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In summary
PMJAY Ayushman Bharat Yojana is a Government of India health protection scheme that provides eligible beneficiaries with financial coverage for specified secondary and tertiary hospitalisation expenses, subject to applicable eligibility criteria, scheme guidelines and coverage conditions. Understanding its eligibility, benefits and treatment provisions can help first-time users determine whether they can access the scheme.
Key takeaways
- PMJAY Ayushman Bharat Yojana is part of the Ayushman Bharat initiative.
- The scheme provides eligible beneficiaries with coverage for specified hospitalisation expenses.
- Treatment is available through empanelled healthcare providers, subject to applicable scheme rules.
- Eligibility depends on the beneficiary’s applicable criteria under the scheme.
- First-time users can check their eligibility and understand the available benefits before seeking treatment.
If you want to prepare for unexpected medical expenses, check now to explore health insurance plans and their benefits.
What is the Ayushman card and how does it work?
Launched by the Government of India in September 2018, Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a component of the Ayushman Bharat initiative that provides health coverage to eligible beneficiaries. The scheme is designed to support access to hospitalisation and healthcare services for eligible families based on the applicable government-defined criteria.
PM-JAY provides health cover of up to Rs. 5 lakh per eligible family per year for specified secondary and tertiary hospitalisation. Eligible beneficiaries can access covered treatment at empanelled public and private hospitals, subject to the scheme’s guidelines and applicable conditions. For more information about health insurance, you can also explore available coverage options.
The scheme covers a range of eligible hospitalisation-related services and medical expenses. Depending on the treatment and applicable package, these can include procedures, diagnostic services, medicines, medical consumables, intensive care and other specified expenses related to covered hospitalisation.
Pro tip
10 key Ayushman card benefits under PMJAY
PMJAY provides eligible beneficiaries with access to specified healthcare services and hospitalisation benefits, subject to applicable scheme guidelines. Key Ayushman card benefits include:
- Healthcare cover of Rs. 5 lakh per family: Eligible families can receive health cover of up to Rs. 5 lakh per year for specified secondary and tertiary hospitalisation expenses under PMJAY, subject to applicable scheme conditions.
- Eligibility based on government-defined criteria: PMJAY eligibility is determined using government-defined beneficiary identification criteria. Beneficiaries can check their eligibility through the official channels specified for the scheme.
- Coverage for eligible family members: PMJAY does not impose a general restriction on family size under its current beneficiary framework. Coverage is available to eligible beneficiaries identified under the applicable scheme criteria.
- Secondary and tertiary hospitalisation: The scheme covers specified secondary and tertiary hospitalisation services through empanelled healthcare providers. Covered treatments can include procedures and medical interventions included under applicable packages.
- Coverage of pre-existing conditions: PMJAY provides coverage for eligible pre-existing conditions from the beginning of the beneficiary's coverage, subject to the scheme's applicable guidelines and treatment packages.
- Cashless treatment: Eligible beneficiaries can access covered treatment on a cashless basis at empanelled hospitals, subject to the applicable scheme rules. Learn more about healthcare cashless.
- Reduced out-of-pocket expenses: PMJAY is designed to reduce eligible beneficiaries' out-of-pocket expenditure for covered hospitalisation by providing financial protection for specified treatments and services under the scheme.
- Empanelled public and private hospitals: Eligible beneficiaries can access covered treatment through empanelled public and private healthcare providers, subject to hospital availability and the applicable scheme guidelines.
- Coverage for specified healthcare services: PMJAY packages can include eligible procedures, hospitalisation, medicines, diagnostic services and other specified medical expenses, depending on the treatment package and applicable scheme provisions.
- Access to healthcare across India: Eligible beneficiaries can access covered treatment at empanelled hospitals across India, subject to the scheme's portability provisions and applicable conditions.
