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Health & Social ProtectionOfficial Info Verified
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
Flagship national health assurance scheme by the National Health Authority (NHA) providing ₹5.00 Lakh cashless annual family cover for secondary and tertiary hospitalization across empanelled hospitals, with expanded universal coverage and the Ayushman Vay Vandana Card for all senior citizens aged 70+.
Department: National Health Authority (NHA), Ministry of Health and Family Welfare (MoHFW), Government of India
Annual Family Cover
₹5.00 Lakh
Per eligible family per year
70+ Senior Citizens
Universal Cover
Ayushman Vay Vandana Card
Pre/Post Hospitalization
3 & 15 Days
Pre: 3 days, Post: 15 days
Pre-existing Diseases
From Day 1
Zero waiting period
Language:
Scheme Overview
What is Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)?
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world's largest government-funded health assurance initiative, launched on 23 September 2018 under the National Health Authority (NHA), Ministry of Health and Family Welfare, Government of India. The scheme provides a comprehensive health cover of ₹5.00 Lakh per eligible family per year for secondary and tertiary care hospitalization across a network of over 29,000 empanelled public and private hospitals nationwide. Beneficiaries receive completely cashless and paperless treatment for covered surgical and medical packages, covering up to 3 days of pre-hospitalization consultations and diagnostics, and 15 days of post-hospitalization medicines and follow-up care. Under the PM-JAY framework, there is no restriction on family size, age, or gender, and all pre-existing medical conditions are covered from Day One without any waiting period. In an expansive policy evolution, PM-JAY now extends universal health assurance of ₹5.00 Lakh per year to all senior citizens aged 70 years and above, irrespective of their socioeconomic or income background, through the dedicated Ayushman Vay Vandana Card. For West Bengal residents, while the state government primarily administers healthcare through its own universal state scheme, Swasthya Sathi, eligible PM-JAY beneficiaries and 70+ senior citizens can access nationwide treatment through national portability at empanelled healthcare providers.
Primary Purpose:To eliminate catastrophic out-of-pocket health expenditures by providing cashless, paperless access to quality secondary and tertiary inpatient healthcare for vulnerable families and senior citizens aged 70+.
Key Scheme Objectives
- Provide cashless financial protection of ₹5.00 Lakh per family per year against catastrophic hospitalization costs.
- Deliver secondary and tertiary inpatient healthcare through a robust network of empanelled public and private hospitals.
- Ensure universal healthcare equity for all senior citizens aged 70+ via the Ayushman Vay Vandana Card.
- Enable seamless national portability allowing beneficiaries to access treatment anywhere across India.
Financial Framework
Cashless Health Assurance Model & Benefit Architecture
PM-JAY is a cashless and paperless health assurance program. It does not provide direct cash handouts; instead, it pays empanelled hospitals directly for pre-defined medical and surgical treatment packages.
Hospitalization Assurance
₹5,00,000
Pre-Hospitalization Window
3 Days
Post-Hospitalization Window
15 Days
Waiting Period
0 Days
Universal PM-JAY Coverage for Senior Citizens Aged 70 and Above
Under the latest policy expansion, all Indian senior citizens aged 70 years and above are eligible for dedicated health cover of ₹5.00 Lakh per year under PM-JAY, regardless of their family income or economic status. Eligible seniors receive the dedicated "Ayushman Vay Vandana Card" through simple Aadhaar-based e-KYC on beneficiary.nha.gov.in.
Understanding the Family-Floater & 70+ Senior Citizen Allocation:
Case 1: Standard Eligible Family (General Floater)
A 5-member eligible family has a total annual coverage pool of ₹5.00 Lakh. If one member undergoes knee replacement surgery costing ₹1.80 Lakh, the remaining ₹3.20 Lakh remains available for any other family member during the same year.
Case 2: Senior Citizen (Aged 70+) in an Already Enrolled Family
If an existing PM-JAY family includes a 72-year-old grandparent, the family retains its ₹5.00 Lakh floater, and the 72-year-old senior receives an EXCLUSIVE dedicated top-up cover of ₹5.00 Lakh under the Ayushman Vay Vandana Card (total ₹10 Lakh family ceiling).
Case 3: Senior Citizen (Aged 70+) in a Non-PM-JAY Family
A 74-year-old senior citizen in an otherwise non-eligible family can independently register on beneficiary.nha.gov.in using Aadhaar to receive their personal ₹5.00 Lakh Ayushman Vay Vandana Card.
Important Distinction & West Bengal Context:
PM-JAY is a central health assurance scheme administered by NHA. It is distinct from West Bengal’s state-funded Swasthya Sathi scheme (which covers resident families statewide with cards issued to the female head) and the West Bengal Health Scheme (WBHS for state employees/pensioners). West Bengal primarily operates Swasthya Sathi within the state, while PM-JAY cards offer seamless national portability across empanelled hospitals in India.
Ayushman Card vs. ABHA (Health ID) Distinction
The Ayushman Card proves eligibility for ₹5.00 Lakh cashless hospitalization under PM-JAY. ABHA (Ayushman Bharat Health Account) is a 14-digit digital health ID used for storing medical records digitally across India. Holding an ABHA card does NOT automatically grant ₹5.00 Lakh insurance cover.
