Ayushman Bharat Yojana: Free Hospital Cover of 5 Lakh Rupees a Year

What the ayushman bharat scheme pays for

It pays for care at the secondary and tertiary level, meaning treatment that needs a hospital stay or a day care procedure such as dialysis or chemotherapy. It includes:

• Room, food, surgery, medicines and tests during the stay.
• Up to 3 days of costs before admission and 15 days after discharge, such as tests and medicines.
• Conditions you already had before joining, from the first day.

The 5 lakh rupees is a family floater. One member can use all of it, or several members can share it within the year. Treatment is offered through fixed health benefit packages, and a PIB note listed about 1,949 procedures. Ordinary doctor visits and medicines bought for home use without admission are outside this scheme.

Ayushman bharat yojana eligibility in plain words

Your family is likely covered if it falls into one of these groups:

• Rural families that met the deprivation tests of the census data, such as a kuchha one room house, no adult member aged 16 to 59, a woman headed home with no adult male, a member with a disability and no able bodied adult, SC or ST households, or landless households earning mainly through manual work.
• Urban families in listed work categories such as rag pickers, domestic workers, street vendors, construction workers, sanitation workers and similar jobs.
• Families that held an active RSBY card, since the older Rashtriya Swasthya Bima Yojana was merged into this scheme.
• ASHA workers, anganwadi workers and anganwadi helpers and their families, added by the Union Cabinet.
• Every citizen aged 70 or more, whatever the income.

States can add more families at their own cost, so the local list may be wider than the central one.

The rule for people aged 70 and above

Since the Cabinet decision on senior citizens, anyone aged 70 or more by the date of birth on Aadhaar can enrol. They get a separate card, often called the Ayushman Vay Vandana card. If the family is already covered, the older members get an extra top up of up to 5 lakh rupees a year for themselves, which they do not share with younger members. Other seniors get cover of up to 5 lakh rupees a year on a family basis.

A senior already using a central health scheme such as CGHS or ECHS must choose either that scheme or this one. A private health policy or ESI cover does not stop them from joining.

How to get the Ayushman card

If you prefer help, go to a CSC centre or the Ayushman desk (Ayushman Mitra) at an empanelled hospital with your Aadhaar and ration card. There is no fee to be listed in the scheme itself.

Using the card at a hospital

Ask for the PM-JAY or Ayushman desk at an empanelled hospital. The staff check your card and Aadhaar, raise a pre authorisation request, and the state health agency then settles the bill with the hospital. A covered package must cost you nothing. Keep the discharge summary. The list of empanelled hospitals can be searched on the official PMJAY site.

Problems and what to do

State health schemes that run with it

Many states join PM-JAY with their own scheme under one card. Maharashtra uses the Mahatma Jyotiba Phule Jan Arogya Yojana, often called the Mahatma Phule Jan Arogya Yojana. Rajasthan runs the Mukhyamantri Ayushman Arogya Yojana, and Odisha has announced the Gopabandhu Jan Arogya Yojana. The benefit amount and family list in these schemes are set by the state, so check the state health agency for details. Some states run fully separate schemes; see our guides to BSKY in Odisha, Chiranjeevi Yojana and Mukh Mantri Sehat Yojana.