Quick answer. PM-JAY gives eligible families cashless hospital cover of up to Rs 5 lakh a year at empanelled hospitals. Everyone aged 70 or above qualifies, whatever their income. Check free on the Ayushman App, beneficiary.nha.gov.in or 14555. Routine out-patient care is not covered. If a hospital refuses, complain through 14555.
A hospital bill can frighten any family. Ayushman Bharat PM-JAY is the government’s health cover for hospital treatment, and many people qualify without knowing it. This guide explains who is covered, how to check, what the scheme pays for, and what to do if a hospital says no. It is general information. For your own case, please check with the helpline or your State Health Agency, as states run the scheme with some differences.
What the scheme gives you
| Feature | What it means | Source |
|---|---|---|
| Cover | Up to Rs 5 lakh per family per year for secondary and tertiary hospital care | PIB, Sep 2024 |
| Cost to you | Cashless at the point of care, at empanelled public and private hospitals | PIB, Sep 2024 |
| Family size and age | No limit on family size, age or gender | PIB, Sep 2024 |
| Existing illnesses | Pre-existing conditions are covered from the first day of enrolment | PIB, Sep 2024 |
| Before and after | Up to 3 days before admission and 15 days after, including tests and medicines | PIB, Sep 2024 |
| Other states | You can use it at any empanelled hospital across India | PIB, Sep 2024 |
| Treatments | More than 1,900 treatment packages | PIB, Jun 2026 |
| Hospitals | 36,218 empanelled as on 5 June 2026: 19,659 public and 16,559 private | PIB, Jun 2026 |
Who qualifies
There are three main routes in.
1. Families on the eligibility list
Families were first identified from the Socio-Economic Caste Census of 2011, using 6 deprivation criteria in rural areas and 11 occupational criteria in urban areas. The Centre later widened the base to 12 crore families, and many states have added more families at their own cost, using sources such as National Food Security Act data. So you may qualify through your state even if you were not on the original list. You cannot tell by income alone, so please check.
2. ASHA and Anganwadi workers
Since March 2024, the scheme also covers ASHAs, Anganwadi Workers, Anganwadi Helpers and their families.
3. Everyone aged 70 and above
The Union Cabinet approved this on 11 September 2024, and the Ayushman Vay Vandana Card was launched on 29 October 2024. Income does not matter. What you receive depends on your situation:
| Your situation at 70 or above | What you get |
|---|---|
| Your family is already covered by PM-JAY | An extra top-up of up to Rs 5 lakh per year for yourself. You do not share it with family members under 70. |
| Your family is not covered | Cover of up to Rs 5 lakh per year on a family basis. |
| You use CGHS, ECHS or Ayushman CAPF | You choose: keep that scheme or opt for PM-JAY. You cannot use both. See our CGHS guide. |
| You have private health insurance or Employees’ State Insurance | You can still get PM-JAY benefits. |
As on 5 June 2026, 1.20 crore senior citizens had enrolled.
Where the scheme runs
West Bengal was the most recent state to join, launching on 16 August 2026 as the 36th state to implement it. Details such as card design, state top-ups and contact numbers can differ by state, so your State Health Agency is the right place for local questions.
How to check if you are eligible
It is free. Nobody needs to be paid for this.
- Use the Ayushman App. It is on Android and iOS in 19 regional languages, and it lets you verify eligibility, download your e-card, see your balance, find empanelled hospitals and raise a complaint.
- Or use the website. Go to beneficiary.nha.gov.in, which is the official self-registration route named by the Health Ministry.
- Or call. The toll-free number is 14555, or give a missed call to 1800110770.
- Or walk in. Seniors aged 70 and above can register at their nearest empanelled hospital.
If you are told you are not on the list but believe you should be, ask your State Health Agency whether the state uses other lists.
How to find an empanelled hospital
Use the Ayushman App to find empanelled hospitals. All government hospitals with in-patient services are deemed empanelled, so a government hospital is a good first place to ask. Private hospitals may offer only some specialties under the scheme, so check that the hospital covers what you need before you travel. You can also use our hospitals pages to look up a hospital’s details, but please confirm PM-JAY status with the hospital or the app.
