Ayushman Bharat Card – Check PMJAY Eligibility Online at pmjay.gov.in

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is a health insurance scheme providing financial protection for secondary and tertiary healthcare. This scheme announced by the Government of India in the Union Budget 2018.
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28-January-2025

Ayushman Bharat Yojana, also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY), is a scheme that aims to help the economically weaker section of society who needs healthcare facilities.

The PMJAY scheme was rolled out by the Prime Minister on September 23, 2018. This health insurance scheme covers about fifty crore citizens in India. Ayushman card already has several success stories to its credit. As a most recent addition to the benefits covered under the PMJAY scheme, all senior citizens above 70 years of age, irrespective of their socio-economic background will be eligible for a Rs. 5 lakh health insurance coverage per year. In this article, we will further discuss in detail the benefits, coverage, eligibility, exclusions, and more about the Ayushman Bharat Yojana.

What is PMJAY (Ayushman Bharat Yojana)?

The Ayushman Bharat Yojana (PMJAY), a flagship health insurance initiative of the Government of India, provides comprehensive coverage for tertiary and secondary hospitalisation expenses. This program is designed to benefit over 12 crores impoverished and vulnerable families.

The Ayushman Bharat Yojana - National Health Protection Scheme has now been renamed Pradhan Mantri Jan Arogya Yojana. This plans to make secondary and tertiary healthcare completely cashless for the underprivileged section of society. The PM Jan Arogya Yojana beneficiaries get an Ayushman card to avail of services at an empanelled hospital, public, or private, anywhere in the country. With the PMJAY scheme, you can enjoy the benefit of walking into a hospital and obtaining cashless treatment.

Key highlights of PMJAY

PMJAY (Pradhan Mantri Jan Arogya Yojana) is a flagship government health insurance scheme with the following features:

  • Coverage: Provides financial protection of up to Rs. 5 lakh per family per year for hospitalisation expenses.
  • Eligibility: Encompasses families identified as beneficiaries under the Socio-Economic and Caste Census (SECC-2011).
  • Geographic reach: Offers nationwide coverage across a comprehensive network of empanelled public and private hospitals.
  • Operational efficiency: Facilitates a seamless and paperless process for accessing healthcare benefits.

What are regular health insurance plans vs. government health insurance scheme?

Regular health insurance plans are offered by private insurers, while government schemes provide affordable coverage for economically weaker sections.

Features

Private Health Insurance

Government Health Insurance Scheme

Eligibility

Available to all sections of society

Available to lower-income groups only

Sum Insured

Maximum sum insured of up to Rs. 6 crores

Maximum sum insured of up to Rs. 5 lakhs

Premium

Rs. 200 per month onwards (depending on the plan)

Rs. 100 per month onwards or fully paid by the government

(depending on the plan)

Coverage

Offers a broader coverage

Offers a narrow coverage

Private Hospital Room

Available

(depending on the plan)

May or may not be available

Policy Purchase

Policy can be purchased instantly

Policy purchase may take time

Network Hospitals

A wide network of empanelled private hospitals

A large number of public and private network hospitals

Maternity Benefits

Available

(depending on the plan)

Available

(Only for a single child in some cases)

Ambulance Charges

Available under most plans

Available under a few plans

Domiciliary Hospitalization Cover

Available

(depending on the plan)

Not available

Online Renewal

Can be renewed online

May or may not be renewed online

Cumulative Bonus

Available if no claim was filed in the previous policy year

Not available

Health Check-up

Covered under some plans

Not covered

Monthly Premium Instalment Facility

Available under some plans

Not available

Tax Benefits

Available under the Income Tax Act, 1961

Not available

 

About Ayushman Bharat scheme and card (PMJAY): Overview

PMJAY provides Rs. 5 lakh coverage to every family per year, thus helping the economically disadvantaged access healthcare services easily. Given below are the key details about the Ayushman Bharat Yojana:

Features

Details

Name of the Scheme

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) or Ayushman Bharat National Health Protection Scheme (NHPS)

Launch date for PMJAY

September 23, 2018

Coverage (per family)

Rs. 5 lakh/year

Procedures covered

1,400 procedures

Pre-hospitalisation expenses coverage

Up to 3 days

Post-hospitalisation expenses coverage

Up to 15 days

Website

https://www.pmjay.gov.in/

Helpline Numbers

1800-111-565 or 14555

Email Id

ayushmanbharat.csc@gmail.com

Family Floater Scheme

Provides coverage for the entire family under one policy.

