Ayushman Bharat PM-JAY 2026: Rs. 5 Lakh, All 36 States

What Ayushman Bharat PM-JAY is

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the Union government's flagship health-insurance scheme. It pays for cashless hospitalisation up to Rs. 5 lakh per family per year at any empanelled public or private hospital, with no premium collected from the beneficiary. Launched on 23 September 2018, it is the world's largest fully government-funded health-assurance programme by coverage.

As of May 2026, PM-JAY has recorded 11.69 crore hospital admissions across 36,229 empanelled hospitals (19,483 government and 16,746 private), per the National Health Authority dashboard. The scheme covers 55 crore Indians from low-income families identified via the Socio-Economic Caste Census 2011 and state-level lists.

The Union Budget 2026-27 raised the PM-JAY allocation to Rs. 9,500 crore from Rs. 9,000 crore in the previous year, per the PIB release of 1 February 2026. A parallel Rs. 4,770 crore was earmarked for the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), a 67.66% jump over the FY 2025-26 revised estimate.

Latest coverage: all 36 states and union territories now on PM-JAY

West Bengal signed the MoU with the National Health Authority on 8 June 2026, becoming the 36th state or union territory to implement PM-JAY. The state's cashless rollout begins on 1 July 2026, per the newsonair.gov.in announcement. This closes a 6-year gap for the state, whose previous Swasthya Sathi scheme ran in parallel without PM-JAY integration.

Delhi joined in April 2025 as the 35th, and Odisha adopted PM-JAY through co-branded health cards in January 2025. As of mid-2026, no Indian state or UT operates without PM-JAY integration. This is the first time every subnational unit is on a unified national health-cover programme.

The immediate impact: a PM-JAY beneficiary from one state can now walk into an empanelled hospital in any other state and get cashless treatment. Portability had partial gaps before Delhi and West Bengal joined; that gap is closed.

Who is covered

Three separate rules decide whether you're covered under PM-JAY.

Under-70 low-income families qualify if the household appears in the SECC 2011 database under any of the seven deprivation criteria for rural families (kaccha house, landless daily wage labour, SC/ST household, female-headed, disabled member, etc.) or in the 11 occupational categories for urban families (rag-picker, street vendor, domestic worker, construction labour, etc.). State-specific lists like Tamil Nadu's Chief Minister's Comprehensive Health Insurance and Andhra Pradesh's YSR Aarogyasri feed into the same PM-JAY beneficiary pool.

Seniors 70 and above qualify under a separate scheme called Ayushman Vay Vandana Yojana (details in the dedicated section below). No SECC listing or income cap applies at 70+.

Migrant workers with an e-Shram card are automatically eligible under a 2024 expansion, and the coverage carries across states via the portability feature.

You cannot check eligibility by producing an income proof; the beneficiary check is against the pre-populated list. Everyone else, including middle-income salaried families, is not covered under PM-JAY. They may buy private health insurance or use state-specific top-up schemes where available.

What is covered

The scheme funds 1,949 medical packages spanning secondary and tertiary care. This is one of the widest procedure lists among government-funded health schemes worldwide. The Rs. 5 lakh cover is a family-floater, meaning one large hospitalisation for one member can consume the entire year's cap.

The scheme also covers COVID-19 hospitalisation as part of standard respiratory care, and mental-health admissions under an expansion notified in 2022.

What is not covered

Some expenses are outside PM-JAY. Outpatient department (OPD) consultations, routine dental work, cosmetic surgery, fertility treatment, drug rehabilitation, self-inflicted injuries, and injuries arising from war or civil unrest are all excluded. Non-empanelled hospitals are not covered even for procedures that would otherwise be on the list, so an emergency admission at a random private hospital cannot be claimed retrospectively.

For OPD care, the parallel Ayushman Arogya Mandirs network of primary health centres offers free consultations and basic medicines. As of 14 May 2026, 1,85,940 Ayushman Arogya Mandirs are operational nationwide.

