Ayushman Bharat: PMJAY (2026) - Everything you need to know about India’s mega health scheme
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana was launched on 23rd September, 2018, by our Hon’ble Prime Minister, Shri Narendra Modi. It was launched after the Union Cabinet meeting in 2017, with the aim of providing free, cashless health insurance coverage to the bottom 40% of India’s population. Ayushman Bharat PM-JAY is the world’s largest public health assurance scheme that is fully funded by the government. It is an insurance aspect of a bigger Ayushman Bharat flagship health program which was launched with the aim of empowering primary healthcare using Health and Wellness Centres.
The key objectives of Ayushman Bharat PM-JAY focuses on cutting down poverty caused due to healthcare costs, improving accessibility to both public and private hospitals for secondary and tertiary care treatments, addressing unmet health care needs, ensuring equitable treatment and offering financial support to vulnerable groups against high medical expenses.
⚡ Most government schemes require you to apply before initiating treatment. Read this guide before your first hospital visit.
Ayushman Bharat PMJAY Benefits and Coverage
To mitigate catastrophic out-of-pocket medical expenses, impoverishment of vulnerable households due to medical emergencies, and exclusion of the poor from quality secondary and tertiary care units, the government provides Rs. 5 lakhs per eligible family per year to cover unexpected medical expenses. This scheme provides cashless treatment across 11 crore empanelled government-funded and private hospitals. It provides coverage for pre- and post-hospitalization, paying pre-admission and post-discharge costs based on approved treatment packages.
The scheme covers the entire family, allowing every eligible member to use the provided fund. The program offers access without restrictions on age, gender, or the number of family members who can benefit from the coverage. Unlike regular health insurance policies, Ayushman Bharat PM-JAY covers pre-existing diseases without any waiting period, and provides access for treatment in any empanelled hospital across the country, irrespective of the home state of the beneficiary or the patient. The scheme also provides coverage for up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses including medical examination, consultation fee, diagnostics and recommended medical drugs.
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana was updated to include all the senior citizens aged 70 and above irrespective of their income, they receive a unique Ayushman Vay Vandana card. These 70+ individuals receive an additional amount of Rs. 5 lakhs if they are already enrolled in the scheme, and they need not share it with their family members. Senior citizens who are already benefiting from other government schemes like Central Government Health Scheme (CGHS), Ex-servicemen Contributory Health Scheme (ECHS), or Central Armed Police Force (CAPF) are free to either continue with their current scheme or opt for AB PM-JAY.
Who is Eligible for Ayushman Bharat Card?
The eligibility criteria for Ayushman Bharat PM-JAY is an entitlement based scheme, where eligibility is structurally divided to target the most vulnerable populations of India. For rural beneficiaries, eligibility is outlined using the deprivation criteria of the Socio-economic Caste Census (SECC 2011). For urban beneficiaries, it is distinguished based on occupational groups.
Ayushman Bharat Eligibility for Rural Areas
Rural inclusion relies on identifying poverty based on explicit household constraints.
- Household without shelter or living on alms.
- Households with no adult members or male earners of age 16-59.
- Households with disabled members and no able-bodied adults.
- SC/ST households.
- Landless households deriving major income from manual casual labour.
- Primitive tribal groups and manual scavenger families.
Ayushman Bharat Eligibility for Urban Workers
Urban inclusion targets workers from unorganized and low-income service sectors.
- Domestic & Street services: Domestic workers, street vendors, hawkers, cobblers, and ragpickers.
- Manual labours: Transport worker, driver, conductor, helper to drivers and conductors, cart puller, rickshaw puller.
- Sanitation workers: Sweeper, sanitation worker, and gardener.
- Artisans: Electrician, mechanic, assembler, repair worker, tailor, handi-craft worker.
- Daily wage workers: Construction worker, plumber, mason, painter, welder, security guard, coolie and other head-load worker.
Who is Not Eligible for Ayushman Bharat Yojana?
The scheme features a strict filtering system to prevent the usage of benefits by well-off households. Households which meet the following criteria are excluded.
- People who own 2, 3, or 4 wheelers.
