The Pradhan Mantri Jan Arogya Yojana (PMJAY), popularly known as Ayushman Bharat, stands as the world’s largest health assurance scheme launched by the Government of India. This flagship healthcare initiative provides ₹5 lakh annual coverage per family for secondary and tertiary care hospitalization, covering over 50 crore beneficiaries from approximately 10.74 crore vulnerable families.

What is PMJAY Scheme?

PMJAY is a comprehensive health insurance scheme designed to provide financial protection to economically weaker sections of society. Launched on September 23, 2018, in Ranchi, Jharkhand by Prime Minister Narendra Modi, the scheme aims to achieve Universal Health Coverage (UHC) and ensure that no one is left behind in accessing quality healthcare.

The scheme operates on an entitlement-based model, meaning eligible families don’t need to enroll separately. Their eligibility is determined based on the Socio-Economic Caste Census (SECC) 2011 data for both rural and urban areas.

Key Benefits of PMJAY

Comprehensive Coverage

PMJAY provides cashless treatment up to ₹5 lakh per family per year with the following inclusions:

• Medical examination, treatment, and consultation

• Pre-hospitalization expenses (up to 3 days)

• Post-hospitalization follow-up care (up to 15 days)

• Medicine and medical consumables

• Diagnostic and laboratory investigations

• Medical implantation services

• ICU and non-intensive care services

• Accommodation and food services during hospitalization

Family Floater Benefit

The ₹5 lakh coverage operates on a family floater basis, allowing all eligible family members to utilize the entire amount. There are no restrictions on family size, age, or gender.

Pre-existing Disease Coverage

One of the standout features is immediate coverage for all pre-existing diseases from day one, eliminating waiting periods that are common in private health insurance policies.

Nationwide Portability

Beneficiaries can access cashless treatment at any empanelled hospital across India, regardless of their location, ensuring healthcare accessibility during travel or relocation.

Eligibility Criteria for PMJAY

Rural Households

Families in rural areas are eligible if they meet at least one of the following six deprivation criteria:

• Living in a single room with kucha walls and kucha roof

• No adult member between ages 16 to 59

• Female-headed households with no adult male member (16-59 years)

• Households with disabled members and no able-bodied adult

• SC/ST households

• Landless households deriving major income from manual casual labor

Automatic inclusion categories include destitute families, manual scavenger households, primitive tribal groups, and legally released bonded labor families.

Urban Households

Eleven occupational categories of workers in urban areas are eligible:

• Ragpicker, Beggar, Domestic worker

• Street vendor/Cobbler/Hawker/Service provider

• Construction worker/Plumber/Mason/Labor/Painter/Welder/Security guard

• Sweeper/Sanitation worker/Mali

• Home-based worker/Artisan/Handicrafts worker/Tailor

• Transport worker/Driver/Conductor/Helper

• Shop worker/Assistant/Peon in small establishments

• Electrician/Mechanic/Assembler/Repair worker

• Washer-man/Chowkidar

Senior Citizens (New Update 2024)

In a major expansion announced in September 2024, all senior citizens aged 70 and above are now eligible for PMJAY coverage regardless of their income or socio-economic status. This expansion benefits approximately 6 crore senior citizens across India.

Step-by-Step Application Process for PMJAY

Step 1: Check Your Eligibility

1. Visit the official PMJAY portal at https://pmjay.gov.in

2. Click on “Am I Eligible” tab on the homepage

3. Enter your mobile number and captcha code

4. Verify with OTP received on your mobile

5. Select your state and district

6. Search using your name, mobile number, ration card number, or HHD number

7. Check your eligibility status displayed on screen

Step 2: Gather Required Documents

Essential documents for PMJAY registration:

• Aadhaar Card (mandatory for identity proof)

• Ration Card or SECC proof

• Address proof (Voter ID, electricity bill, etc.)

• Caste Certificate (if applicable)

• Income Certificate (if applicable)

• Passport-size photographs

• Mobile number for verification

Step 3: Visit Enrollment Center

Two options available for registration:

• Common Service Centre (CSC) in your area

• Empanelled hospital with PMJAY facility

Step 4: Complete Registration Process

1. Submit all required documents to the Arogya Mitra (operator)

2. Biometric verification using Aadhaar authentication

3. Family member details verification and updating

4. Document scanning and uploading by the operator

5. Application submission to insurance company/trust for approval

6. Approval/rejection notification within specified timeframe

Step 5: Receive Your PMJAY E-Card

Upon approval, your PMJAY e-card will be generated instantly and can be downloaded from the portal. No physical card issuance is required as the scheme operates on digital cards.

Step 6: Avail Cashless Treatment

• Present your PMJAY e-card at any empanelled hospital

• No advance payment required for covered treatments

• Direct settlement between hospital and insurance provider

• Complete paperless and cashless process

PMJAY Coverage and Exclusions

Covered Treatments

PMJAY covers approximately 1,949 medical procedures including:

• All types of surgeries and medical interventions

• Cancer treatment and chemotherapy

• Cardiac procedures and heart surgeries

• Neurological treatments

• Orthopedic procedures

• Maternity and newborn care

• Emergency medical treatments

Exclusions Under PMJAY

Treatments not covered under the scheme:

• Outpatient Department (OPD) services

• Cosmetic and aesthetic procedures

• Organ transplants (except specific cases)

• Drug rehabilitation services

• Experimental or investigational treatments

Recent Updates and Expansions

Digital Integration

PMJAY is increasingly integrated with the Ayushman Bharat Digital Mission (ABDM) to provide digital health records and seamless healthcare access.

Delhi Implementation

In April 2025, Delhi became the 35th state/UT to implement PMJAY, with card distribution beginning from April 10, 2025. The Delhi government provides an additional ₹5 lakh top-up over the central government’s ₹5 lakh coverage.

Achievements

As of March 2025, more than 36.9 crore Ayushman cards have been created under the scheme, with Government Health Expenditure increasing from 29% to 48% between FY 2015 and FY 2022.

Frequently Asked Questions

Q: Is there any registration fee for PMJAY?
A: No, PMJAY registration and treatment are completely free for eligible families.

Q: Can I use PMJAY card in private hospitals?
A: Yes, PMJAY cards are accepted at both government and empanelled private hospitals across India.

Q: What if my name is not in the SECC list?
A: Currently, new families cannot be added to PMJAY. However, additional family members can be added to existing eligible families.

Q: Is there a limit on the number of times I can use PMJAY benefits?
A: No, you can use the benefits multiple times until the annual limit of ₹5 lakh is exhausted.

Conclusion

PMJAY represents a revolutionary step toward achieving Universal Health Coverage in India, providing comprehensive healthcare protection to over 50 crore citizens. The scheme’s cashless and paperless approach, combined with nationwide portability and immediate coverage for pre-existing conditions, makes it a truly transformative healthcare initiative.

For eligible families, PMJAY offers financial security against medical emergencies and ensures access to quality healthcare without the burden of high medical costs. With continuous expansions and digital integration, PMJAY continues to strengthen India’s healthcare infrastructure and move toward the goal of leaving no one behind in healthcare access.

To check your eligibility and apply for PMJAY, visit the official portal at https://pmjay.gov.in or contact the helpline at 14555 or 1800-111-565.

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