Ayushman Bharat PMJAY (Pradhan Mantri Jan Arogya Yojana) is the world's largest government-funded health insurance scheme. Launched in September 2018, it covers over 55 crore Indians and provides ₹5 lakh per family per year for hospitalization. The October 2024 expansion added all citizens aged 70 and above, regardless of income or social category. Here is the honest 2026 walkthrough — what it covers, who qualifies, and how to actually use it.
What is PMJAY in 2026
PMJAY is the second pillar of the Ayushman Bharat programme. The first pillar is Health and Wellness Centres (Ayushman Arogya Mandirs); the second is the insurance scheme. Most people use "Ayushman Bharat" and "PMJAY" interchangeably — for this guide they refer to the insurance side.
### Quick facts
- Launched: 23 September 2018
- Expanded: October 2024 (added 70+ universal coverage as PM-JAY Vay Vandana scheme)
- Cover amount: ₹5,00,000 per family per year, on a family floater basis
- Cost to beneficiary: Zero — fully government-funded, no premium
- Eligible families: ~12 crore (original SECC list) + ~6 crore (70+ expansion)
- Total beneficiaries (April 2026): ~55 crore individuals
- Empanelled hospitals: 25,000+ across India (60% private, 40% public)
- Hospital admissions covered (cumulative since 2018): 8+ crore
- Government spending (FY 2024-25): ~₹13,800 crore
Eligibility — the original SECC criteria
The original beneficiary list was drawn from the Socio-Economic Caste Census (SECC) 2011, which captured "deprivation indicators" for every Indian household. PMJAY uses 11 criteria — being rural-eligible requires meeting at least 1 deprivation criterion, while urban-eligible requires being in 11 specific occupational categories.
### Rural eligibility (any 1 of 7 deprivation indicators)
1. Households with only one room with kucha (mud) walls and kucha roof 2. Households with no adult member aged 16-59 3. Female-headed households with no adult male member aged 16-59 4. Households with a disabled member and no able-bodied adult 5. Scheduled Caste / Scheduled Tribe households 6. Landless households earning a major part of income from manual casual labour 7. Households living in destitution and surviving on alms
### Urban eligibility (11 occupational categories)
1. Ragpicker 2. Beggar 3. Domestic worker 4. Street vendor / cobbler / hawker / other service provider on streets 5. Construction worker / plumber / mason / painter / welder / security guard / coolie / head-load worker 6. Sweeper / sanitation worker / mali (gardener) 7. Home-based worker / artisan / handicraft worker / tailor 8. Transport worker / driver / conductor / helper / cart puller / rickshaw puller 9. Shop worker / peon in small establishment / helper / delivery assistant / attendant / waiter 10. Electrician / mechanic / assembler / repair worker 11. Washer-man / chowkidar (watchman)
The 2024 expansion — PM-JAY Vay Vandana for senior citizens 70+
In October 2024, the Government of India announced a major expansion: every Indian citizen aged 70 years or above is now eligible for PMJAY benefits, regardless of income or social category. This added an estimated 6 crore additional beneficiaries.
### Key features of PM-JAY Vay Vandana
- Eligibility: Any Indian citizen aged 70+ on the date of card issuance
- Cover: ₹5 lakh per year, separate from any family member's existing PMJAY entitlement (so a 75-year-old senior already in a PMJAY family gets an additional ₹5 lakh top-up exclusively for themselves)
- Income: No upper or lower limit
- Pre-existing conditions: Covered from day 1
- Card type: Distinct senior citizen Ayushman card, marked Vay Vandana
- Application: Free, online via Ayushman App or pmjay.gov.in
This is a substantial benefit. Private health insurance for a 70-year-old in India costs ₹40,000-₹1,50,000 per year for ₹5 lakh cover, and most private insurers refuse new policies after age 70. PMJAY-Vay Vandana fills this gap entirely.
How to check if you are eligible
### Step 1 — Online check
Go to mera.pmjay.gov.in (the official beneficiary checker).
You can search using: - Mobile number (registered with Aadhaar) - Name + state + district - Ration card number - HHD number (Household Identification Number from SECC)
The portal returns: - Your eligibility status (eligible / not eligible) - Your family ID - The category under which you are eligible (rural / urban / 70+ Vay Vandana) - Your nearest empanelled hospital list
### Step 2 — Offline check at Common Service Centre (CSC)
If you cannot use the online portal, visit any Common Service Centre or Village Level Entrepreneur (VLE). They run the same check and print your eligibility certificate.
### Step 3 — Helpline
Call 14555 (toll-free PMJAY helpline) — available in 13 languages. They check eligibility based on your Aadhaar/mobile.