Cashless Healthcare

Beneficiaries can avail of cashless treatment at empanelled hospitals.

Pre-Existing Diseases Covered

From the very first day of policy activation.

Transport Costs Reimbursed

Includes expenses incurred for reaching the hospital.

Daycare Expenses Included

Covers treatments that don't require hospitalization.

Health and Wellness Centres

Establishes 1.5 lakh centers for primary healthcare across India.

 

Benefits of Ayushman Bharat Yojana

The Pradhan Mantri Jan Arogya Yojana (PMJAY) provides crucial healthcare access to approximately 40% of India's population, encompassing the most vulnerable segments. Key advantages of the scheme include:

  1.  Comprehensive coverage: Encompasses 27 specialty areas, encompassing oncology, cardiology, and orthopaedics.
  2.  Post-Discharge care: Ensures coverage for post-discharge care and associated medication expenses.
  3.  Multi-surgical coverage: Provides financial support for multiple surgeries, with subsequent procedures covered at reduced rates (50% and 25% for the second and third surgeries, respectively).
  4.  Critical illness coverage: Extends financial assistance for the treatment of critical illnesses, including cancer, heart surgery, organ transplants, and other life-threatening conditions.

Pro Tip

A comprehensive health plan not only covers hospitalization but also pre & post-treatment expenses, ensuring complete financial protection against rising medical costs.

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State/UT-wise beneficiary verification and Ayushman card creation details

State/UT

Number of beneficiaries verified /Ayushman

cards created

Andaman And Nicobar Islands

40,616

Andhra Pradesh

1,17,09,939

Arunachal Pradesh

82,607

Assam

75,02,411

Bihar

77,68,696

Chandigarh

1,41,662

Chhattisgarh

1,70,41,356

Dadra and Nagar Haveli & Daman and Diu

4,30,863

Goa

27,076

Gujarat

1,77,43,275

Haryana

81,37,302

Himachal Pradesh

11,31,516

Jammu And Kashmir

81,42,855

Jharkhand

1,05,82,316

Karnataka

1,36,97,728

Kerala

71,46,371

Ladakh

1,30,420

Lakshadweep

26,031

Madhya Pradesh

3,55,34,316

Maharashtra

91,61,278

Manipur

4,82,457

Meghalaya

17,79,340

Mizoram

4,34,506

Nagaland

4,35,497

Puducherry

4,09,804

Punjab

79,90,610

Rajasthan

1,00,91,251

Sikkim

52,614

Tamil Nadu

1,85,50,814

Telangana

41,98,258

Tripura

13,13,815

Uttar Pradesh

2,61,56,403

Uttarakhand

50,17,750

 

What are the Eligibility criteria of PMJAY for rural and urban?

Eligibility for PMJAY is determined based on data from the Socio-Economic and Caste Census 2011 (SECC-2011). The following criteria apply to rural and urban households:

Rural households:

  • Households residing in dwellings constructed with unbaked mud or other non-durable materials and comprising only a single room.
  • Households lacking any adult male member within the age group of 16 to 59 years.
  • Families with at least one disabled member and no able-bodied adult member for support.
  • Households belonging to Scheduled Castes (SC) or Scheduled Tribes (ST) communities.
  • Landless families primarily dependent on manual, casual labor for their livelihood.

Urban households:

PMJAY coverage extends to individuals employed in the following occupations:

  • Domestic workers
  • Street vendors
  • Sanitation workers
  • Construction laborers
  • Transport workers (including drivers, conductors, and rickshaw pullers)

Eligibility criteria for senior citizens above 70 years

On September 12, 2024, the Union Cabinet approved the expansion of PMJAY for all senior citizens above 70 years of age. The specifications of the eligibility have been given below:

  • All senior citizens, above 70 years of age, irrespective of their social-economic status will be given a health coverage of up to Rs. 5 lakh under this scheme.
  • This expansion will enable the ease of financial expenses that may be required by senior citizens for healthcare.
  • The Centre and State governments will share the cost of this extended coverage.
  • Senior citizens aged 70 and above, who belong to families already covered under AB PM-JAY, will receive an additional top-up coverage of up to Rs 5 lakh per year exclusively for themselves. This coverage will not need to be shared with other family members below the age of 70.
  • Senior citizens with private health insurance can benefit from the scheme alongside their existing coverage.
  • Seniors enrolled in other public health schemes, such as CGHS, ECHS, or Ayushman CAPF, must choose between their existing coverage and the new Ayushman Bharat health insurance.

