Ayushman Bharat – PMJAY Card: Eligibility Rules, Health Coverage Benefits & How to Get PM-JAY Card

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana – AB PM-JAY which is one of India’s most ambitious public healthcare initiatives was launched with the goal that it will achieving Universal Health Coverage. This scheme was Introduced in line with the National Health Policy 2017 and this scheme focuses on ensuring that quality healthcare services are accessible and affordable for economically vulnerable sections of society. This programme was officially launched on 23 of September 2018 in Ranchi, Jharkhand, by the Hon’ble Prime Minister of India, Shri Narendra Modi. Under AB PM-JAY, eligible families receive cashless health insurance coverage of up to rs 5 lakh per year for secondary and tertiary hospitalisation. This benefit is designed to protect poor and vulnerable households from catastrophic healthcare expenses. With coverage extended to more than 10.74 crore families—roughly 50 crore individuals

Core Components of Ayushman Bharat

Ayushman Bharat is structured around two complementary healthcare delivery mechanisms:

Health Coverage and Treatment Benefits Under PM-JAY

One of the most significant strengths of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana is the wide range of expenses covered under its rs 5 lakh annual limit. The scheme is designed to be fully cashless and paperless at empanelled hospitals.

1. Doctor consultations and medical examinations
2. Pre-hospitalisation expenses
3. Medicines and medical consumables
4. Diagnostic tests and laboratory investigations
5. Non-intensive and intensive care services
6. Surgical procedures and implants, where required
7. Hospital accommodation charges
8. Food services during hospital stay
9. Treatment-related complications
10. Post-hospitalisation care for up to 15 days

The coverage is provided on a family floater basis, meaning the total amount can be utilised by one or multiple family members. There is no restriction on family size, age, or gender. Importantly, all pre-existing diseases are covered from day one, eliminating waiting periods that are common in private health insurance policies.

Who Is Eligible for Ayushman Bharat PM-JAY?

Eligibility under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana is determined using data from the Socio-Economic Caste Census (SECC) 2011. Separate criteria apply to rural and urban households.

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Families in rural areas qualify if they meet at least one of the following conditions:

1. Family need to be Living in a single-room house with kucha walls and roof
2. No adult member aged between 16 and 59 years should be available in family
3. Households without an adult male member in the 16–59 age group
4. Families with a disabled member and no able-bodied adult
5. Scheduled Caste or Scheduled Tribe households
6. Landless families dependent mainly on manual casual labour

Additionally, households falling under automatic inclusion categories such as destitute individuals, manual scavengers, primitive tribal groups, and legally released bonded labourers are also covered.

Exclusion Rules You Should Know

Despite meeting occupational or deprivation criteria, certain households are excluded from PM-JAY coverage. These exclusions include families who:

1. Candidate who Own motorised vehicles or fishing boats
2. Possess mechanised farming equipment
3. Hold Kisan Credit Cards with limits above ₹50,000
4. Are government employees or work in government enterprises
5. Earn more than ₹10,000 per month
6. Own refrigerators, landlines, or solidly built houses
7. Own five acres or more of agricultural land

How to Apply Offline for PM-JAY E-Card

The application process for Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana is primarily offline and assisted by trained representatives known as Arogya Mitras.

1. Visit an empanelled hospital or Common Service Centre (CSC)
2. Provide identification details such as ration card number, mobile number, PM letter, or RSBY URN
3. The Arogya Mitra searches beneficiary details in the Beneficiary Identification System (BIS)
4. Submit Aadhaar or other government-issued ID along with family identification documents
5. Family details are verified and uploaded for approval
6. The State Health Agency or insurance trust reviews the application
7. Upon approval, a PM-JAY e-card is issued

Documents Required for Registration

Applicants must carry the following documents during verification:

1. Aadhaar Card or PAN Card
2. Proof of address
3. Mobile number and email ID
4. Caste certificate (if applicable)
5. Income certificate
6. Family status proof (joint or nuclear family)

Important Links

Guidelines

Guidelines For Beneficiary Identification

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Guidelines On Payment For Special Cases

Guidelines On Claim Settlement

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