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Key features and coverage of the Ayushman card (PMJAY)
The Ayushman card provides eligible beneficiaries access to healthcare benefits under PMJAY. Key features and coverage include:
- Cashless healthcare: Eligible beneficiaries can access cashless treatment for specified secondary and tertiary hospitalisation at empanelled hospitals, subject to the applicable scheme guidelines and treatment packages. The scheme provides coverage of up to Rs. 5 lakh per eligible family per year.
- Eligibility criteria: Eligibility is determined according to government-defined beneficiary identification criteria under the scheme. Beneficiaries should verify their eligibility through the official PMJAY channels.
- Health coverage: PMJAY covers specified medical procedures, hospitalisation and other healthcare services included under approved treatment packages. The available coverage depends on the applicable package and scheme guidelines.
- Pan-India access: Eligible beneficiaries can access covered treatment at empanelled hospitals across India, subject to the scheme's portability provisions and applicable conditions.
- Cashless treatment: Covered treatment is provided on a cashless basis at eligible empanelled hospitals, subject to the applicable scheme rules and package limits.
- Pre- and post-hospitalisation coverage: Certain pre- and post-hospitalisation expenses may be covered when they are included within the applicable treatment package and scheme provisions. Learn more about pre- and post-hospitalisation expenses.
- Portability: PMJAY provides portability, allowing eligible beneficiaries to access covered treatment at empanelled hospitals outside their home state, subject to applicable scheme provisions.
- No general age restriction: PMJAY does not impose a general age limit for eligible beneficiaries. Eligibility and coverage are determined according to the applicable beneficiary criteria and scheme guidelines.
- Empanelled hospital network: PMJAY enables eligible beneficiaries to access covered healthcare services through empanelled public and private hospitals across India, subject to hospital availability and applicable scheme provisions.
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Who is eligible for Ayushman card benefits?
PMJAY identifies eligible beneficiaries based on defined criteria for rural and urban households. The beneficiary identification framework includes the following categories:
Rural beneficiary categories
- D1: Households living in a dwelling with only one room and kucha walls and a kucha roof.
- D2: Households with no adult member between 16 and 59 years of age.
- D3: Households with no adult male member between 16 and 59 years of age.
- D4: Households with a disabled member and no able-bodied adult member.
- D5: Households belonging to Scheduled Caste (SC) or Scheduled Tribe (ST) categories.
- D6: Landless households deriving a major part of their income from manual casual labour.
Urban beneficiary categories
For urban areas, beneficiary identification includes specified occupational categories, such as:
- Ragpickers
- Beggars
- Domestic workers
- Street vendors, cobblers, hawkers and other street-based service providers
- Construction workers, plumbers, masons, labourers, painters, welders, security guards, coolies and other head-load workers
- Sweepers, sanitation workers and gardeners
- Home-based workers, artisans, handicraft workers and tailors
- Transport workers, drivers, conductors, helpers, cart pullers and rickshaw pullers
- Shop workers, assistants, peons, helpers, delivery assistants, attendants and waiters in small establishments
- Electricians, mechanics, assemblers and repair workers
- Washermen and chowkidars
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Arjun Mehta
13 Jul 2025
I opted for the Health Infinity plan for my parents. The digital onboarding was incredibly fast with no medical tests required since they are under 50. We had a minor daycare procedure last month, and the cashless approval came through in less than 2 hours. Very impressed with the efficiency.
Priya Sharma
28 Feb 2025
The Bajaj Finance Health app is a lifesaver. I use it for my regular OPD consultations and medicine orders. The 10% discount on pharmacy bills and the easy reimbursement for doctor visits make it much more than just a 'hospitalization' policy. It’s daily health support.
Sneha Kapoor
15 Mar 2025
Switched my family floater to Bajaj General this year. The network of hospitals in my city (Pune) is excellent. The only downside was a slight delay in getting my physical card, but the digital copy on the app works everywhere. The 'Wellness Rewards' for hitting step goals is a cool touch!