All eligible senior citizens will be issued a separate health card to facilitate easier access to the scheme’s benefits.

PMJAY Rural

The 71st round of the National Sample Survey Organisation reveals that a staggering 85.9% of rural households do not have access to any healthcare insurance or assurance. Additionally, 24% of rural families access healthcare facilities by borrowing money. Ayushman Bharat Yojana aims to help this sector by providing yearly assistance of up to Rs. 5 lakh per family. The scheme will aid economically disadvantaged families as per data in the Socio-Economic Caste Census 2011. Here too, households enrolled under the Rashtriya Swasthya Bima Yojana (RSBY) will come under the ambit of the PM Jan Arogya Yojana.

In the rural areas, the PMJAY health cover is available to:

  • Those living in scheduled caste and scheduled tribe households
  • Beggars and those surviving on alms
  • Families with no individuals aged between 16 and 59 years
  • Families having at least one physically challenged member and no able-bodied adult member
  • Landless households who make a living by working as casual manual labourers
  • Primitive tribal communities
  • Legally released bonded labourers
  • Families living in one-room makeshift houses with no proper walls or roof
  • Manual scavenger families

PMJAY Urban

According to the National Sample Survey Organisation (71st round), 82% of urban households do not have health insurance. Further, 18% of Indians in urban areas have addressed healthcare expenses by borrowing money in one form or the other. Pradhan Mantri Jan Arogya Yojana helps these households avail of healthcare services by providing funding of up to Rs. 5 lakh per family per year. PMJAY will benefit urban workers’ families in the occupational category present in the Socio-Economic Caste Census 2011. Further, any family enrolled under the Rashtriya Swasthya Bima Yojana will benefit from the PM Jan Arogya Yojana.

In the urban areas, those who can avail of the government-sponsored scheme consist mainly of:

  • Washerman/ watchmen
  • Rag pickers
  • Mechanics, electricians, repair workers
  • Domestic help
  • Sanitation workers, gardeners, sweepers
  • Home-based artisans, or handicraft workers, tailors
  • Cobblers, hawkers, and other services provided on streets or pavements
  • Plumbers, masons, construction workers, porters, welders, painters, and security guards
  • Transport workers like drivers, conductors, helpers, cart, or rickshaw pullers
  • Assistants, peons in small establishments, delivery boys, shopkeepers, and waiters

People not entitled to health coverage under Pradhan Mantri Jan Arogya Yojana:

  • Those who own a two, three or four-wheeler or a motorised fishing boat
  • Those who own mechanised farming equipment
  • Those who have kisan cards with a credit limit of Rs. 50000
  • Those employed by the government
  • Those who work in government-managed non-agricultural enterprises
  • Those earning a monthly income above Rs. 10000
  • Those owning refrigerators and landlines
  • Those with decent, solidly built houses
  • Those owning 5 acres or more of agricultural land

While not everyone is entitled to these government schemes, getting health, motor or other general insurance policies may not be suitable for all pockets. Thus, Bajaj Finance brings insurance and subscription plans affordable for all.

What is covered under Ayushman Bharat Yojana Scheme or PMJAY?

With the aim of providing accessible healthcare to the economically disadvantaged, the Ayushman Bharat Yojana Scheme, including the AB-PMJAY and Ayushman card, offers comprehensive coverage of up to Rs. 5 lakh per family annually for secondary and tertiary hospitalisation care.

Health insurance provided under AB-PMJAY encompasses various components, such as medical examination, consultation, and treatment, pre-hospitalisation services, both non-intensive and intensive care, medication and medical consumables, diagnostic and laboratory tests, accommodation, medical implants where necessary, food services, treatment-related complications, and post-hospitalisation expenses for a duration of up to 15 days.

What is not covered under Ayushman Bharat Yojana Scheme or PMJAY?

