Ayushman Bharat Health Insurance - PM Jan Arogya Yojana
Ayushman Bharat (PMJAY) provides financial assistance to low-income households for secondary and tertiary healthcare. It operates through Health & Wellness Centres (HWCs) and PM-JAY, covering hospitalisation, pre- and post-hospitalisation, and medical expenses — with a yearly claim limit of Rs. 5 lakh per family.
AB PM-JAY is India's flagship government health insurance scheme, launched in 2018. It offers free healthcare coverage of Rs. 5 lakh per family per year for hospitalization, targeting the bottom 40% of India's population — over 10.74 crore families. Costs are shared between the Central and State Governments.
Free Health Coverage for All Senior Citizens
In 2024, AB PM-JAY was expanded to cover all senior citizens aged 70 and above, regardless of income. They receive a separate card with Rs.5 lakh coverage per year. Those already enrolled under AB PM-JAY get an additional Rs.5 lakh top-up, exclusively for them — not shared with younger family members.
Who Can Apply? Eligibility for Senior Citizens
The eligibility criteria for Ayushman Bharat Health Insurance scheme for senior citizens are as listed below:
- Aged 70 years and above — regardless of income
- Coverage of Rs. 5 lakh per family per year
- Already enrolled in AB PM-JAY? Get an additional Rs. 5 lakh top-up, exclusively for yourself
- Private health insurance holders are also eligible
- Those under CGHS, ECHS, or CAPF must choose between their existing scheme and AB PM-JAY
- All beneficiaries receive a unique card to access benefits
What Expenses Does the Scheme Cover?
Ayushman Bharat Scheme has extensive coverage for pre- and post-treatment, consultation, and medical examination including approximately 1,393 procedures:
- Accommodation and food during hospitalization
- ICU and non-ICU treatments
- Diagnostics, implants, medicines, and consumables
- Pre-hospitalization expenses (3 days) and post-hospitalization (15 days)
- Complications arising during medical care
- COVID-19 treatment
Key Benefits and Features You Should Know
Some of the salient features of 'Modicare' are mentioned below:
Features | Details |
Coverage Amount | Rs. 5 lakh per family per year |
Beneficiaries | More than 10 crore families across India |
Portability | Benefits are portable pan-India |
Treatment Type | Cashless treatment at any empanelled hospital |
Hospital Empanelment | Both private and public hospitals empanelled |
Payment Method | Based on predetermined package rates by Government of India |
Governing Principle | Flexibility and cooperative federalism across all states and UTs |
Apex Body | Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) |
Apex Body Head | Union Health and Family Welfare Minister |
State Implementation | State Health Agencies (SHA) required for each state |
Fund Transfer | Via escrow account to State Health Agencies (SHAs) |
How to Get Your Golden Card: Step-by-Step Guide
The Ayushman Bharat Yojana offers a paperless and cashless health insurance scheme, providing beneficiaries with the "Ayushman Bharat Golden Card" for seamless healthcare transactions. This card is valid at all network hospitals participating in the scheme. To download the card online, follow these steps:
Step 1: Visit the official website for the Ayushman Bharat Yojana scheme
Step 2: Log in with your registered mobile number.
Step 3: Enter the ‘Captcha Code’ given to generate the OTP.
Step 4: Choose the HHD code and provide it to the Common Service Centre (CSC). The HHD code and other information will be verified by the CSC.
Step 5: The remaining process will be done by 'Ayushman Mitra' (CSC representatives).
Step 6: To obtain your Ayushman Bharat card, pay a fee of Rs.30.
List of Illnesses Covered under Ayushman Bharat Yojana
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) offers nearly 1,350 medical packages at any of the private network hospitals and all the public hospitals. The following are some of the critical illnesses that the Ayushman Yojana covers:
- Anterior Spine Fixation
- Carotid Angioplasty with Stent
- Coronary Artery Bypass Grafting
- Double Valve Replacement Surgery
- Prostate Cancer
- Pulmonary Valve Surgery
- Skull Base Surgery
- Tissue Expander for Disfigurement Following Burns
Are You Eligible? Criteria for Rural and Urban Families
Parameters | Rural Beneficiaries | Urban Beneficiaries |
Basis of Eligibility | Socio-economic and household deprivation criteria | Occupational categories of workers |
Number of Categories | 8 Categories | 11 Occupational Categories |
Primary Focus | Household vulnerability and deprivation | Nature of work and employment type |
Income Criteria | Families earning from manual labor without land ownership | No specific income criteria; based on occupation |
Age-Based Criteria | Households with no earning member between 16–59 years | No age-based criteria |
Disability Criteria | Families with one or more disabled members | No specific disability criteria |
Housing Criteria | Families living in kuccha houses with one room | No housing criteria |
Gender-Based Criteria | Households with no male member aged 16–59 years | No gender-based criteria |
Type of Work | Manual scavenging and manual labor | Skilled, semi-skilled, and unskilled urban occupations |
Examples of Beneficiaries | Landless laborers, manual scavengers, disabled families | Ragpickers, drivers, domestic workers, construction workers |
Portability of Benefits | Cashless treatment at any empanelled hospital across India | Cashless treatment at any empanelled hospital across India |
Coverage Amount | Rs.5 lakh per family per year | Rs.5 lakh per family per year |
How to Check Your Eligibility Online in Minutes
Beneficiaries who are eligible do not require a separate enrolment process. You can check your eligibility by following the steps given below:
Step 1: Visit the official website for the Ayushman Bharat Scheme or PMJAY (https://pmjay.gov.in/ )
Step 2: Click on the ‘Am I Eligible’ icon.
