Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY)

The Ayushman Bharat Yojana is the Government of India’s flagship health insurance scheme launched in 2018, based on the recommendations made under the National Health Policy 2017. The scheme aims to provide universal healthcare coverage at all levels (primary, secondary and tertiary) across the country. It is a comprehensive, need-based healthcare scheme that covers everything from prevention to treatment and awareness campaigns.

The Ayushman Bharat health yojana consists of two essential pillars to address the country’s healthcare needs holistically:

1) Health and Wellness Centres (HWCs): This includes more than 1.5 lakh primary health centres and sub-centres across India, developed to provide comprehensive health care services, including free drugs, diagnostic services, and maternal and child care. Their focus is to provide localised primary healthcare directly to communities.

2) Pradhan Mantri Jan Arogya Yojana (PM-JAY): It is a health assurance scheme that provides free insurance coverage of up to ₹5 lakh for a single eligible family in a year. PMJAY is the world’s largest government health plan covering 42 crore people as of Oct 2025.

Essentially, the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) provides free healthcare coverage for secondary and tertiary hospitalisation in empanelled hospitals. Beneficiaries can get paperless and cashless treatment at these hospitals with comprehensive coverage of treatments, medicines, consultations, and more.

Here are the key highlights of the Pradhan Mantri Jan Arogya Yojana (PMJAY):

The Ayushman health insurance policy is meant for vulnerable and disadvantaged families as defined by the Socio-Economic Caste Census (SECC) conducted in 2011. The following categories of families are eligible for the Ayushman Bharat cover in rural and urban areas:

Eligibility in Rural Areas

Automatically Included Categories

1. Destitute or living on alms
2. Households with manual scavenging members
3. Primitive tribal groups
4. Legally released bonded labourers

Deprivation Categories

1. One-room houses with kucha walls and kucha roofs (D1)
2. Households with no adults between 16 and 59 years (D2)
3. Households with no adult males between 16 and 59 years (D3)
4. Families with one or more disabled members and no able-bodied adult member (D4)
5. SC/ST households (D5)
6. Landless households mainly engaged in manual labour (D6)

Eligibility in Urban Areas

1. Ragpickers
2. Beggars
3. Domestic workers
4. Cobblers, hawkers and street vendors
5. Construction workers, labourers, painters, welders, etc.
6. Sanitation workers and sweepers
7. Artisans, tailors and handicrafts workers
8. Transport workers, drivers, conductors, etc.
9. Helpers, assistants and workers in small businesses
10. Electricians, mechanics, repair workers, etc.
11. Chowkidars and washermen

Excluded Categories in PMJAY

1. Households owning two, three or four-wheeled vehicles
2. Families with mechanised farming tools
3. Kisan cardholders with a credit limit of ₹50,000+
4. Any government employees
5. Family member earning over ₹10,000/month
6. Families owning refrigerators and landlines
7. Those owning 5 acres of agricultural land or more
8. Families owning solid, pucca homes

Eligibility for Senior Citizens

Since September 12, 2024, the Indian Government has started offering PM medical insurance for senior citizens aged 70 years and above. This benefit is available to all senior citizens regardless of their income and wealth. Senior citizens covered by other government schemes, such as CGHS or ECHS, can choose between PMJAY or another scheme.

To get the Ayushman Bharat e-card, you need to go to your nearest empanelled hospital with the following documents:

• Aadhaar card
• Proof of Identity: Aadhaar card, PAN card, voter ID card, or any other government ID
• Address Proof: Ration card, utility bills or voter ID card
• Contact Details: Mobile number and email ID
• Proof of Eligibility: SECC identification certificate, PM letter, RSBY (Rashtriya Swastha Bima Yojana) URN, or any other proof of inclusion in a government scheme
• Family Details: Any government ID of family members, proof of current family status
• Other Documents: Caste certificate or income certificate

The list of eligible beneficiaries of the Prime Minister's health insurance scheme is derived from the previous census of socio-economic groups. You can find out if your name is on that list and if you are eligible for the scheme by following these steps:

Step 1: Go to the official web portal of the National Health Authority (NHA).

Step 2: Click on ‘Beneficiary’ and enter the captcha code as shown on screen. Then, enter your registered mobile number and verify it via One-Time Password (OTP).

Step 3: Select the scheme name, sub-scheme and your state from the respective dropdown menus in the next page.

Step 4: Select a verification option in the ‘search by’ field and enter a verification number, including mobile number, Aadhaar number or ration card number.

Step 5: Enter the other required information, including your name, age, income details, etc. Your name will be displayed if you are eligible for the PMJAY scheme.

Eligible beneficiaries cannot apply for the Ayushman Bharat health insurance card online. Instead, they must go to an empanelled private or public hospital or a Community Service Centre (CSC) to apply for the PMJAY e-card. Here are the steps to do so:

Step 1: Go to your nearest service centre/hospital with proof of identity, address proof and other required documents.

Step 2: At the PMJAY kiosk, provide verification details, such as your mobile number, RC Number, RSBY URN or PM letter to the operator.

Step 3: Provide other required details, such as your name, location, mobile number, ration card number, etc. The operator will enter these details on the BIS Application to search your name in government databases.

Step 4: Present documents, such as your ration card, Aadhaar card or other ID, as well as your family’s ID, which will be scanned and uploaded.

Step 5: Following biometric and additional verification, your application will be sent to the state health agency (SHA). Then, you will receive an acknowledgement slip for reference.

Once your application is processed and accepted, your PMJAY e-card will be generated. You can receive the physical document at the CSC or download it online.