Just like other health insurance policies, Ayushman Bharat Yojana Scheme has its exclusions. The following components are not covered under the scheme:

  • Out-Patient Department (OPD) expenses
  • Drug rehabilitation
  • Cosmetic surgeries
  • Fertility treatments
  • Individual diagnostics
  • Organ transplant

COVID-19 Coverage Under PMJAY

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) provides coverage for expenses incurred during COVID-19 treatment, encompassing the following:

  • Quarantine and isolation costs: Financial support is extended for expenses associated with quarantine and isolation procedures.
  • Hospitalisation for COVID-19-related complications: The scheme covers hospitalisation costs for individuals experiencing complications arising from COVID-19 infection.
  • Diagnostic tests at empanelled hospitals: PMJAY covers the costs of diagnostic tests for COVID-19 conducted at empanelled hospitals within the scheme's network.

How to check Ayushman Bharat Yojana eligibility online?

To verify your eligibility for Ayushman Bharat online, adhere to the following steps:

Step 1: Go to the official website of Ayushman Bharat Yojana

Step 2: Access the "Am I Eligible" section on the homepage.

Step 3: Input your mobile number and captcha code on the subsequent page, then click the "Generate OTP" button.

Step 4: Enter the OTP received on your mobile and click the "Verify OTP" button.

Step 5: On the subsequent page, furnish essential information such as name, state, age, family members, and income details.

Step 6: Once all details are entered, click the "Submit" button.

Medical packages and hospitalisation process in Ayushman Bharat Yojana (PMJAY)

Individuals in specific and families, in general, can benefit from the Rs. 5 lakh insurance cover provided by the Pradhan Mantri Jan Arogya scheme. This lump sum is enough to cover the medical and surgical treatments in 25 specialities: cardiology, neurosurgery, oncology, paediatrics, orthopaedics, etc. However, medical and surgical expenses cannot be reimbursed simultaneously.

If multiple surgeries are necessary, the highest package cost is paid for in the first instance, followed by a 50% waiver for the second and a 25% discount for the third. Unlike other health insurance schemes, there is no waiting period for pre-existing diseases under the PMJAY scheme, which comes under the larger umbrella scheme of Ayushman Bharat Yojana. Should any beneficiary or anyone in their family require hospitalisation, they need not pay anything, provided they are admitted in any empanelled government or private hospital.

The cashless treatment and hospitalisation are possible due to a 60:40 cost-sharing agreement between the centre and states. Once identified as a genuine beneficiary, you or your family member will be issued a health card by specially trained Ayushman Mitras. They manage kiosks in hospitals for those unaware of the PMJAY scheme.

PMJAY illness coverage: List of critical diseases covered under PM Jan Arogya Yojana

PMJAY helps households access secondary and tertiary care by funding up to Rs. 5 lakh per family per year. This assistance is valid for daycare procedures and even applies to pre-existing conditions. PMJAY extends coverage for over 1,350 medical packages at empanelled public and private hospitals.

Some of the illnesses under critical health insurance are as follows:

  • Prostate cancer
  • Coronary artery bypass grafting
  • Double valve replacement
  • Carotid angioplasty with stent
  • Pulmonary valve replacement
  • Skull base surgery
  • Laryngopharyngectomy with gastric pull-up
  • Anterior spine fixation
  • Tissue expander for disfigurement following burns

Here are some of the exclusions under PMJAY:

  • OPD
  • Drug rehabilitation programme
  • Cosmetic-related procedures
  • Fertility-related procedures
  • Organ transplants
  • Individual diagnostics (for evaluation)

 

Read more : How to apply for Ayushman card

Ayushman Bharat Yojana: PMJAY patient card generation

Once you are eligible for the PMJAY benefits, you can work towards getting an e-card through the official website pmjay.gov.in. Your Aadhaar card or ration card will be verified at the PMJAY kiosk before issuing a card. Family identification proofs include a government-certified list of members, a PM letter, and an RSBY card. After verification, the e-card is printed along with the unique AB-PMJAY ID. You can use this as proof at any point in the future.

Government schemes offer higher coverage at lower premium prices. However, you can also look for health insurance policies with higher coverage and nominal premiums at the Bajaj Finance Insurance Mall. These policies provide coverage for critical illnesses, accidents, health check-ups, and additional add-on benefits.

PMJAY toll-free helpline

For inquiries or support, please contact the PMJAY helpline at:

  • 14555
  • 1800-111-565

Advantages of health insurance in India

The main advantage of having a health insurance policy is that you can avail of medical treatment without suffering any strain on your finances. Moreover, as many Indians end up borrowing money informally to pay medical bills, utilising the features of PMJAY helps avoid the risk of a debt trap. You can get up to Rs. 5 lakh treatment under the Ayushman Bharat Yojana.