Ayushman Vay Vandana Yojana for senior citizens 70+

Vay Vandana is a stand-alone extension of PM-JAY launched on 29 October 2024 for Indians aged 70 and above. It gives every eligible senior an additional Rs. 5 lakh per family per year, on top of any existing PM-JAY cover the family already has. So a 70+ senior in a low-income family gets Rs. 5 lakh through regular PM-JAY plus Rs. 5 lakh through Vay Vandana, a combined Rs. 10 lakh yearly cover.

Eligibility is a single line: 70 years or older on the date of enrolment, resident Indian. There is no income cap, no SECC dependency, and no BPL requirement. Middle-income and even affluent families' seniors are covered on equal terms with low-income families.

Enrolment happens through beneficiary.nha.gov.in or the Ayushman App using Aadhaar-based e-KYC. The applicant enters their Aadhaar-linked mobile number, verifies via OTP, and the Vay Vandana card is generated typically within minutes. A separate Vay Vandana card is issued in addition to the family's regular Ayushman card if one exists.

As of mid-2026, 3.4 crore seniors have enrolled since the October 2024 launch. Uptake has been strongest in Karnataka, Kerala, Andhra Pradesh, and Uttar Pradesh, based on state-wise enrolment figures published by the National Health Authority.

How to check if you're a beneficiary

Go to beneficiary.nha.gov.in, enter your Aadhaar-linked mobile number, verify via OTP, and search by state and name or ration card number. The portal shows whether you're on the list, whether your Ayushman card has been generated, and which household members are covered.

You can also call the toll-free helpline 14555 or 1800-11-1565 and share your name, state, and district. The operator checks the same central beneficiary list and reads back the result. Common Service Centres and empanelled hospitals also perform on-the-spot checks with just your Aadhaar.

The Ayushman App on the Play Store and App Store bundles the same eligibility check with card download, Aadhaar e-KYC, and hospital lookup in one place. It is the fastest single-shot path if you have a smartphone.

How to enrol and get an Ayushman card

If you are already on the beneficiary list, enrolment is a card-generation step, not an application. Walk into any empanelled hospital or Common Service Centre with your Aadhaar and mobile phone. The operator confirms your identity via Aadhaar e-KYC, prints the card, and hands it over. The card is free.

If you are 70 or older and not yet in the beneficiary list, the same Aadhaar e-KYC flow at a CSC or empanelled hospital generates a Vay Vandana card. This works even if your family is not otherwise PM-JAY eligible.

If your state runs its own health scheme (Tamil Nadu, Kerala, Andhra Pradesh, Karnataka, and others), your existing state-scheme card may double as your PM-JAY card, or a joint co-branded card is issued. Check with the state health department for the specific card format your state uses.

How treatment works: pre-auth, admission, claim

Every PM-JAY hospitalisation runs through a defined four-step process, published in the National Health Authority's Claims Adjudication Manual.

Step 1 is pre-authorisation. The hospital's PM-JAY desk enters your diagnosis, proposed procedure package, and admission details into the online portal. The State Health Agency reviews and approves the package within hours in most cases. Emergency admissions can proceed before approval, with the paperwork completed within 24 hours.

Step 2 is admission. Once pre-auth is approved, you are admitted without any deposit or upfront payment. The hospital cannot ask for the Ayushman cover amount, security deposit, or any other charge for covered procedures. Show your Ayushman card and Aadhaar at check-in.

Step 3 is discharge. When you're discharged, the hospital issues a standard discharge summary. You do not sign any payment slip because there is no bill payable by you. Take the discharge summary with you for follow-up care records.

Step 4 is the hospital's claim. The hospital submits the discharge summary, investigation reports, and package code to the SHA portal within 24 hours of your discharge. The SHA approves within 15 days and releases payment to the hospital within 15 days after that.

If a hospital refuses admission despite valid pre-authorisation, or asks you to pay upfront, call 14555 immediately. Refusal or upfront demand at an empanelled hospital is a violation of the empanelment agreement and can trigger de-empanelment.