See Also: How to Download Ayushman Card Online?

All the eligible candidates or PMJAY beneficiaries can avail of the cashless and paperless transactions using the scheme if they have an Ayushman card. The Ayushman or PMJAY card has the detailed information of the beneficiaries. By showing this card at any empanelled government and private hospitals, they can avail of the scheme benefits. Below are the steps to issue a PMJAY Golden or Ayushman card.

Step 1: To get the card, visit the official PMJAY website.

Step 2: Next, log in to the account using your registered mobile number.

Step 3: Further, add the captcha code to generate OTP.

Step 4: Next, choose the HHD code option.

Step 5: Following that, provide the HHD code to the representative in the Common Service Centre (CSC) of Ayushman Bharat Yojana.

Step 6: A CSC representative will complete the rest of the process of downloading an Ayushman card.

Individuals, by following these steps, can easily find the PMJAY hospital list.

Step 1: To check the hospital list, go to the official PMJAY hospital list tab.

Step 2: Next, enter the "State" and "District".

Step 3: Now, select the hospital preference, private or government hospital.

Step 4: Further, look for the medical speciality.

Step 5: After entering the captcha code, click on the search icon to know the hospital listed under the PMJAY scheme in your area.

As mentioned before, the Ayushman Bharat- PMJAY scheme covers secondary and tertiary healthcare needs of eligible beneficiaries. The following is what’s included and excluded:

Procedures Included

• Examination, treatment and doctor consultation
• Pre and post-hospitalisation expenses
• Medicines and consumables
• Medical device implantation
• Intensive and non-intensive care
• Diagnostics and laboratory tests
• Hospital accommodation
• Food services
• Complications during treatment

Procedures Excluded

• Primary care
• OPD (outpatient department) services
• Standalone diagnostic tests
• Cosmetic treatments
• Organ transplant
• Fertility treatments
• Drug and alcohol rehabilitation

List of Treatments Covered

Currently, PMJAY covers 1929 procedures and treatments, including:

• Cardiovascular diseases (angioplasty, coronary artery disease)
• Neurological disorders (Parkinson’s, epilepsy, spinal disorders)
• Respiratory conditions (asthma, tuberculosis, pneumonia)
• Obstetric and gynaecological conditions (child delivery, ovarian cysts)
• Pediatric treatment (neonatal care, malnutrition, congenital heart disease)
• Cancer treatment (chemotherapy, radiation therapy)
• Infectious diseases (typhoid, cholera, HIV/AIDS)
• Liver diseases (liver cirrhosis, gallbladder stones)
• Orthopaedic conditions (fractures, hip replacement, osteoporosis)
• Mental health disorders (bipolar disorder, PTSD, schizophrenia)

The Ayushman Bharat PMJAY offers comprehensive coverage for free, cashless treatments, access to quality healthcare and other benefits. Here is a list of advantages of the PMJAY scheme:

Coverage up to ₹5 Lakh

The Prime Minister's health insurance scheme provides free health insurance of up to ₹5 lakh to each eligible family every year. The entire cost is borne by the central and state governments. All lower-income families in specific occupation-based categories are covered.

Pan-India Facilities

Once registered, beneficiaries can get treatments from any empanelled private or public hospitals across the country. As of Oct 2025, the scheme covers 33,000 empanelled hospitals, including 17,685 public hospitals and 15,380 private hospitals.

Provides Secondary and Tertiary Care

The PMJAY health insurance covers only serious conditions beyond primary care. This includes secondary care for intermediate needs, including surgeries and the implantation of medical devices. It also provides tertiary care for complex and severe conditions that require multi-disciplinary teams.

Cashless Treatments

Beneficiaries can get cashless treatment at any empanelled hospital or community service centre by just using their Ayushman Bharat health ID card. No hospital can charge any money for these services, ensuring no delays or corruption.

Range of Services and Treatments

The Ayushman Bharat Health Yojana covers all expenses related to secondary and tertiary healthcare services. At
present, it covers 1929 treatments, including the cost of medicines, examination, consultation, diagnostics, supplies, doctor fees, ICU charges, room rent, medical device implantation, food, and other expenses.

Day One Coverage

All benefits are covered from the first day of enrolment, including pre-existing conditions, such as diabetes, asthma, hypertension, heart disease, etc. This results in zero waiting period, which is common with most health plans.

Pre and Post-Hospitalisation

The scheme covers pre-hospitalisation expenses, including diagnostic tests, consultations and examinations, for up to 3 days. It also covers post-hospitalisation expenses and follow-up care for up to 15 days.

See Also: Benefits of Ayushman Bharat Yojana

The Ayushman Bharat PMJAY (Pradhan Mantri Jan Arogya Yojana) provides cashless health insurance cover of up to ₹5 lakh to the country’s poorest families. It aims to prevent catastrophic expenses that push nearly 6 crore Indians into poverty every year. Since its launch, the PM health insurance scheme has saved ₹1.52 lakh crore in medical expenses for a vulnerable population.

However, people who own assets and earn a decent income cannot avail the benefits of the Ayushman Bharat- PMJAY. A traditional medical insurance plan works better in such cases, as it poses no restrictions on who or what can be covered. There are several types of health insurance plans you can get based on your needs.

To get comprehensive coverage for a single person, the TATA AIG Individual Health Insurance is the best option. It covers everything from hospitalisation and post-hospitalisation expenses to daycare procedures and preventive health checkups. Moreover, you can customise your plan by adding 30+ optional covers, such as accident cover, critical insurance, etc.