- People who own motorized fish boats and farming equipment.
- People owning decent, solidly built houses.
- Government employees.
- Monthly income exceeding Rs. 10,000.
- Households with refrigerators and landline telephones.
- People owning 5 acres or more of agricultural land.
- Farmers who have kisan cards with a credit limit of Rs. 50,000.
Ayushman Vay Vandana Card for Senior Citizens (70+)
Senior citizens aged 70 and above are exempted from these criteria, and are universally allowed to enjoy the benefits of the scheme.
Ayushman Bharat PMJAY Statistics and Achievements
Since its historic launch, Ayushman Bharat PM-JAY has evolved to be the world’s largest government funded health assurance initiative, so far, over 12 crore vulnerable families have had access to quality healthcare treatment. A defining milestone of the scheme is, it has successfully implemented public-private collaboration. With approximately 55% of all secondary and tertiary treatments provided by private multi-specialty hospitals. To date, over 43.5 crore Ayushman cards have been issued, with more than 1 crore senior citizens aged 70 and above. Women account for nearly 49% of the total enrollment and a significant share of treatments, which has bridged long-standing gender gaps. By absorbing catastrophic medical costs, the scheme has saved an unprecedented Rs. 1.73 lakh crore in out-of-pocket expenses according to the Economic Survey of India (2024-25).
How to Apply for Ayushman Bharat Card Online
Since Pradhan Mantri Jan Arogya Yojana is an entitlement based scheme, there is no formal registration form, enrollment fee, or an active application process. Instead, people are already selected by the central government based on Socio-economic Caste Census (SECC 2011) data. If a household meets the strict deprivation parameters or urban occupational groups, their names are already listed within the National Health Authority (NHA) database. To enable the benefits, eligible individuals have to authenticate their identity, and then generate the unique PVC Ayushman card.
How to Check Ayushman Bharat Card Eligibility Online
The first step is to confirm if the individual’s household is included in the beneficiaries’ registry. This verification can be completed independently either through digital portals or through local administrative channels.
For Online Verification:
Citizens with access to smartphones or internet can check their eligibility status within minutes by following these specific steps:
- Visit the official, verified National Health Authority beneficiary portal (https://beneficiary.nha.gov.in/) or download the Ayushman App from the Google Play Store.
- On the homepage, enter a valid 10-digit mobile number, select the appropriate user profile (Beneficiary), and click on the Verify button to generate an OTP.
- Enter the received OTP into the verification field, fill in the displayed CAPTCHA code, and click ‘Login’ to open the secure search dashboard.
- Once logged in, choose the specific State from the menu and select the PM-JAY health insurance scheme.
- The portal offers multiple filtered search methods to locate a family unit. Select one of the following criteria:
- Aadhaar Number: The fastest, most precise method to scan individual and family linkages.
- Ration Card: Used to check the enrollment status of an entire household at once.
- Location Parameters: Searching by selecting District, Sub-District, and specific Village or Town names to get a localized community ledger.
- The system will generate a complete list of matching family members. Each name will display an execution status icon: a green icon indicates the individual is verified, while a blue/orange icon indicates that the individual is eligible but needs to complete their card generation process.
For Offline Verification:
The government provides localized verification options for individuals living in rural areas with limited internet connectivity:
- Citizens can visit their nearest village-level Common Service Centres, where a trained individual will access the central database to check the household’s registry status.
- Every government medical college, district hospital, and registered private multi-specialty facility have a dedicated PM-JAY helpdesk managed by a trained healthcare coordinator known as an Ayushman Mitra.
- Frontline grassroots health workers such as specifically Accredited Social Health Activists (ASHA) and Auxiliary Nurse Midwives (ANM) carry localized, printed beneficiary manifests directly to rural households during village outreach camps.
Documents Required for Ayushman Card + e-KYC Process
Beneficiaries can initiate their identity verification by visiting any of these three authorized physical touchpoints mentioned above:
- Submitting Mandatory Verification Documents
- A physical Aadhaar Card is highly mandatory for real-time biometric mapping.
- An active Ration Card, a government-stamped Family Composition Certificate, or a PM-JAY letter sent previously to the household address.