Finding an empanelled hospital

The empanelled-hospital list is published on pmjay.gov.in and refreshed weekly. Filter by state, district, hospital type (public or private), and speciality. As of May 2026, the widest empanelled coverage is in Uttar Pradesh, Madhya Pradesh, Rajasthan, and Karnataka; every district in the country has at least one empanelled hospital.

The Ayushman App also offers a location-based lookup that surfaces empanelled hospitals within a chosen radius. This is the quickest option in an emergency because it works without typing the state or district.

For tertiary procedures like cancer treatment, cardiac surgery, or transplants, the empanelled list includes AIIMS, most large PSU hospitals, and about 60% of NABH-accredited private hospitals nationwide. Availability and waiting time vary heavily by state, so book pre-authorisation as early as possible rather than treating it as a last-minute step.

ABHA card and digital health records

Ayushman Bharat Health Account (ABHA) is a separate digital initiative that runs alongside PM-JAY. ABHA gives every citizen a 14-digit health ID that stores medical records, prescriptions, lab reports, and hospital discharge summaries in one place. As of May 2026, 93.95 crore ABHA IDs have been generated and 105 crore health records linked, per the Ayushman Bharat Digital Mission dashboard.

ABHA is not required to access PM-JAY treatment, but it makes the pre-authorisation step faster because past records are already in the system. You create an ABHA number for free at abdm.gov.in using Aadhaar or a mobile number.

In 2026, wearable-device integration was added. Fitness bands and smartwatches with the ABDM certification can push heart rate, sleep, and activity data into your ABHA record if you grant explicit consent. This is an opt-in privacy-controlled channel.

The Union Budget 2026-27 raised the Ayushman Bharat Digital Mission allocation to Rs. 350 crore, a 7.94% rise, to expand telemedicine and interoperable hospital information systems.

State-wise scheme integration

Several states run their own health-cover schemes in parallel with PM-JAY, and the two are integrated to varying degrees.

Tamil Nadu's Chief Minister's Comprehensive Health Insurance Scheme covers around 1.6 crore families with a Rs. 5 lakh general cover and an additional Rs. 1.5 lakh for specified procedures, and shares empanelled hospitals with PM-JAY. Andhra Pradesh's YSR Aarogyasri covers around 1.4 crore families with a Rs. 25 lakh cover for critical procedures, and every AP resident with a valid ration card is automatically enrolled in PM-JAY as well. Kerala's Karunya Health Scheme runs on the same empanelment network. West Bengal's Swasthya Sathi scheme (family cover of Rs. 5 lakh, launched 2016) will run in parallel with PM-JAY from 1 July 2026, with beneficiaries free to use either.

Where a state has its own scheme, the co-branded card is usually accepted at any empanelled hospital nationwide, but the specific package rates and pre-authorisation flow may vary. Check the state health department's website for the current rulebook if you're planning a large procedure.

Grievance and helpline

The PM-JAY helpline is 14555 (toll-free) or 1800-11-1565 (alternative). Both operate 24 hours a day in Hindi and English, with regional-language operators available in most state hours. Complaints on hospital refusal, upfront demand, denied pre-authorisation, or non-payment of empanelled hospitals can be filed directly on the call.

For written complaints or slower issues like card correction or family-member addition, use the grievance portal at pmjay.gov.in. Response time is typically 15 to 30 working days.

If a hospital continues to demand payment or refuses admission despite pre-authorisation, escalate to the State Health Agency office. Contact details for every SHA are published on pmjay.gov.in under Contact Us.

If a hospital refuses treatment under PM-JAY

An empanelled hospital cannot refuse to treat an eligible beneficiary for a procedure covered under the scheme, and it cannot ask you to pay for one. Refusals and demands for payment still happen, and knowing what you are entitled to is what resolves them.

The treatment is cashless at the point of care. That is the design of the scheme. You are not meant to pay and claim reimbursement afterwards, and a hospital telling you to pay now and get the money back later is describing something the scheme does not do.

