile.
Ayushman Bharat for senior citizens aged 70+
One of the major changes to PM-JAY is the expansion to senior citizens.
Under the 2024 expansion, all citizens aged 70 years and above are eligible irrespective of socio-economic status.
Eligible senior citizens receive an Ayushman Vay Vandana Card.
For senior citizens who are already part of a PM-JAY-covered family, the government has stated that the 70+ beneficiary receives an additional top-up cover of up to ₹5 lakh per year for themselves rather than sharing that additional amount with family members below 70.
Senior citizens who already have private health insurance or are covered under the Employees’ State Insurance Scheme can also be eligible for AB PM-JAY under the 70+ expansion.
Ayushman Bharat PM-JAY Guide: Benefits and Coverage
The scheme covers healthcare services included in the applicable health benefit packages.
Depending on the package and applicable rules, the benefits can include:
- Hospitalization
- Day-care treatment where applicable
- Medical consultation and treatment
- Medicines and medical consumables
- Diagnostic services associated with covered treatment
- Surgery
- ICU-related services where included
- Implants where applicable
- Accommodation and nursing
- Food during hospitalization
- Follow-up care
- Pre-hospitalization expenses
- Post-hospitalization expenses
NHA materials specify up to 3 days of pre-hospitalization and up to 15 days of post-hospitalization expenses for applicable covered treatment.
The exact services covered depend on the applicable health benefit package and treatment.
Are pre-existing diseases covered?
Yes.
The PM-JAY framework provides coverage for pre-existing conditions from day one.
This is an important difference from many private health insurance policies, where waiting periods can apply to certain pre-existing conditions.
However, the treatment itself must fall within the applicable PM-JAY benefit package and scheme rules.
Can you use PM-JAY outside your home state?
Yes, PM-JAY provides national portability.
An eligible beneficiary can use the scheme at an empanelled hospital in another state, subject to the PM-JAY process and applicable package availability.
For example, a beneficiary registered in Odisha may be able to receive covered treatment at an empanelled hospital in another state.
NHA’s operational material describes portability across India, and NHA’s beneficiary guidance states that the home state remains responsible for the treatment expense in the portability process.
What is an Ayushman Card?
The Ayushman Card is used to identify and authenticate eligible beneficiaries so that they can access PM-JAY benefits.
It should not be confused with a private health insurance card.
The card itself does not mean that every medical expense is automatically free.
Treatment must generally be:
- covered under the scheme,
- provided at an empanelled hospital, and
- processed according to PM-JAY rules.
How to get an Ayushman Card
The exact process can vary according to beneficiary category and the current NHA/state process.
Eligible beneficiaries may use official PM-JAY/NHA channels, including beneficiary services, the Ayushman mobile application, Common Service Centres and empanelled hospitals, depending on the category and available process.
For senior citizens aged 70+, the government has specifically stated that enrolment can be undertaken through the Ayushman App, the beneficiary web portal or a nearby empanelled hospital/CSC.
Basic process
- Check whether your name/category is eligible.
- Complete beneficiary verification.
- Complete e-KYC where required.
- Submit the required identity information/documents.
- Generate or download the Ayushman Card after successful verification.
- Use the card at an empanelled hospital for eligible treatment.
What documents may be required?
Documents can vary according to the beneficiary category and verification process.
Common identity or beneficiary documents may include:
- Aadhaar or another accepted government identity document
- Ration card
- Proof of relationship where required
- Mobile number
- Other government-issued documents accepted under the applicable process
The NHA privacy and beneficiary documentation identifies several possible identity/address documents, including Aadhaar, ration card, MNREGA job card, driving licence, voter ID and other government-issued documents.
Do not assume that every applicant needs every document listed above. The required documents depend on the applicable verification process.
How to find an Ayushman Bharat empanelled hospital
PM-JAY benefits are generally available through empanelled public and private hospitals.
Before planned treatment, check whether the hospital is currently empanelled and whether the required treatment/package is available.
This is especially important because the ₹5 lakh cover does not mean that every hospital or every medical service is automatically covered.
