The Ayushman Bharat PMJAY scheme is India’s flagship government health insurance program aimed at providing financial protection to economically vulnerable families. Launched in 2018, the scheme offers cashless hospitalisation coverage up to ₹5 lakh per family per year for serious health conditions.
This guide explains the 10 essential benefits of the Ayushman Bharat PMJAY scheme, eligibility criteria, how to apply, empanelled hospitals, challenges, and practical tips, helping families use the scheme effectively.
What Is Ayushman Bharat and PMJAY?
Ayushman Bharat
Ayushman Bharat is the government’s national health mission, focusing on preventive care, primary healthcare, and financial protection. It has two main components:
- Health and Wellness Centres (HWCs): Provide preventive care, maternal and child health services, and basic diagnostics.
- PMJAY (Pradhan Mantri Jan Arogya Yojana): Offers insurance for major hospital treatments including surgeries, ICU care, and cancer treatment.
Pradhan Mantri Jan Arogya Yojana (PMJAY)
Under the PMJAY, eligible families can access cashless treatment at empanelled hospitals nationwide. The scheme is portable, meaning treatment can be accessed in any state or union territory.
Official PMJAY portal is the authoritative source for registration, hospital listings, and updated information about the scheme.
10 Essential Benefits of the Ayushman Bharat PMJAY Scheme
- Cashless treatment: Hospital bills are directly settled with the government.
- Coverage up to ₹5 lakh per family per year: Reduces financial stress on families.
- No waiting period for pre-existing conditions: Immediate treatment is available.
- Wide range of medical procedures: Surgeries, ICU care, cancer treatment, and diagnostics.
- Nationwide portability: Receive treatment at any empanelled hospital across India.
- Beneficiary-friendly claim process: Minimal paperwork required for empanelled hospitals.
- Focus on vulnerable families: Targets economically weaker sections identified in SECC 2011.
- Support for large households: Coverage applies to all members of an eligible household.
- Private hospital participation: Many private hospitals are empanelled, offering more treatment choices.
- Grievance redressal: Official portals allow beneficiaries to report service or payment issues.
Eligibility Criteria for the Ayushman Bharat PMJAY Scheme
Eligibility is determined using Socio-Economic Caste Census (SECC) 2011 and other government data.
Eligible households include:
- Economically vulnerable families listed under SECC
- Families without a fixed income above government thresholds
- All members of an eligible household
You can check eligibility online via the PMJAY portal to see if your family qualifies for the the programme
How to Apply for an Ayushman Card
The Ayushman card is required to avail cashless treatment. Steps to apply under PMJAY:
- Visit the official PMJAY portal or a Common Service Centre (CSC).
- Enter your Aadhaar number or mobile number for verification.
- Complete KYC using OTP.
- Download or receive your Ayushman card.
- Carry it to empanelled hospitals when seeking treatment.
Empanelled Hospitals Under the scheme.
- Only empanelled hospitals provide cashless treatment under the scheme.
- Both government and private hospitals are included.
- Use the PMJAY hospital locator to find active hospitals near you.
Important points:
- Some private hospitals may withdraw due to reimbursement delays.
- Not all empanelled hospitals provide every type of treatment.
Real-World Challenges
Although beneficial, some challenges exist:
- Hospital payment delays – Certain hospitals face reimbursement delays.
- Limited private hospital participation – Some private hospitals opt out.
- Low awareness – Many eligible families are unaware of the Ayushman Bharat PMJAY scheme process.
- Technical verification issues – Hospitals may face difficulties checking beneficiary records.
Fraud and Misuse
- Fake Ayushman cards have been reported in certain areas.
- Suspicious hospital claims occasionally occur.
Always use official portals for registration to avoid misuse.
The National Health Portal provides guidance on safe usage of the Ayushman Bharat PMJAY scheme.
Limitations of the Scheme
- Outpatient (OPD) treatments are not covered.
- Cosmetic procedures and elective fertility treatments are excluded.
- Coverage depends on hospital empanelment and available services.
Tips for Beneficiaries
- Verify hospital empanelment before seeking treatment.
- Keep documents ready: Ayushman card, Aadhaar, ID proofs.
- Check coverage for your required treatment.
- Report issues via the official grievance portal
Impact and Reach
Since 2018:
- Millions of families have received Ayushman cards.
- Hospital access for vulnerable families has improved.
- The Ayushman Bharat PMJAY scheme continues to improve access to hospital care for millions of families across India.
- Awareness campaigns and outreach programs have increased scheme usage.
You can also explore: How to Download Ayushman Card
Frequently Asked Questions (FAQ)
How can beneficiaries report issues related to the scheme?
Beneficiaries can report issues such as card errors or hospital-related problems through the official grievance redressal system available on the PMJAY portal.
What is the Ayushman Bharat PMJAY scheme?
The Ayushman Bharat PMJAY scheme is India’s government health insurance program that provides cashless hospitalisation coverage of up to ₹5 lakh per family per year for eligible households.
Who is eligible for the Ayushman Bharat PMJAY scheme?
Eligibility is based on Socio-Economic Caste Census (SECC) 2011 data and includes economically vulnerable rural and urban households identified by the government. All members of an eligible family are covered. Check eligibility on the PMJAY portal using Aadhaar or mobile number, or visit a local CSC.
What benefits are provided under the Ayushman Bharat PMJAY scheme?
The scheme offers cashless treatment, coverage for major medical procedures, nationwide portability, no waiting period for pre-existing conditions, and access to empanelled public and private hospitals.
How can I apply for an Ayushman card?
You can apply by visiting the official PMJAY portal or a nearby Common Service Centre (CSC), verifying your Aadhaar or mobile number, completing KYC, and downloading your Ayushman card.
What treatments are covered under PMJAY?
PMJAY covers hospitalisation-related treatments such as surgeries, ICU care, cancer treatment, emergency services, and related diagnostics at empanelled hospitals.
Can Ayushman Bharat PMJAY be used anywhere in India?
Yes, the scheme is portable across India and can be used at any empanelled hospital in any state or union territory.
How can I find empanelled hospitals under PMJAY?
You can locate empanelled hospitals by using the hospital locator available on the official PMJAY portal.
Are pre-existing conditions covered under the scheme?
Yes, pre-existing medical conditions are covered from day one, with no waiting period, at empanelled hospitals.
What are some challenges faced while using Ayushman Bharat PMJAY?
Some challenges include limited awareness, verification issues, reimbursement delays for hospitals, and varying availability of services at empanelled hospitals.