Conclusion
Understanding the PMJAY beneficiary categories can help you determine whether you may be eligible for benefits under the Ayushman Bharat scheme. Before choosing health coverage, review the available benefits, eligibility requirements and policy terms to make an informed decision based on your healthcare needs. Apply now to explore health insurance plans and choose suitable coverage for your requirements.
| ABHA Card | Pradhan Mantri Jeevan Jyoti Bima Yojana |
| Beneficiary NHA | PMJAY Registration |
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Frequently Asked Questions
Know More About PMJAY Ayushman Bharat Yojana
How to apply online for the Ayushman Bharat Yojana?
To apply for Ayushman Bharat Yojana online, follow the steps below:
- Visit the official website of Ayushman Bharat - https://pmjay.gov.in/
- Click on the 'Am I Eligible?' tab and enter your mobile number
- Enter the Captcha code and click on 'Generate OTP'
- Enter the OTP received on your mobile number and click on 'Verify OTP'
- Enter the required details, including your name, address, and Aadhaar number
- Submit the application
What services are offered under the Ayushman Bharat Scheme?
The Ayushman Bharat Scheme covers a range of healthcare services, including:
- Medical consultations, diagnostic tests and treatment
- Surgical procedures and interventions
- Hospitalisation expenses
- Medical expenses related to critical illnesses
What are the critical diseases covered under the Ayushman Bharat Health Scheme?
PM-JAY covers specified medical procedures and hospitalisation packages rather than maintaining a simple disease-only list. Coverage can include treatments for several serious conditions, subject to approved packages, beneficiary eligibility and applicable scheme guidelines.
What is the process to get an Ayushman card?
First, check your eligibility under PM-JAY through an official channel. Complete the required beneficiary verification and identity authentication process. Once verified, the Ayushman card can be generated through authorised government services or designated centres.
Is Ayushman Bharat health card free?
Yes. Eligible beneficiaries do not pay a premium to receive PM-JAY benefits. The scheme provides financial coverage of up to Rs. 5 lakh per eligible family per year for specified hospitalisation expenses, subject to applicable guidelines.
What are the key exclusions in Ayushman Bharat health scheme?
The key exclusions in Ayushman Bharat health scheme include cosmetic surgery, dental procedures, and organ transplants. It also does not cover treatment of lifestyle diseases like obesity, infertility, and mental illness.
Who is eligible for Ayushman card?
Eligibility for an Ayushman card depends on the beneficiary identification criteria applicable under PM-JAY and subsequent government provisions. Beneficiaries can check their eligibility through official PM-JAY channels before proceeding with card generation.
Is Ayushman card valid for everyone?
No. The Ayushman card is available to eligible beneficiaries identified under the applicable PM-JAY criteria. It is not automatically available to every resident. Eligibility should be verified through official government channels before seeking benefits.
Which diseases are not covered under Ayushman Bharat?
Given below is the list of diseases not covered in the Ayushman Bharat scheme:
- Outpatient department (OPD) consultations and procedures
- Fertility-related treatments such as in-vitro fertilisation (IVF)
- Cosmetic surgeries and procedures
- Dental treatments and procedures
- HIV/AIDS treatment
- Drug and alcohol rehabilitation
How do I apply for and activate Ayushman card benefits?
PM-JAY does not have a waiting period for eligible pre-existing diseases. Covered pre-existing conditions are included from the beginning of coverage, subject to beneficiary eligibility, applicable treatment packages and scheme guidelines.
Is there a waiting period for pre-existing diseases under Ayushman card?
PM-JAY does not have a waiting period for eligible pre-existing diseases. Covered pre-existing conditions are included from the beginning of coverage, subject to beneficiary eligibility, applicable treatment packages and scheme guidelines.
Can I use the Ayushman card for treatment in another state?
Yes. PM-JAY provides portability, allowing eligible beneficiaries to access covered treatment at empanelled hospitals outside their home state. Treatment remains subject to scheme guidelines, hospital empanelment, approved packages and applicable eligibility conditions.
What should I do if a hospital demands cash from an Ayushman cardholder?
If an empanelled hospital demands payment for a covered PM-JAY service, ask for clarification and retain relevant documents or receipts. You can report the issue through the official PM-JAY grievance redressal channels for further assistance.
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