Step 3: Fill in your contact details.
Step 4: Click on ‘Generate OTP’.
Step 5: Select your state
Step 6: Search by your name, ration card number, HHD number, or mobile number.
Documents You Needs To Apply
- Proof of Age (PAN Card or Aadhaar Card)
- Proof of Identity (Aadhaar Card or PAN Card)
- Proof of Income (annual income should not exceed Rs.5 lakh p.a.)
- Details for communication such as mobile number, address for correspondence, and email ID)
- Caste certificate
- Document proof of the current status of the family (joint or nuclear)
Toll-free Number & Address
There are various helplines for any queries regarding the Ayushman Bharat scheme. You can call the following numbers to address any grievances:
Line 1: 14555 | 1800111565
You can address any queries to the following address:
7th and 9th Floor,
Tower-L, Jeevan Bharati Building,
Connaught Place, New Delhi - 110001
FAQs on Ayushman Bharat Health Insurance
- How long is the Ayushman Bharat Scheme valid?
The Ayushman Bharat Scheme needs to be renewed every year on 31st May to avail of its benefits.
- Does Ayushman Bharat Scheme card cover MRI scans?
Yes, beneficiaries of the Ayushman Bharat Scheme can use it for covering the costs of diagnostic tests like MRI and PET Scans.
- Is the ABHA card the same as the Ayushman Bharat Yojana card?
No, the cards are not the same. While anyone who is an Indian citizen is eligible for an Ayushman Bharat Health Account (ABHA) card, the Ayushman Bharat Yojana card is only for those with an annual income not exceeding Rs.5 lakh.
- Who pays for the Ayushman Bharat Scheme?
The scheme is covered by both the central (60%) and state (40%) governments to provide free health care for the poor and vulnerable sections of society.
- Which illnesses are not covered by the Ayushman Bharat Scheme?
The scheme does not cover costs for chronic liver diseases or treatments for blood cancer.
- On which number should I call in case I need assistance related to the Ayushman Bharat scheme?
You can call the number 14555 for assistance related to the Ayushman Bharat scheme.
- Can I avail myself of cashless treatment under the Ayushman Bharat scheme?
Yes, you can avail yourself of cashless treatment under the Ayushman Bharat scheme.
News on Ayushman Bharat Health Scheme
Implementation of Ayushman Bharat Yojana approved by Delhi CM
The Ayushman Bharat Yojana scheme has been approved by the Delhi Chief Minister Rekha Gupta. The scheme comes with a top-up of Rs.5 lakh. The scheme was launched by the Government of India as per the National Health Policy 2017. The main aim of the scheme is to advance Universal Health Coverage
Over 47 Lakh Senior Citizens Register for Ayushman Bharat Scheme
Since its announcement last year, over 47 lakh senior citizens above the age of 70 have registered for the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). In just three months, this age group has accounted for 1.10 lakh hospital admissions, resulting in claims worth Rs. 202.96 crore. The scheme provides free medical treatment of up to Rs. 5 lakh per family per year to all senior citizens aged 70 and above, regardless of their socioeconomic background, through the Ayushman Vay Vandana card.
According to data from the Union Ministry of Health and Family Welfare, more than 47.2 lakh Ayushman Vay Vandana cards were issued as of 6 February 2025. Madhya Pradesh leads with 13.57 lakh cards, followed by Uttar Pradesh (8 lakh), Kerala (6.07 lakh), and Rajasthan (over 2 lakh).
Enrollment requires Aadhaar-based e-KYC and beneficiaries of other central and state government health insurance schemes can opt for Ayushman Bharat. Private health insurance holders and members of the Employee State Insurance Scheme are also eligible.
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