- Executing the Biometric e-KYC Verification
- The individual will be asked to place their finger on a registered biometric scanner to match data with Aadhaar.
- The individual’s eyes will be scanned using specialized authorized cameras.
- If biometric scanners fail, the operator can take a live photograph using an NHA-approved application or send a secondary secure OTP to the Aadhaar-linked mobile phone number.
- Final Processing and Ayushman Card Generation: Once the biometric data matches the census records, the application moves automatically to the State Health Agency for electronic approval. Upon validation, the system generates a distinct Ayushman Card featuring a unique PM-JAY ID number and a secure QR code. This card can be printed immediately onto a durable plastic PVC sheet by the CSC operator or downloaded directly through the Ayushman App. After this the family can utilize the benefits whenever a medical emergency arises.
What is Not Covered Under Ayushman Bharat PMJAY?
Despite giving massive coverage of Rs. 5 lakhs per family per year, PM-JAY features critical structural limitations that leave patients facing catastrophic health expenditures. While basic oncology packages like chemotherapy and radiotherapy are included, advanced treatments such as next-generation immunotherapy checkpoint inhibitors that cost up to Rs. 3.5 lakh per cycle and CAR-T cell gene therapies are entirely excluded due to the scheme’s rigid cost ceilings.
Similarly, high-end organ transplants like Liver and Heart surgeries that cost more than Rs. 15 to RS. 30 lakhs remain excluded. Furthermore, lifelong genetic diseases and rare conditions including Muscular Dystrophy, Spinal-Muscular Atrophy and Lysosomal Storage disorders are completely omitted from PM-JAY packages; patients are instead redirected to a volatile, one-time crowdfunding grant under a separate rare disease policy.
Most devastatingly, even when basic transplant surgeries are covered, the scheme’s strict 15-day post-discharge medication limit leaves patients entirely vulnerable. It ignores the lifelong, astronomical costs of vital immunosuppressant drugs, turning a lifesaving surgery into a temporary fix that poor families cannot afford to maintain in the long run.
What to Do When Ayushman Bharat Coverage Runs Out
While Ayushman Bharat PM-JAY is a monumental safety net, healthcare emergencies in India often outpace its limits. When the Rs. 5 lakh annual limit is reached, all cashless benefits are paused. Any additional medical expenses, hospitalizations, or treatments must be paid out-of-pocket by the beneficiary. For vulnerable families, crossing this limit leaves them in an extreme state of financial distress.
Complex interventions like bone marrow transplants or advanced oncology protocols can routinely scale up to Rs. 15 to Rs. 25 lakhs, this ceiling is shattered almost instantly. This is when medical crowdfunding platforms like Milaap become a lifeline to those families. Unlike bureaucratic government grants, which are extremely slow, crowdfunding leverages social networks to pool micro-donations and arrange emergency liquid capital within a few hours.
Additionally, millions of contemporary poor and migrant families are left out of the SECC 2011 database due to outdated ration cards or technical errors. Finally, while PM-JAY covers internal clinical costs, it completely ignores the cost of a family traveling from a village to a metro hospital, or the loss of daily wages for the breadwinner. Crowdfunding helps fill this gap by providing families with funds to cover vital daily living expenses and survive the shock of a medical crisis.
Is Ayushman Bharat Enough for Major Medical Expenses?
Ayushman Bharath Pradhan Mantri Jan Arogya Yojana has significantly transformed healthcare access across India, and saved millions from medical bankruptcy. However, as medical technology evolves, the gap between government caps and the actual cost of advanced treatments keep rising, creating financial distress for middle- & low- class families. While the government expands safety nets like the Ayushman Vay Vandana Card, we need community-driven platforms like Milaap to ensure that no patient is left stranded when those limits are reached. Together, institutional policy and collective empathy form the ultimate lifeline for India’s most vulnerable.
How Families Raise Funds for Medical Treatment on Milaap
Even with insurance and government schemes, most families face a gap. Here is what we have seen work — and what makes the difference between campaigns that raise enough and those that fall short.
