Introduction
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is the world's largest health insurance scheme, providing a health cover of up to ₹5 lakh per family per year. The scheme is designed for poor and vulnerable families, offering cashless treatment at empanelled public and private hospitals across the country. The Ayushman card is the proof of enrolment under this scheme, and with it, families can access hospital care without worrying about the cost. This guide explains the benefits, eligibility, documents, and the complete application process.
What is Ayushman Bharat PM-JAY?
Ayushman Bharat is a national health protection mission launched by the Government of India. Under the Pradhan Mantri Jan Arogya Yojana component, eligible families get a health cover of ₹5 lakh per year, which is used for hospitalisation expenses. The scheme covers more than 1,500 medical procedures, including surgery, treatment of serious illnesses, and follow-up care. The cover is provided at no cost to the beneficiary, and there is no upper limit on the age or the number of members in the family.
Key Benefits of the Ayushman Card
- Cashless treatment at empanelled public and private hospitals.
- Cover of up to ₹5 lakh per family per year.
- Pre-existing diseases are covered from day one of the policy.
- Coverage of 3 days pre-hospitalisation and 15 days post-hospitalisation expenses.
- No age limit and no restriction on the family size.
- Free health services at empanelled hospitals for the listed procedures.
Who Is Eligible?
Eligibility is decided on the basis of the Socio-Economic Caste Census (SECC) database, which lists families that qualify under the economic criteria. Families in the rural and urban poor categories, including landless households, casual labourers, and families living in temporary shelters, are typically covered. The exact list is decided by the state government, so it is important to check whether your family's name appears in the beneficiary list before applying.
- Families listed in the SECC database as eligible.
- Rural and urban poor families as per the government criteria.
- Beneficiaries of specific state health schemes merged into PM-JAY.
- The head of the family or a family member can hold the Ayushman card.
Documents Required
- Aadhaar card of the family members.
- Ration card, which is used to identify the family.
- A mobile number for receiving OTPs and updates.
- A passport-size photograph of the applicant.
- The SECC details or any previous health scheme card, if available.
How to Check Eligibility and Apply
- Visit the official PM-JAY portal or use the Ayushman app to check the beneficiary list.
- Search with your ration card number or your name to confirm eligibility.
- If eligible, visit a Common Service Centre or the nearest enrolment centre with your documents.
- Complete the biometric and OTP verification.
- Provide the family details and a photograph.
- The Ayushman card is generated instantly with a unique card number.
- Collect the printed card or the digital copy.
- Show the card at any empanelled hospital when you need treatment.
What the Scheme Covers
PM-JAY covers hospitalisation, surgeries, and treatment for the procedures listed in the health benefit packages. This includes treatment for serious diseases such as cancer, heart conditions, kidney problems, and major surgeries, along with the pre and post-hospitalisation expenses. Day-care procedures that do not require an overnight stay are also covered. The treatment is cashless, meaning the hospital claims directly from the scheme, and the patient does not pay for the covered procedures.
Important Tips
- Check your eligibility on the official portal before visiting a centre, so you know the exact documents to carry.
- Keep the Ayushman card and a photo ID together when visiting a hospital.
- Choose an empanelled hospital from the scheme's list to get the cashless benefit.
- Note the helpline number for complaints and for checking the status of any claim.
- Renew and update the card details whenever there is a change in the family, such as a new member or a change of address.
What Is Not Covered
PM-JAY covers hospitalisation and listed procedures, but it does not cover outpatient (OPD) treatment, routine check-ups, and treatment in hospitals that are not empanelled under the scheme. Cosmetic procedures and certain lifestyle treatments are also outside the cover. Knowing what is and is not covered helps you plan your health expenses realistically.
How to Use the Card at a Hospital
When you need treatment, first confirm that the hospital is empanelled under PM-JAY. Carry the Ayushman card and a photo ID, and inform the hospital that you are a PM-JAY beneficiary. The hospital checks the beneficiary list, admits the patient for the covered procedure, and settles the claim directly with the scheme. In case of any difficulty, the PM-JAY helpline can be contacted for assistance.
Frequently Asked Questions
Is Ayushman Bharat free of cost?
Yes, the premium and the health cover under PM-JAY are fully paid by the government; the beneficiary pays nothing for the enrolment or for the covered treatment.
What is the cover amount under PM-JAY?
Each eligible family gets a health cover of up to ₹5 lakh per year for hospitalisation expenses.
Do pre-existing diseases get covered?
Yes, pre-existing diseases are covered from the first day of the policy, unlike most private health insurance plans.
Can I get treatment at any hospital?
Treatment is cashless only at hospitals empanelled under the scheme; the list of empanelled hospitals is available on the official portal.
What if my family is not in the beneficiary list?
If your name is not in the SECC list, you may not qualify under the current criteria, and you should contact the district PM-JAY office for clarification.
How long is the Ayushman card valid?
The card is valid as long as the family continues to be eligible under the scheme, and the benefit can be used multiple times within the annual cover.
Can I use the Ayushman card in any state?
The scheme is portable in principle, but you must use an empanelled hospital, and the rules of your home state apply to the beneficiary list.
Conclusion
The Ayushman card is a lifeline for families that could otherwise never afford hospital treatment. The cover of ₹5 lakh protects the family budget against serious illnesses. If you need help checking your eligibility, enrolling, or generating your Ayushman card, visit Usmani Cyber Cafe — we check the beneficiary list, fill the enrolment, and issue your card at affordable rates.