The National Health Authority maintains hospital-related PM-JAY systems and lists of empanelled facilities.
Official PM-JAY website:
National Health Authority — PM-JAY
What is not automatically covered?
PM-JAY is primarily designed around hospitalization and covered health benefit packages.
Therefore, you should not assume that every healthcare expense is covered.
For example, NHA’s published FAQ materials identify services such as routine outpatient care, cosmetic treatment and certain other services among exclusions under the applicable PM-JAY framework.
Coverage can also depend on:
- the medical procedure,
- package availability,
- hospital empanelment,
- pre-authorisation requirements,
- state implementation rules,
- applicable exclusions.
Always verify the specific treatment before assuming that it will be cashless.
What if an empanelled hospital refuses treatment?
If you believe an empanelled hospital has wrongly denied an eligible PM-JAY service, you can use the official grievance mechanism.
The scheme has grievance redressal arrangements at district, state and national levels. Government information also identifies 14555 as the PM-JAY helpline.
Do not pay an unofficial fee simply because someone says it is required to “activate” your Ayushman Card.
If there is a dispute, ask the hospital’s Ayushman Mitra/Arogya Mitra or the relevant PM-JAY help desk for clarification and use the official grievance channel if necessary.
Ayushman Bharat PM-JAY: Important facts at a glance
| Question | Answer |
|---|---|
| Full name | Ayushman Bharat Pradhan Mantri Jan Arogya Yojana |
| Short name | AB PM-JAY |
| Annual cover | Up to ₹5 lakh per family |
| Main purpose | Financial protection for eligible hospitalization |
| Main treatment | Secondary and tertiary care |
| Hospital network | Empanelled public and private hospitals |
| Cashless treatment | Yes, for covered services |
| Portability | Yes, across India |
| Pre-existing conditions | Covered from day one under PM-JAY framework |
| 70+ expansion | All citizens aged 70+ irrespective of socio-economic status |
| Main helpline | 14555 |
The latest government update states that, as of June 30, 2026, AB PM-JAY had authorized 12.69 crore hospital admissions worth ₹1.92 lakh crore through a network of 37,413 public and private hospitals.
This Ayushman Bharat PM-JAY Guide is designed to help you understand the main eligibility rules, coverage, Ayushman Card process and important limitations before you apply or seek treatment.
Final Takeaway
The Ayushman Bharat PM-JAY Guide provides a starting point for understanding eligibility, ₹5 lakh health cover, Ayushman Card services and hospital benefits. Eligibility and treatment coverage should always be verified through the official PM-JAY system because beneficiary categories, packages and implementation rules can vary.
If you believe you are eligible, check your beneficiary status through the official government channels before relying on the information for medical treatment.
Frequently Asked Questions
Q1. Is Ayushman Bharat PM-JAY free?
For eligible beneficiaries, covered PM-JAY services at empanelled hospitals are provided on a cashless basis according to scheme rules and applicable health benefit packages.
Q2. Does everyone get ₹5 lakh?
No. The ₹5 lakh benefit is not a universal cash payment. Eligibility depends on the applicable PM-JAY beneficiary category. The 70+ expansion is an important exception because all citizens aged 70 years and above are eligible irrespective of socio-economic status.
Q3. Can a person have private health insurance and Ayushman Bharat?
For senior citizens aged 70+, the government has specifically stated that people with private health insurance can still be eligible for AB PM-JAY.
For other categories, verify the applicable rules before assuming dual coverage.
Q4. Is there an age limit for ordinary PM-JAY families?
The core PM-JAY framework does not impose a general age restriction on members of an eligible family.
Q5. Can I use Ayushman Bharat in another state?
Yes. PM-JAY has national portability, allowing eligible beneficiaries to receive covered treatment at empanelled hospitals outside their home state.
Q6. Are pre-existing diseases covered?
Yes, the PM-JAY framework provides coverage for pre-existing conditions from day one.
Q7. How can I check my eligibility?
Use the official PM-JAY beneficiary services or contact the PM-JAY helpline at 14555. You can also visit an eligible CSC or empanelled hospital for assistance.
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