How to get the Ayushman card
### Eligibility confirmed — what next
The Ayushman Bharat card (also called PMJAY card or Golden Card) is what you actually present at the hospital. It comes in two formats:
- PVC card: Physical plastic card, mailed to your address (older issuance method)
- e-Card: Digital PDF, downloadable from pmjay.gov.in or the Ayushman App
### Step-by-step e-Card download
1. Go to pmjay.gov.in → "Am I Eligible?" 2. Verify eligibility with mobile OTP 3. Click "Download Card" 4. Aadhaar OTP authentication 5. Card downloads as PDF — print on plain paper (works fine at hospitals)
### Step-by-step physical card
1. Visit the nearest Common Service Centre (CSC) or empanelled hospital 2. Carry Aadhaar, mobile, and ration card (if available) 3. Biometric authentication (fingerprint or iris) 4. Card printed and laminated on the spot in 15 minutes 5. Cost: Free (some CSCs may charge ₹30 for lamination — that is the only legitimate fee)
### Multiple cards per family
PMJAY is a family floater scheme, but each adult gets their own card. The ₹5 lakh limit is shared across the family.
For 70+ Vay Vandana beneficiaries, the card is distinct and the ₹5 lakh limit is separate from any family entitlement.
What PMJAY covers — the 1,949 packages
The scheme covers 1,949 specific medical and surgical packages defined in the Health Benefit Package (HBP). The HBP was last revised in November 2024 to add new procedures and update prices.
### Major covered categories
1. Cardiology and cardiac surgery — angioplasty, CABG, valve replacement 2. Oncology — chemotherapy, radiation, surgical oncology, palliative care 3. Orthopaedics — joint replacement (hip, knee), spine surgery, fracture management 4. Neurosurgery — brain tumour, stroke management, spine procedures 5. Nephrology and urology — dialysis, kidney transplant, prostate surgery 6. Obstetrics and gynaecology — caesarean section, hysterectomy, infertility (limited) 7. Paediatrics and neonatology — child surgery, NICU care 8. General surgery — appendix, gallbladder, hernia, hydrocele 9. Ophthalmology — cataract, retinal surgery, glaucoma 10. ENT — tonsillectomy, deviated septum, ear surgeries 11. Mental health — psychiatric inpatient care (added 2022) 12. Burns and reconstructive surgery 13. Critical care / ICU — including ventilator support 14. Diagnostics linked to admission — investigations during hospital stay
### Pre-existing conditions
Day 1 coverage. Unlike private insurance which has 2-4 year waiting periods for pre-existing conditions, PMJAY covers them from day 1 of the card being issued.
### Pre-hospitalization and post-hospitalization
- Pre-hospitalization: 3 days of expenses before admission (consultation, diagnostics)
- Post-hospitalization: 15 days after discharge (medicines, follow-up consultations)
What PMJAY does NOT cover
This is where most beneficiaries get surprised. PMJAY is for hospitalization, not for outpatient or routine care.
### Excluded items
1. OPD (Outpatient Department) consultation — not covered. Visiting a doctor for fever or back pain costs you out of pocket. 2. Routine diagnostics — blood tests, X-rays, MRI not done as part of admission 3. Dental procedures — most not covered (some states extend; check locally) 4. Cosmetic surgery — fully excluded 5. Fertility treatment / IVF — fully excluded 6. Sex change / gender reassignment — excluded 7. Drug rehabilitation — generally excluded; some states fund separately 8. Dialysis at standalone centres — covered only if part of hospital admission package 9. Hearing aids, prosthetics, lifestyle medications — excluded 10. Treatment abroad — excluded; only Indian hospitals
### Specific exclusions to know
- Self-inflicted injuries — not covered
- Substance abuse-related admissions — limited coverage
- Cosmetic procedures even if medically indicated (some exceptions for burn reconstruction)
Empanelled hospitals — finding one near you
PMJAY works at empanelled hospitals only. As of April 2026, ~25,000 hospitals across India are empanelled.
### Composition
- Private hospitals: ~60% (15,000+)
- Government hospitals: ~40% (10,000+)
### Major hospital chains accepting PMJAY
- Apollo Hospitals (select centres)
- Fortis Healthcare (select centres)
- Max Healthcare (select centres)
- Manipal Hospitals
- Narayana Health
- KIMS Hospitals
- AIIMS (all 23 centres)
- All government medical college hospitals
### How to find empanelled hospitals
1. Go to pmjay.gov.in → "Find Hospital" 2. Select state, district, and specialty 3. List of empanelled hospitals appears with address, contact, and specialties 4. Or call 14555 for nearest hospital
Tip: Save the list of 3-4 nearest empanelled hospitals to your phone. In an emergency, you cannot search and decide.
How cashless treatment actually works
PMJAY is a cashless scheme. You should not pay the hospital and seek reimbursement. Here is the real process.
### Step 1 — Reach the hospital
Walk into the empanelled hospital with the patient and the Ayushman card.
### Step 2 — Approach the PMJAY desk
Every empanelled hospital has a dedicated PMJAY help desk (called the Pradhan Mantri Arogya Mitra counter). Walk there first, before any other registration.
### Step 3 — Verification
The Arogya Mitra: 1. Scans your Ayushman card 2. Authenticates via Aadhaar biometric 3. Pulls up your eligibility from the PMJAY portal 4. Determines available balance (out of ₹5 lakh) 5. Pre-authorises the procedure with the State Health Authority
### Step 4 — Treatment
You receive treatment without paying anything for items in the covered package. Hospital files the claim with PMJAY directly.
