Government Schemes
Ayushman Bharat — who is eligible and how to get your card
📅 Updated May 2026⏱ 5 min read✍️ InsureIQ Research
The short answer
Ayushman Bharat gives Rs.5 lakh free health cover per family per year for secondary and tertiary hospitalisation. Check eligibility at pmjay.gov.in or call 14555. If eligible, get your card free at any government hospital or CSC centre. Pre-existing conditions are covered from day one.
What Ayushman Bharat actually covers
Ayushman Bharat — officially called PM Jan Arogya Yojana (PM-JAY) — is the world's largest health coverage scheme. It covers over 1,949 medical procedures including:
- Cancer treatment — surgery, chemotherapy, radiation
- Heart surgery — bypass, valve replacement, angioplasty
- Kidney failure — dialysis and transplant
- Orthopaedic procedures — joint replacement, spine surgery
- Childbirth and newborn care
- Mental health treatment
- Pre and post hospitalisation expenses (3 days before, 15 days after)
✓ No waiting period for pre-existing conditions. Unlike private insurance which excludes pre-existing conditions for 2–4 years, Ayushman Bharat covers them from day one. Diabetes, BP, heart conditions — all covered immediately.
Who is eligible
Eligibility is based on the Socio-Economic Caste Census (SECC) 2011 data. You are likely eligible if your family belongs to any of these categories:
| Category | Eligibility basis |
|---|
| Rural families | Only one room kutcha house, no adult earner 16–59 years, female-headed household, disabled member, ST/SC category, daily wage agricultural labour |
| Urban families | Ragpickers, beggars, domestic workers, street vendors, construction workers, plumbers, painters, security guards, transport workers, sanitation workers |
| Senior citizens (70+) | All citizens aged 70 and above regardless of income — expanded in 2025 |
| Former government employees | CGHS / ECHS covered separately — PM-JAY is an additional benefit |
⚠️ Middle-income salaried families are generally not eligible. If you earn a regular salary and live in a pucca house, you likely do not qualify for PM-JAY. Check the portal to confirm — do not assume.
How to check if you are eligible — step by step
1
Go to pmjay.gov.in on your phone or computer.
2
Click "Am I Eligible" on the homepage.
3
Enter your mobile number and verify with OTP.
4
Enter your state, then search by ration card number or your name + location.
5
If your name appears — you are eligible. Note down your HHD number.
6
Alternatively, call 14555 and check over phone. Free call.
How to get your Ayushman card
1
Visit any government hospital, Common Service Centre (CSC), or empanelled private hospital.
2
Carry your Aadhaar card and ration card. The Aadhaar must be linked to your mobile number for OTP verification.
3
A health worker will verify your eligibility and take a photo.
4
Your ABHA (Ayushman Bharat Health Account) card is issued immediately. It is free.
5
Download the Ayushman Bharat app to access your card digitally.
✓ The card covers your entire family — all members listed on your ration card. One card, Rs.5 lakh cover per year, for everyone.
If your name is not on the list
Your name may be missing even if you are eligible. This happens when:
- Your ration card was issued after the 2011 SECC survey
- Your name is misspelled in the database
- You recently moved and your ration card address does not match
What to do: Contact your district's Ayushman Bharat nodal officer. File a grievance at the pmjay.gov.in portal. Call 14555 and explain the issue. The process takes 15–30 days.
What Ayushman Bharat does not cover
| Not covered | Why |
|---|
| OPD (outpatient) visits | Only hospitalisation of 24+ hours is covered |
| Medicines bought outside hospital | Only medicines during hospitalisation are covered |
| Cosmetic procedures | Not medically necessary |
| Fertility treatments | Excluded by scheme design |
| Self-inflicted injuries | Standard exclusion |
Check all schemes you qualify for
InsureIQ checks your eligibility for Ayushman Bharat, PMJJBY, PMSBY, ESIC, and state schemes — all in one free assessment.
Check my eligibility free →
Frequently asked questions
Can I use Ayushman Bharat at a private hospital? +
Yes — at empanelled private hospitals. Search the list at hospitals.pmjay.gov.in. Not all private hospitals are empanelled. Before admission, confirm with the hospital that they accept Ayushman Bharat. Show your ABHA card at the hospital's Ayushman Bharat helpdesk.
What if the hospital says they don't accept Ayushman Bharat? +
If the hospital is on the empanelled list and still refuses — call 14555 immediately and report it. You can also escalate to your state's Ayushman Bharat nodal office. Empanelled hospitals cannot refuse eligible patients.
Does Ayushman Bharat cover parents aged 70 and above? +
Yes. Since the 2025 expansion, all citizens aged 70 and above are eligible for Ayushman Bharat regardless of income. This is a significant change — even upper-middle-class families with parents above 70 can now access this benefit. Apply at pmjay.gov.in or call 14555.
Can I have both Ayushman Bharat and private health insurance? +
Yes. You can hold both simultaneously. Use Ayushman Bharat for covered procedures at empanelled hospitals. Use private insurance for hospitals outside the network or for OPD expenses. They complement each other well.