Ayushman Bharat PM-JAY: Eligibility, ₹5 Lakh Cover, Card

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) gives eligible families free, cashless hospital treatment of up to ₹5 lakh per family per year at empanelled public and private hospitals, as of October 2026. You are eligible if your family is in the scheme's deprivation-based list, if you belong to an ASHA or Anganwadi worker's family, or if you are aged 70 or above, whatever your income. You can check and download your Ayushman card yourself at beneficiary.nha.gov.in or on the Ayushman app in a few minutes.

PM-JAY is not health insurance you buy; it is a government scheme run by the National Health Authority (NHA) with state health agencies. That changes how eligibility, claims and complaints work, so read on before relying on it as your only cover.

Who is eligible (as of October 2026)

The scheme started with about 10.74 crore families in 2018; the target was revised to 12 crore families in January 2023, and with the 70+ expansion it now covers about six crore additional seniors. With West Bengal signing on in June 2026, PM-JAY is implemented in all 36 states and union territories.

Platform and gig workers were announced for coverage in Budget 2025-26 through registration on the e-Shram portal. If you are a delivery or ride-hailing worker, register on e-Shram and check your status on the PM-JAY portal; rollout details can differ by state.

Things that do not decide eligibility

• Family size: there is no cap on the number of members or their age.
• Pre-existing illness: covered from day one.
• Having a bank account or PAN: not required for PM-JAY itself.

If your name is not in the list, you generally cannot "apply" in the way you apply for a loan. The list is fixed by the government and the state. You can ask at a district PM-JAY office or empanelled hospital's Ayushman Mitra desk whether your state has opened any additional enrolment.

The 70+ expansion: Ayushman Vay Vandana card

From late October 2024, every Indian citizen aged 70 or above can get the Ayushman Vay Vandana card:

• Family already covered by PM-JAY: the senior gets an additional top-up of up to ₹5 lakh a year for their own use, which they do not share with younger family members.
• Family not covered: the senior(s) get ₹5 lakh a year, shared on a family basis among the members aged 70 and above (for example, a husband and wife both over 70 share one ₹5 lakh cover).
• Private health insurance or ESI: you can still take the card.
• CGHS, ECHS or CAPF scheme members: you must choose one; you cannot use both.

What the ₹5 lakh covers

PM-JAY pays for secondary and tertiary care under a health benefit package of close to 2,000 procedures across over 25 specialties, as of October 2026. Coverage includes:

• Hospital stay, ICU care, surgery, doctor's fees and implants within package rates.
• Diagnostics and medicines.
• Up to 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses (diagnostics and medicines).
• Food and accommodation during admission.

What it does not cover:

• Routine OPD consultations and medicines without admission.
• Treatment at non-empanelled hospitals.
• Procedures outside the package list, cosmetic treatment, and items the scheme excludes.

Hospitals are paid fixed package rates by the state health agency. An empanelled hospital is not allowed to charge you for a covered procedure. Treatment is portable: you can use your card in an empanelled hospital in another state.

Worked example: how the family floater runs out

A family of six in a covered household has ₹5 lakh for the year (illustrative):

The math: ₹5,00,000 − ₹45,000 − ₹1,80,000 = ₹2,75,000. The December bill of ₹3,20,000 exceeds what is left by ₹45,000, which the family would have to pay or seek through a state scheme.

Now suppose the grandfather is 72. With the Vay Vandana top-up, any treatment he needs draws from his own separate ₹5 lakh, so his hospital stay does not eat into the family's ₹2,75,000.

The cover resets each year. Medical costs rise faster than general prices, so a ₹5 lakh limit buys less every year; our inflation calculator shows how quickly that happens.

How to check eligibility and get your Ayushman card

1. Go to beneficiary.nha.gov.in or download the Ayushman app (from the official app store listing by the National Health Authority).
2. Log in with your mobile number and OTP. Choose "Beneficiary".
3. Search by state and scheme (PM-JAY), then by Aadhaar number, family ID/ration card, or name.
4. Complete e-KYC with an Aadhaar OTP or face authentication, and a live photo if asked.
5. Seniors aged 70+: choose the senior citizen enrolment option, verify age through Aadhaar, and add a spouse who is also 70+.
6. Download the card once approved. It can take from a few minutes to a few days.

You can also visit a Common Service Centre (CSC) or the Ayushman Mitra desk at any empanelled hospital. Checking eligibility and e-KYC are free; a CSC may charge a small fee for a printed PVC card.

Using the card at a hospital

• Use the "Find Hospital" option on the portal or app to see empanelled hospitals and their specialties.
• At admission, go to the Ayushman Mitra desk with your card or Aadhaar. The hospital seeks pre-authorisation from the scheme.
• You should not be asked to pay for a covered package, buy medicines from outside, or sign blank forms.

Ayushman card vs private health insurance

For an eligible family, PM-JAY is valuable base cover. For a middle-income family that is not eligible, or one that wants a wider hospital choice, private cover still matters. See our health insurance checklist, and if you already rely on group cover through work, read is employer health insurance enough. A super top-up policy can sit above PM-JAY or employer cover at a lower premium.

Problems and where to complain

Common problems include a hospital asking for payment for a covered procedure, refusing admission, or your name not appearing in the list.

1. At the hospital: ask the Ayushman Mitra desk and the hospital's grievance officer in writing.
2. Call the national helpline 14555 (or your state health agency's helpline) and note the complaint number.
3. File online through the grievance section on pmjay.gov.in, which routes complaints to the district and state grievance committees.
4. Keep records: card number, admission date, receipts, and the names of staff you spoke to. Money wrongly collected can be ordered refunded.

Because PM-JAY is a government scheme, IRDAI's Bima Bharosa and the Insurance Ombudsman generally do not handle PM-JAY complaints, even in states where an insurer administers the scheme. Use the scheme's own grievance route.

Watch out for fraud

The card is free. Ignore calls, SMS or social media posts asking for money to "activate", "upgrade" or "renew" an Ayushman card, and never share an OTP with a caller. Report such fraud at cybercrime.gov.in or call 1930.

Key takeaways

• PM-JAY gives up to ₹5 lakh per family per year in cashless hospital care at empanelled hospitals, as of October 2026.
• Every Indian aged 70+ is eligible through the Vay Vandana card, regardless of income; covered families get a separate ₹5 lakh top-up for the senior.
• There is no cap on family size and pre-existing illnesses are covered from day one.
• OPD treatment is not covered; 3 days before and 15 days after admission are.
• Check eligibility and download the card free at beneficiary.nha.gov.in or on the Ayushman app.
• For complaints use the hospital desk, helpline 14555 and the pmjay.gov.in grievance portal.