What is covered
The package is meant to cover the whole episode of care. The Bihar State Health Agency lists these items, and the national backgrounder says the same in general terms:
- medical examination, treatment and consultation
- medicines and consumables
- tests and laboratory investigations
- ICU and non-ICU care
- implants, where needed
- food and accommodation
- complications during treatment
- pre-hospitalisation (3 days) and post-hospitalisation medicines (up to 15 days)
The same page says hospitals are paid a package rate that includes all of this, and they are not allowed to charge you anything beyond it.
What is not covered
The Bihar State Health Agency lists these exclusions:
- out-patient care, such as a routine clinic visit with no admission
- individual diagnostics done only for evaluation
- drug rehabilitation programmes
- cosmetic treatment
- assisted reproduction, such as fertility treatment
- organ transplant
This is one state’s published list, and it is based on an older package count than the current national list. Please confirm with the hospital or 14555 before planning around it, especially for transplants. For out-patient care, your nearest Ayushman Arogya Mandir may help.
At the hospital: what to do
- Carry your Ayushman card or e-card, along with the ID you used to enrol.
- Tell the admissions desk you want treatment under the scheme, and ask for the person who handles PM-JAY.
- Ask which package applies, and whether anything falls outside it.
- Keep every paper you receive, including discharge papers.
- If you are asked to pay, ask what the charge is for and ask for it in writing. Then call 14555.
If a hospital refuses or asks for money
The Health Ministry told Parliament that, under the terms of empanelment, hospitals cannot deny treatment to eligible beneficiaries, and beneficiaries can complain if they do. There is a three-tier system at district, state and national level, each with a nodal officer and a committee.
You can complain in any of these ways:
- by calling 14555, the central and state call centre number
- on the Centralized Grievance Redressal Management System, the official web portal, or through the Ayushman App
- by email or by letter to your State Health Agency
In your complaint, give the patient’s name and card ID, the hospital’s name, the date, what happened and how much was asked for. Note the reference number you are given. Do not hand over your card or a payment to anyone who promises to speed things up.
Common questions
Is there any fee to get an Ayushman card?
No. In its West Bengal launch report, the government broadcaster says cards are issued free of cost to every eligible family member. Be wary of anyone charging for one.
I have a pre-existing illness. Will I be turned away?
The government says all pre-existing conditions are covered from the first day of enrolment, with no waiting period.
Can I use my card in another state?
Yes. The portability feature lets beneficiaries use any empanelled hospital, regardless of where they live.
My father is 72 and has a CGHS card. Can he have both?
No. He must choose between his existing scheme and PM-JAY. Compare them before deciding, and ask CGHS how a switch would work.
Does the Rs 5 lakh pay for medicines bought for use at home?
Only as part of a hospital episode: medicines up to 15 days after discharge are included. Regular out-patient medicines are not part of the package.
Sources
- Press Information Bureau: Cabinet approves cover for all senior citizens aged 70 and above, 11 Sep 2024, checked 2 Nov 2026.
- Press Information Bureau backgrounder: Six Years of Ayushman Bharat PM-JAY, 23 Sep 2024, checked 2 Nov 2026.
- Press Information Bureau: Update on AB PM-JAY, written reply in the Lok Sabha, 28 Mar 2025, checked 2 Nov 2026.
- Press Information Bureau backgrounder: India’s Health Transformation, 6 Jun 2026, checked 2 Nov 2026.
- Press Information Bureau: Enrollment for Ayushman Vay Vandana Cards reaches 25 lakhs, checked 2 Nov 2026.
- Press Information Bureau: Update on Ayushman Bharat Vay Vandana Cards, 29 Jul 2025, checked 2 Nov 2026.
- Scheme, coverage and process, Bihar Swasthya Suraksha Samiti (Bihar State Health Agency), checked 2 Nov 2026.
- Akashvani News: West Bengal to launch AB PM-JAY, 16 Aug 2026, checked 2 Nov 2026.
- Beneficiary portal, National Health Authority, address as given by the Health Ministry, checked 2 Nov 2026.
- About PM-JAY, National Health Authority, the page content and pmjay.gov.in did not load for our check on 2 Nov 2026, so scheme details above come from the official releases listed here.