### Step 5 — Discharge
On discharge, you sign the patient feedback form. No payment to hospital for the covered procedure.
### Step 6 — Post-discharge
The hospital receives payment from the State Health Authority within 30-60 days of submitting the claim.
Common reasons for rejection at hospital
1. Hospital not empanelled — many private hospitals appear similar to empanelled ones; verify on pmjay.gov.in before going 2. Procedure not in HBP — only the 1,949 listed procedures are covered 3. Card not authenticated via Aadhaar biometric — ensure your Aadhaar is linked to your mobile and biometrics are recent 4. Family already used ₹5 lakh limit — refresh in next financial year (April-March cycle) 5. Pre-authorization rejected — sometimes the State Health Authority disputes whether the procedure is medically necessary; doctor must justify 6. Wrong category card — Vay Vandana card cannot be used for non-senior family members and vice versa
If denied, escalate via the helpline (14555) or complaint cell at the State Health Authority. Most disputes are resolved within 24 hours.
Regional variations — state-specific schemes
Several states run their own health schemes that work in parallel with PMJAY. Some have merged with PMJAY; others remain separate.
### State-specific schemes (selected)
- Maharashtra: Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) — merged with PMJAY in 2020. Single Ayushman + MJPJAY card covers up to ₹5 lakh.
- Tamil Nadu: Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS) — separate, covers ₹5 lakh additional. PMJAY-eligible Tamil Nadu residents get both.
- Telangana: Aarogyasri — flagship state scheme, integrated with PMJAY for the eligible.
- Karnataka: Arogya Karnataka — integrated with PMJAY in 2018.
- Kerala: Karunya Arogya Suraksha Padhati (KASP) — runs alongside PMJAY.
- Rajasthan: Mukhyamantri Chiranjeevi Yojana — provides ₹25 lakh cover; replaces PMJAY in Rajasthan for most beneficiaries.
- Delhi (CGHS area): Central Government Health Scheme covers government employees separately.
### Practical implication
If you live in a state with its own scheme, your effective coverage is often higher than PMJAY's ₹5 lakh. Check with your nearest CSC.
How PMJAY stacks with private health insurance
If you have private health insurance, you can use both — but in a specific order.
### The right sequence
1. Use PMJAY first at an empanelled hospital 2. PMJAY pays up to ₹5 lakh for covered procedures 3. Excess (anything beyond ₹5 lakh, or non-covered items like single private room upgrade, certain implants) goes through private insurance 4. Private insurance acts as a top-up, not a replacement
### Why this order matters
PMJAY has zero co-payment, zero deductible, and zero waiting period for pre-existing conditions. Private insurance has all three. Using PMJAY first preserves your private insurance NCB (No Claim Bonus).
### When PMJAY does NOT work for you
If you want a private deluxe room, branded implants, or treatment at a non-empanelled hospital, PMJAY does not pay. Private insurance covers that gap.
How to maximise PMJAY benefit
1. Get your card before you need it. Treatment without card on hand can be denied even if you are eligible. 2. Save 3-4 nearest empanelled hospitals in your phone for emergencies. 3. Aadhaar mobile linking is non-negotiable. Without it, biometric authentication fails at hospital. 4. Senior citizens 70+ in your family — apply for Vay Vandana card even if they have other coverage. It is free and is an additional ₹5 lakh. 5. Pre-authorize whenever possible. For planned surgeries, get pre-authorization 7-15 days before admission to avoid delays. 6. Keep discharge summaries. Required for post-hospitalization claims of medicines and follow-ups. 7. Use the 14555 helpline. Not just for eligibility — also for dispute resolution.
Common questions
### Can I use PMJAY in another state?
Yes. PMJAY is fully portable across India. You can travel from Bihar to Tamil Nadu and use it at any empanelled hospital there.
### What if my hospital says they need cash deposit?
Empanelled hospitals are contractually prohibited from demanding cash deposits for PMJAY-covered procedures. Refuse politely, escalate to the Arogya Mitra, then to 14555 if needed.
### What if my family already used ₹5 lakh this year?
Wait until 1 April of the next financial year — the limit refreshes. For genuine emergencies between, you fall back to private insurance or out-of-pocket.
### Does PMJAY cover OPD after the 2024 expansion?
No. OPD remains excluded. The 2024 expansion was about adding 70+ citizens, not about adding OPD.
### Can NRIs get PMJAY?
No. PMJAY is for Indian residents only. NRIs are excluded.
Related reading
- How to File ITR-1 in 2026: Step by Step
- PMAY 2026: Pradhan Mantri Awas Yojana Explained
- NPS Vatsalya 2026: Pension Scheme for Children
Related calculators
- Health Insurance Calculator — model your private health insurance needs alongside PMJAY
Our source
PMJAY eligibility, package list, and operational details per pmjay.gov.in and nha.gov.in (National Health Authority) as of April 2026. PM-JAY Vay Vandana details per Cabinet decision dated 11 September 2024 and operational guidelines released October 2024. Health Benefit Package (HBP 2.2) released November 2024. State scheme integration data per respective state health authorities.