PM-JAY (Ayushman Bharat) — Free ₹5 Lakh Health Cover Guide

Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the largest publicly funded health insurance scheme in the world. Launched in September 2018 under Ayushman Bharat, PM-JAY covers over 12 crore beneficiary families with cashless secondary and tertiary care at empanelled public and private hospitals.

Coverage

Each beneficiary family is entitled to ₹5 lakh of cashless hospitalisation per year on a family floater basis. The scheme covers over 1,900 medical and surgical procedures across cardiology, oncology, orthopaedics, neurology, urology, ophthalmology and emergency care. There is no cap on family size, age or pre-existing conditions.

Eligibility criteria

Eligibility is based on the Socio-Economic Caste Census (SECC) 2011 data, with specific deprivation and occupational criteria for rural and urban families. Rural eligible categories include landless households dependent on manual labour, households with no adult earner, SC/ST households and households with kachcha houses. Urban categories include 11 specific occupational groups such as rag pickers, beggars, domestic workers, street vendors and construction workers.

How to check eligibility

Visit the official PM-JAY portal (pmjay.gov.in), click "Am I Eligible", enter your mobile number and OTP, and search by ration card number, mobile number, or SECC name. State-specific portals also offer the same lookup. Common Service Centres (CSC) help non-digital beneficiaries verify eligibility.

Applying for the Ayushman Card

Eligible families can apply for the Ayushman Card at any empanelled hospital, CSC or Pradhan Mantri Arogya Mitra kiosk. Required documents: Aadhaar, ration card, recent passport size photograph. The card is generally issued the same day for free.

List of treatments covered

• Cardiology — angioplasty, bypass, valve replacements
• Oncology — chemotherapy, radiation, surgical oncology
• Orthopaedics — joint replacements, fracture surgeries
• Neurology — stroke management, neurosurgery
• Urology and nephrology including dialysis
• Obstetrics and gynaecology including caesarean
• Paediatrics including NICU care
• Mental healthcare for select conditions
• COVID-19 treatment (where notified)

Cashless treatment process

Walk into any empanelled hospital (over 27,000 across India) with the Ayushman Card. The hospital's Arogya Mitra verifies eligibility, raises pre-authorisation request, and on approval initiates treatment. There is no payment at any stage. Discharge happens after the hospital uploads the discharge summary.

Beyond ₹5 lakh — what next?

For treatment cost above the family floater limit, beneficiaries may apply to the State Health Agency for additional sanction under the Rashtriya Arogya Nidhi (RAN) or state-specific top-up schemes. The Health Minister's Discretionary Grant covers select rare diseases.