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HealthCentrally sponsored schemeLaunched 2018

Ayushman Bharat PM-JAY — ₹5 Lakh Health Cover

A health assurance scheme providing up to ₹5 lakh per family per year of cashless secondary and tertiary hospital treatment at empanelled public and private hospitals.

Administered by Ministry of Health and Family Welfare — National Health Authority.

Last updated

Official source last verified 9 August 2026

At a glance

Cover
Up to ₹5 lakh per family per year
Basis
Family floater — shared across all members
Premium
None. Fully funded by government
Cap on family size or age
None
Treatment type
Cashless and paperless at empanelled hospitals

Who this scheme is for

  • Families identified as eligible on the basis of the deprivation and occupational criteria used by the scheme.
  • Senior citizens aged 70 and above, who were brought within the scheme irrespective of income under the expansion approved in September 2024.

Benefits

  • Up to ₹5 lakh per family per year for secondary and tertiary hospitalisation, on a family floater basis.
  • Cashless and paperless treatment at empanelled public and private hospitals anywhere in the country — the cover is portable across States.
  • No premium, no waiting period for pre-existing conditions, no cap on family size or age.
  • Covers a defined package of medical and surgical procedures including surgery, chemotherapy, dialysis, neonatal care and mental health treatment.
  • Pre-hospitalisation and post-hospitalisation expenses are covered for defined periods around the admission.

Eligibility

  • Eligibility is determined by the criteria adopted under the scheme, based on deprivation and occupational categories, rather than by an application anyone can simply make.
  • Families already covered under certain State health schemes may be included through State convergence arrangements.
  • Senior citizens aged 70 and above are eligible irrespective of income, under the expansion approved by the Union Cabinet in September 2024.
  • The reliable way to check is the official beneficiary portal, which confirms whether your household is on the eligible list.

Documents required

  • Aadhaar card of the member being enrolled
  • Ration card or another family identification document, to establish the household
  • Mobile number for OTP verification
  • For senior citizens, age proof establishing that the person is 70 or above

How to apply

  1. Open the official beneficiary portal at beneficiary.nha.gov.in.
  2. Log in using your mobile number and the OTP sent to it.
  3. Search for your household using your State, district and the scheme category, or by Aadhaar, ration card or family identification number depending on what the portal offers for your State.
  4. If your family appears in the list, select the member to be enrolled and complete e-KYC using Aadhaar authentication.
  5. Upload a photograph if prompted, and submit. The Ayushman card can be downloaded once the request is approved.
  6. Alternatively, visit an empanelled hospital’s Ayushman Mitra help desk, a Common Service Centre, or an Ayushman camp when one is held in your area. Carry Aadhaar and your ration card.
Ayushman Bharat PM-JAY official portal — pmjay.gov.inThe official portal for this scheme.https://pmjay.gov.in/(opens the official website in a new tab)Beneficiary portal — check eligibility and apply for an Ayushman cardApply directly on the official portal.https://beneficiary.nha.gov.in/(opens the official website in a new tab)

How to check your status

  1. Log back into beneficiary.nha.gov.in with your mobile number and OTP.
  2. Your enrolment status and card download option appear under the member record.
  3. If the family is not found, the household may not be on the eligible list — the portal states this rather than leaving it ambiguous.
  4. Grievances can be raised through the portal’s grievance option or the national helpline listed on pmjay.gov.in.

How treatment actually works

  1. Go to a hospital empanelled under PM-JAY. The list is searchable on pmjay.gov.in, and empanelled hospitals display the Ayushman Bharat signage.
  2. Find the Ayushman Mitra help desk, usually near the reception. This is the point of contact for the scheme inside the hospital.
  3. Present your Ayushman card along with a photo identity document. Verification is done electronically.
  4. The hospital raises a pre-authorisation request for the treatment package. Once approved, treatment proceeds cashless.
  5. You should not be asked to pay for anything covered by the approved package. If you are, raise it with the Ayushman Mitra desk immediately, and escalate through the grievance mechanism if it is not resolved.

What the scheme does not cover

PM-JAY is designed for hospitalisation. It is not a substitute for a comprehensive health insurance policy, and there are meaningful gaps worth understanding before relying on it exclusively.

  • Outpatient consultations and treatment that does not involve admission are generally outside the scheme.
  • Treatment at hospitals that are not empanelled is not covered, even in an emergency, so knowing your nearest empanelled hospital in advance matters.
  • The cover is a defined package list. Procedures outside the list, or costs above the approved package rate, are not covered.
  • The ₹5 lakh limit is shared across the whole family for the year, not per person.

Frequently asked questions

How do I know if my family is eligible for PM-JAY?
Check the official beneficiary portal at beneficiary.nha.gov.in, which tells you directly whether your household appears on the eligible list. Eligibility is determined by the scheme’s criteria rather than by open application, so the portal is the authoritative answer. Senior citizens aged 70 and above are eligible irrespective of income.
Is there any premium or fee to pay?
No. The scheme is fully funded by government, there is no premium, and getting an Ayushman card is free. Treatment at empanelled hospitals for covered packages is cashless. Nobody should charge you to make or activate a card.
Does the ₹5 lakh apply to each family member?
No — it is a family floater. The ₹5 lakh limit is shared across everyone in the household for the year. If one member uses ₹3 lakh, ₹2 lakh remains for the rest of the family until the cover resets.
Can I use my card in another State?
Yes. The cover is portable across the country, so an eligible beneficiary can receive cashless treatment at any empanelled hospital in any State. This is one of the scheme’s more significant features for migrant workers and families living away from home.
Are pre-existing conditions covered?
Yes. There is no waiting period for pre-existing conditions under PM-JAY, which is a material difference from most commercial health insurance policies.
What if a hospital refuses treatment or demands payment?
Raise it first with the Ayushman Mitra help desk at the hospital. If that does not resolve it, use the grievance mechanism on pmjay.gov.in or the national helpline listed there. Empanelled hospitals are not permitted to charge eligible beneficiaries for covered packages.

Official sources

Every figure on this page is traceable to the official source below. If a source has changed since the date shown, please tell us and we will correct it.