You may choose to buy a family health insurance plan to secure your entire family under one umbrella or go for an individual health insurance plan. For senior citizens, it is advised to have a separate health insurance plan to cover their medical expenses. Several health insurance plans for senior citizens provide adequate financial coverage.

Alternatively, you can also explore small-ticket health policies like Pocket Insurance offered through Bajaj Finance, which offers affordable policies catering to specific needs. You can easily apply for these policies online.

Read more

Ayushman Card Status

Central Govt health scheme

Ayushman Bharat Golden Card2

Benefits of Ayushman Bharat Yojana

Ayushman Bharat Digital Mission

List of diseases covered under Ayushman Bharat

Frequently asked questions

How can I check if I am eligible for the PMJAY scheme?

The Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme provides free medical treatment and hospitalisation for certain illnesses and procedures. To determine your eligibility for this incredible program, simply visit the official PMJAY website and enter your mobile number or ration card number. You will receive instant confirmation of your eligibility status, allowing you to take advantage of the many benefits provided by this scheme.

Is the PMJAY scheme applicable to all states in India?

The Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme applies to all states in India, providing medical treatment and hospitalisation benefits to eligible individuals in need.

Can I avail of cashless treatment under Ayushman Bharat Yojana?

Yes, you can avail of cashless treatment under the Ayushman Bharat Yojana. This scheme provides a range of benefits, including free medical treatment and hospitalisation for eligible individuals in need. To avail of cashless treatment, simply visit a hospital or medical facility that is empanelled under the Ayushman Bharat Yojana. The hospital will then provide cashless treatment, allowing you to receive the care you need without worrying about upfront payment.

Are pre-existing conditions covered under the PMJAY scheme?

Yes, there is coverage for pre-existing conditions under the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme. This means that if you have a medical condition that existed prior to being enrolled in the PMJAY scheme, you can still receive free medical treatment and hospitalisation benefits. However, certain exclusions and limitations may be applicable.

How do I register for a PMJAY card?

In order to register for a PMJAY (Pradhan Mantri Jan Arogya Yojana) card, you can visit your nearest empanelled hospital or Ayushman Mitra to complete the registration process. You will need to provide your identification documents, such as your Aadhaar card, to complete the registration process.

How can I link my Ayushman card with an Aadhaar card?

You can link your Ayushman card with an Aadhaar card by visiting the official Ayushman Bharat website or by visiting your nearest Ayushman Mitra. You will need to provide your Aadhaar card details and follow the process outlined on the website or by the Mitra.

How do I check the validity of my Ayushman card?

You can check the validity of your Ayushman card by visiting the official Ayushman Bharat website or by contacting your nearest Ayushman Mitra. You will need to provide your Ayushman card number and follow the process outlined on the website or by the Mitra to check the current validity status of your card.

Can I avail of PMJAY benefits if I have a pre-existing medical condition?

Yes, even if you have a pre-existing medical condition, you can still avail of the benefits under PMJAY. However, the treatment for your pre-existing condition will not be covered under the scheme. Under PMJAY, the government provides financial cover of up to Rs. 5 lakh per family for secondary and tertiary health services.

What is the eligibility for Ayushman Yojana?

People belonging to SC/ST category, families with no earning member above 16 years of age, having income less than Rs. 2.5 lakh, and the one’s listed in the PMJAY beneficiary list are eligible to apply for Ayushman Yojana. All senior citizens above 70 years, irrespective of their socio-economic status are also eligible under the scheme.

How can I check my Ayushman Bharat balance?

You can check your Ayushman Bharat balance through the official PMJAY-Beneficiary Portal by logging in as a beneficiary and entering your mobile number and captcha code.

Is PMJAY valid in private hospitals?

Yes, PMJAY is valid in empanelled private hospitals across India.

What needs to be done to get an Ayushman card made?

To get an Ayushman card, you can visit the official PMJAY website or contact your nearest Common Service Centre (CSC) for assistance with the application process.

Who are the beneficiary of PMJAY?

The beneficiaries of PMJAY are families identified as living below the poverty line based on the Socio-Economic Caste Census (SECC) data.

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