Ayushman Bharat (PM-JAY): ₹5 Lakh Health Cover Explained

A single hospital admission can wipe out years of a family's savings. Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) was created to prevent exactly that. It is the world's largest publicly funded health assurance scheme, offering eligible families cashless treatment of up to ₹5 lakh per year. This guide explains how it works and how to use it.

What is Ayushman Bharat PM-JAY?

Launched in September 2018, PM-JAY provides a health cover of ₹5 lakh per family per year for secondary and tertiary hospitalisation. "Secondary care" means conditions treated by specialists, while "tertiary care" refers to advanced, often surgical, treatment. The cover is on a family floater basis, meaning the ₹5 lakh can be used by any one member or shared across the family in a year.

Crucially, treatment is cashless and paperless at empanelled hospitals — you don't pay upfront and then claim reimbursement. You can read the structured overview on our Ayushman Bharat scheme page.

There is no cap on family size, age or gender under PM-JAY — a deliberate design choice to make sure large and multi-generational families are fully covered.

Who is eligible?

Eligibility is drawn from the Socio-Economic Caste Census (SECC) 2011 database, using deprivation and occupational criteria for rural and urban households. You do not apply to "get selected" — either your household is already in the eligible list or it is not.

Broad eligible groups include:

• Rural families identified through specific deprivation categories (such as households with no adult member, or manual scavenger households).
• Urban workers in defined occupational categories (such as ragpickers, street vendors, domestic workers, construction workers and more).
• Senior citizens aged 70 and above, who are covered under the Ayushman Vay Vandana expansion regardless of income.

Benefits in detail

Feature	Detail
Cover amount	Up to ₹5 lakh per family per year
Basis	Family floater (shared across members)
Treatment type	Cashless and paperless
Coverage	Pre- and post-hospitalisation, diagnostics, medicines
Portability	Valid at empanelled hospitals across India

The scheme covers more than 1,900 medical packages spanning cardiology, oncology, orthopaedics, neurosurgery and many other specialities. Pre-existing conditions are covered from day one — an unusually generous feature compared to typical private insurance.

How to check if your name is on the list

1. Visit the official PM-JAY beneficiary portal at pmjay.gov.in.
2. Enter your mobile number and verify with the OTP.
3. Select your state and search by name, ration card number, or Aadhaar.
4. If your household appears, you are eligible to generate an Ayushman Card.

You can also call the national helpline 14555 or visit an empanelled hospital's Ayushman Mitra desk for help.

How to make your Ayushman Card

The Ayushman Card is your key to cashless treatment, and it is free to make.

1. Confirm eligibility using the portal or the Ayushman app.
2. Complete e-KYC using Aadhaar-based OTP or face authentication.
3. Provide the requested details and a photo.
4. Once approved, download your Ayushman Card as a PDF or collect it from a CSC.

Make a card for every family member so anyone can be admitted without delay in an emergency.

Using PM-JAY at a hospital

When a covered member needs treatment:

• Go to any empanelled public or private hospital.
• Visit the Ayushman Mitra / Pradhan Mantri Arogya Mitra help desk.
• Present the Ayushman Card for verification.
• The hospital raises a pre-authorisation request and, once approved, treatment proceeds cashless within the package limits.

Always confirm that the hospital is empanelled before admission — treatment at non-empanelled facilities is not covered.

What is not covered

While PM-JAY is broad, it does not typically cover:

• Outpatient department (OPD) consultations that don't lead to admission.
• Cosmetic procedures and fertility treatments (with limited exceptions).
• Treatment at hospitals that are not empanelled under the scheme.

How PM-JAY fits with other protections

Health cover is one layer of a family's safety net. Combine PM-JAY with low-cost life and accident cover such as the Pradhan Mantri Jeevan Jyoti Bima Yojana and Suraksha Bima Yojana, and a retirement plan like the National Pension System or Atal Pension Yojana. Together these give a household protection against illness, accidents and old-age income loss.

Frequently Asked Questions

Is Ayushman Bharat really free?

Yes. Making the Ayushman Card is free, and covered treatment up to ₹5 lakh per family per year at empanelled hospitals is cashless.

Do I need to buy or renew a policy every year?

No. PM-JAY is a government-funded assurance scheme, not a policy you purchase. As long as your household remains eligible, the cover continues.

Can senior citizens get Ayushman Bharat?

Yes. Under the Ayushman Vay Vandana expansion, senior citizens aged 70 and above are eligible for cover regardless of their income.

What if the hospital asks me to pay?

At an empanelled hospital, covered treatment should be cashless. If you are asked to pay for a covered procedure, contact the Ayushman Mitra desk or call the helpline 14555.

Final thoughts

Ayushman Bharat PM-JAY has fundamentally changed access to hospital care for crores of Indian families. The most important action you can take today is to check your eligibility and make Ayushman Cards for every family member — so that in an emergency, treatment is one card-swipe away, not a financial crisis. Verify everything on the official portal at pmjay.gov.in.

Disclaimer: SchemeSphere is an independent informational platform and is not affiliated with any government body. Please verify all details on the official portal before applying.