Crowdfunding works best when it starts early and leads with the human story rather than the medical one. A campaign that says “my father has cirrhosis” raises less than one that shows who he is, what the family has already done, and what recovery means for them. Donors give to people, not diagnoses.
What every Milaap campaign gets:
- Zero Platform Fees
- Fast Withdrawals
- Employer Matching Benefits
- A dedicated campaign manager for story, media, and outreach
- Frequent beneficiary/project updates via email and WhatsApp
The families who raise the most start their campaign before admission not after. Starting early gives donors time to share and give.
Frequently Asked Questions
At Milaap, we’ve found that eligibility depends on where you live. If you’re in a rural area, we look at deprivation criteria from the SECC 2011 census, such as households without shelter, no adult earning member, or SC/ST families. In urban areas, we see eligibility extended to over 10 occupational categories including street vendors, domestic workers, and construction labourers. Since 2024, we’ve also seen the scheme opened up to all senior citizens aged 70 and above, regardless of income.
We recommend visiting the official beneficiary portal at beneficiary.nha.gov.in or downloading the Ayushman App. Once you enter your mobile number and verify with an OTP, you can search using your Aadhaar number, ration card, or by selecting your district and village. If you don’t have internet access, we’ve seen many families verify their status through a local Common Service Centre or an Ayushman Mitra at their nearest hospital.
In our experience helping families navigate this process, you’ll need a physical Aadhaar card for biometric verification, along with either a ration card, a family composition certificate, or a PM-JAY letter sent to your household. Once these are submitted, we’ve seen the e-KYC process completed through fingerprint scanning, iris scanning, or a live photograph if biometrics fail.
We know Ayushman Bharat PMJAY provides Rs. 5 lakh per family per year, and this amount covers the entire household regardless of family size. Senior citizens aged 70 and above receive an additional Rs. 5 lakh on top of this, which they don’t need to share with other family members. While this is meaningful coverage, we’ve often seen it fall short for complex procedures like transplants, which is where our platform steps in.
Unfortunately, we’ve found that high-end organ transplants like liver and heart surgeries, which typically cost between Rs. 15 to Rs. 30 lakhs, remain excluded from PMJAY due to the scheme’s cost ceilings. This is one of the most significant gaps we see families facing, since a liver transplant alone can cost Rs. 21-23 lakhs on average, well beyond what the scheme’s Rs. 5 lakh cap can support.
Through our work with thousands of families, we’ve identified several major exclusions: advanced immunotherapy and CAR-T cell therapies, liver and heart transplants, and lifelong genetic conditions like Muscular Dystrophy and Lysosomal Storage disorders. We’ve also seen that even when a transplant surgery itself is covered, the scheme’s 15-day post-discharge limit doesn’t account for the lifelong cost of immunosuppressant medication that patients need afterward.
Once a family exhausts the Rs. 5 lakh annual limit, we’ve seen that all cashless benefits stop, and any further treatment costs must be paid out of pocket. For complex cases like bone marrow transplants or advanced oncology, which can scale up to Rs. 15-25 lakhs, we know this ceiling gets crossed almost immediately. This is exactly the gap we built Milaap to fill, helping families raise emergency funds within hours rather than waiting on bureaucratic processes.
Yes, we’ve seen the scheme updated to include all citizens aged 70 and above under the Ayushman Vay Vandana Card, regardless of their income level or existing exclusion criteria. If a senior citizen is already covered under schemes like CGHS, ECHS, or CAPF, we know they can choose to either continue with that scheme or opt into PM-JAY instead.
Yes, we’ve confirmed that PMJAY covers pre-existing diseases from day one, with no waiting period. This is one of the scheme’s stronger features compared to typical private health insurance, where we often see waiting periods of two to four years before pre-existing conditions are covered.
We built Milaap to be the bridge families need when government schemes reach their limits. While PMJAY moves through structured government channels, we’ve designed our platform to mobilize social networks and pool micro-donations, often arranging emergency funds within hours instead of weeks. We also help cover costs PMJAY doesn’t touch at all, like travel to a metro hospital or lost daily wages for the family’s breadwinner, so no family is left stranded when the scheme’s coverage runs out.
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