How to Apply for Ayushman Bharat Health Insurance in India: Eligibility and Process

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world's largest government-sponsored health insurance scheme, providing coverage of up to Rs 5 lakh per family per year for secondary and tertiary hospitalisation. The scheme covers over 12 crore families (approximately 55 crore beneficiaries) and is designed to reduce the financial burden of healthcare for economically vulnerable populations. This guide explains how to check your eligibility and apply.

Who Is Eligible for Ayushman Bharat PM-JAY

Eligibility is determined based on the Socio-Economic Caste Census (SECC) 2011 data. In rural areas, families are identified based on deprivation criteria such as households with no adult member aged 16-59, female-headed households with no adult male member aged 16-59, households with a disabled member and no able-bodied adult, SC/ST households, landless households deriving income from manual labour, and several other deprivation categories.

In urban areas, eligibility covers occupational categories including rag pickers, beggars, domestic workers, street vendors, construction workers, plumbers, masons, painters, security guards, coolies, transport workers, rickshaw pullers, and shop workers among others.

From September 2024, the scheme has been extended with universal coverage for all citizens aged 70 years and above, regardless of their economic status. Senior citizens already covered under another government health insurance scheme can choose to use PM-JAY additionally.

What Does Ayushman Bharat Cover

PM-JAY provides cashless and paperless coverage of up to Rs 5 lakh per family per year. The coverage includes hospitalisation expenses from 3 days before admission (pre-hospitalisation) to 15 days after discharge (post-hospitalisation). It covers surgical procedures, ICU charges, medicines, diagnostic tests, room charges, and food during hospitalisation. Over 1,900 medical procedures across 27 specialities are covered under the scheme.

The scheme does not cover outpatient consultations, fertility treatments, cosmetic procedures, individual health check-ups, or organ transplants (except kidney transplant, which is covered). Pre-existing conditions are covered from day one, with no waiting period.

How to Check Your Eligibility

Step 1: Visit the official PM-JAY beneficiary identification portal at beneficiary.nha.gov.in. You can also check eligibility by calling the toll-free helpline at 14555.

Step 2: Enter your mobile number, and verify with the OTP received. Search using your name, ration card number, RSBY URN, or mobile number linked to your records. If your family appears in the SECC 2011 database under the eligible categories, you will see a confirmation message.

Step 3: If you are eligible but do not appear in the database, visit your nearest Common Service Centre (CSC) or empanelled hospital. Carry your Aadhaar card, ration card, and any other government-issued ID. The CSC operator can verify your eligibility and help you enrol.

How to Apply and Get Your Ayushman Card

Step 1: If eligible, you can create your Ayushman card online through the beneficiary portal or through the PM-JAY mobile app. You will need your Aadhaar number for e-KYC verification.

Step 2: Alternatively, visit a Common Service Centre (CSC), empanelled hospital, or a PM-JAY Arogya Mitra (health assistant) stationed at government and empanelled hospitals. Carry your Aadhaar card and one additional ID proof.

Step 3: The Arogya Mitra will verify your identity through biometric authentication (fingerprint or iris scan linked to Aadhaar). Upon successful verification, your Ayushman card will be generated on the spot or mailed to your registered address.

Step 4: The Ayushman card is free of cost. There is no premium, no registration fee, and no renewal requirement. The card remains valid as long as the scheme continues and your family meets the eligibility criteria.

How to Use Your Ayushman Card at a Hospital

When you need hospitalisation, visit any empanelled hospital (government or private). Present your Ayushman card and Aadhaar card. The hospital's Arogya Mitra will verify your identity, check your remaining coverage balance, and initiate the pre-authorisation process. The treatment is entirely cashless. You do not need to pay anything upfront or submit reimbursement claims.

To find empanelled hospitals near you, search on the PM-JAY hospital finder at pmjay.gov.in or call 14555. Over 29,000 hospitals are empanelled across India.

Grievance Redressal

If you face any issues such as denial of treatment, demand for payment at an empanelled hospital, or difficulty in obtaining your Ayushman card, you can file a grievance through the PM-JAY portal, the mobile app, or by calling 14555. You can also escalate complaints to the district-level implementation authority or the State Health Agency. For broader consumer protection issues related to health services, you can approach the consumer court.

Related Guides

For more on government schemes and legal rights, see our guides on how to apply for legal aid under NALSA, how to file a consumer complaint in India, and how to file an RTI application.

Key Takeaways

Ayushman Bharat PM-JAY provides Rs 5 lakh per family per year for hospitalisation. Eligibility is based on SECC 2011 data, with universal coverage for citizens aged 70 and above from September 2024. Check eligibility at beneficiary.nha.gov.in or by calling 14555. The Ayushman card can be obtained for free at CSCs or empanelled hospitals with Aadhaar-based e-KYC. Treatment is cashless at over 29,000 empanelled hospitals. Coverage includes 3 days pre-hospitalisation and 15 days post-hospitalisation. Pre-existing conditions are covered from day one with no waiting period.

For related guidance, see our guide on how to apply for Aadhaar card online in India and how to file a consumer complaint online in India.