Eligibility Guidelines
Who is Eligible to Apply?
Review standard qualifying conditions, income limits, and applicable waiver categories. Read our guide on understanding eligibility
Standard Eligibility Requirements
- Families identified in eligible socioeconomic databases / SECC or state-expanded PM-JAY beneficiary lists
- All Indian senior citizens aged 70 years and above (irrespective of income, via Ayushman Vay Vandana Card)
- Valid Aadhaar card or approved Government photo ID for biometric / OTP e-KYC verification
- Treatment must be availed at officially empanelled public or private PM-JAY network hospitals
Not Eligible:
- Families and individuals not meeting the prescribed central/state beneficiary database criteria (except senior citizens aged 70+).
- Standalone outpatient department (OPD) visits, routine pharmacy purchases, or cosmetic procedures not linked to covered hospitalization.
- Non-empanelled private nursing homes and hospitals outside the official PM-JAY network.
₹5.00 Lakh Family Cover
Cashless Inpatient Healthcare across Empanelled Hospitals
National Health Authority (NHA), MoHFW
Comprehensive financial cover for secondary and tertiary care surgeries, ICU, diagnostics, and medicines with zero out-of-pocket costs for covered packages.
70+ Universal Benefit
Ayushman Vay Vandana Card for Senior Citizens
Universal ₹5 Lakh annual health assurance for all Indian seniors aged 70 and above, regardless of income status.
Required Documentation
Commonly Required Documents
Exact document requirements can depend on the application type and applicant circumstances. View our common documents checklist
Standard
Aadhaar Card of Beneficiary
Primary identity document used for biometric or mobile OTP-based e-KYC on the NHA portal.
Conditional
Ration Card / Family Proof Document
Official document linking the individual to the eligible PM-JAY beneficiary family unit.
Standard
Active Mobile Number for OTP Verification
Aadhaar-linked mobile number for online card generation and instant e-KYC authentication.
Standard
Age Proof for Senior Citizens (Aadhaar / Voter ID)
Official document verifying date of birth and 70+ age milestone for Ayushman Vay Vandana Card registration.
Guidance: Ensure the applicant’s bank account is active and matches the beneficiary name exactly before institutional submission.
Application Process
How to Apply for Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
Step-by-step application and verification procedure based on official guidelines. Read our official portals guide
1
Verify Eligibility on NHA Portal or Ayushman App
Visit the official NHA portal (beneficiary.nha.gov.in) or download the Ayushman App to verify eligibility using Aadhaar number or Ration Card details.
2
Complete Online e-KYC via Aadhaar OTP or Biometrics
Authenticate beneficiary identity through Aadhaar OTP, facial authentication on the Ayushman App, or fingerprint scanner at CSC / hospital helpdesk.
3
Generate & Download Ayushman / Vay Vandana Card
Once verified, instantly download the official digital Ayushman Card (or Ayushman Vay Vandana Card for 70+ seniors).
4
Visit Empanelled Hospital & Meet Arogya Mitra
At the hospital, approach the dedicated PM-JAY helpdesk where the "Ayushman Mitra" (Arogya Mitra) verifies the card and processes the admission.
5
Avail Cashless Inpatient Treatment & Discharge
Receive covered medical/surgical treatment, diagnostics, and 15 days of post-discharge medicines with zero out-of-pocket payment.
Payment Method
Treatment under PM-JAY is 100% cashless and paperless for the patient. The National Health Authority (NHA) settles pre-authorized treatment and package costs directly with the empanelled hospital through the electronic Transaction Management System (TMS).
National Launch Date:Launched on 23 September 2018 by the Government of India
Important to Know
PM-JAY provides ₹5.00 Lakh cashless annual family cover for covered secondary and tertiary hospitalizations.
All senior citizens aged 70+ are universally eligible for a dedicated ₹5.00 Lakh cover under the Ayushman Vay Vandana Card.
Covers up to 3 days of pre-hospitalization diagnostics and 15 days of post-hospitalization medicines.
Pre-existing medical conditions are covered from Day One without any waiting period.
In West Bengal, the state runs Swasthya Sathi; PM-JAY cards enable nationwide treatment across 29,000+ empanelled hospitals.
Frequently Asked Questions
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) Frequently Asked Questions
Common questions and answers regarding eligibility, benefits, documents, and application process for Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a Government of India health assurance scheme providing ₹5.00 Lakh cashless annual family coverage for secondary and tertiary hospitalizations.
Sources Checked
All factual information on this page has been compiled and verified against official government portals, gazettes, and departmental guidelines.
Last Verified: 2026-08-19T00:00:00Z
Independent Platform Notice:
WBScheme is an independent information platform and is not the Government of India or Government of West Bengal. PM-JAY eligibility, coverage, hospital empanelment, beneficiary identification, application procedures and Government rules may change through official notifications. Always verify the latest information through the National Health Authority and the relevant Government health department before relying on this information.
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