If you are refused, the practical sequence is this. Ask for the Ayushman Mitra, the dedicated help desk that empanelled hospitals are required to run. Most refusals at the counter come from staff unfamiliar with the process rather than from a considered decision, and the help desk exists precisely for this.

Ask for the reason in writing. A hospital that is genuinely unable to treat you, because the procedure is outside its empanelment scope or a specialist is unavailable, can say so. A hospital that is simply declining will usually not put it on paper, and asking often resolves the situation on the spot.

Record what you can. The date, time, the name of the person you spoke to, and the department. If you escalate, this is what makes the complaint actionable rather than a general grievance.

Escalate through the grievance channels covered in the section below rather than accepting the refusal. Complaints against empanelled hospitals are taken seriously because empanelment is a privilege that can be suspended, and hospitals know this.

Two things are worth being clear about, because they are not refusals. A procedure genuinely outside the covered package is not something the hospital can authorise, and a hospital that is not empanelled at all has no obligation under the scheme. Check empanelment before admission wherever the situation allows it.

Using your card in another state

PM-JAY is portable across India. An eligible beneficiary can receive treatment at any empanelled hospital in the country, not only in the state where the card was issued.

This matters most for the people most likely to be unaware of it. Migrant workers, students living away from home, and families travelling for treatment to a city with better facilities are all covered, and portability is a deliberate feature of the scheme rather than an exception granted case by case.

The practical requirements are the same as at home: the beneficiary must be verified, the hospital must be empanelled, and the procedure must fall within a covered package. What does not change is your entitlement. The cover is attached to the family, not to the state.

Two things are worth knowing before travelling. State-run health schemes that have been integrated with PM-JAY may offer additional benefits within their own state that do not travel with you, so the cover available elsewhere is the PM-JAY package rather than the enhanced state package. And empanelled hospital availability varies considerably between states, so checking the hospital list for your destination is worth doing before you need it rather than during an emergency.

Frequently asked questions

How do I check if I am eligible for Ayushman Bharat PM-JAY? Visit beneficiary.nha.gov.in, enter your Aadhaar-linked mobile number, verify OTP, and search by name or ration card. You can also call 14555 or ask at any empanelled hospital or Common Service Centre.

What is the current Ayushman Bharat cover amount? Rs. 5 lakh per family per year for cashless hospitalisation at any of 36,229 empanelled hospitals as of May 2026, covering 1,949 medical packages including cancer, cardiac, and dialysis.

Is West Bengal covered under PM-JAY in 2026? Yes. West Bengal signed the MoU with the National Health Authority on 8 June 2026 and cashless rollout began on 1 July 2026. This made West Bengal the 36th state or union territory to implement PM-JAY.

Who qualifies under PM Vay Vandana Yojana? Any Indian citizen aged 70 or older, regardless of income, caste, or SECC status. Enrol online at beneficiary.nha.gov.in or via the Ayushman App with Aadhaar e-KYC.

Can I use PM-JAY at a private hospital? Yes, but only at hospitals empanelled with PM-JAY. Non-empanelled private hospitals cannot bill the scheme, and treatment there is not reimbursable.

Do I need to renew my Ayushman card every year? No. The card is valid as long as you are on the beneficiary list. Vay Vandana cards for seniors 70+ have no renewal requirement either.

What if a hospital refuses to admit me even though I have an Ayushman card? Call 14555 immediately and report the refusal. Empanelled hospitals cannot decline admission or demand payment for covered procedures. Persistent violations lead to de-empanelment.

Does PM-JAY cover outpatient (OPD) treatment? No. PM-JAY covers hospitalisation only. For OPD, the parallel network of 1,85,940 Ayushman Arogya Mandirs offers free consultations and basic medicines.

Is PM-JAY cover portable across states? Yes. A card issued in one state works at any empanelled hospital in any other state. Portability improved significantly after all 36 states or UTs joined the scheme by mid-2026.

Do I need an ABHA card to use PM-JAY? No. ABHA is a separate digital health record system. It makes pre-authorisation faster because your past records are already accessible, but the Ayushman card alone is enough for treatment.

Official links and helplines