PM-JAY in India (2026 Legal Guide) — Rules & Requirements
About this article
Sourced from Indian central (Union) law — Constitution of India, central Acts of Parliament, and Supreme Court decisions. State-level information reflects each state's own Acts and High Court rulings. Written in plain language for general understanding — this is educational content, not legal advice. Our editorial standards
What is this right?
PM-JAY is the largest publicly funded health-insurance scheme in the world by population covered. Up to ₹5 lakh per family per year, family-floater basis, for secondary and tertiary hospitalisation, cashless at over 28,000 empanelled hospitals, portable across India.
- Eligibility: Approximately 12 crore families (about 55 crore individuals) identified based on the Socio-Economic Caste Census (SECC), 2011 — primarily BPL families, rural families in specified occupational categories, and urban families in specified categories.
- Coverage: Up to ₹5 lakh per family per year (family-floater basis) for hospitalisation — covers surgery, medicines, diagnostics, ICU charges, and follow-up for 15 days.
- Over 27 specialties: Covers cardiology, oncology, neurosurgery, orthopaedics, nephrology (including dialysis), and more — over 1,900 defined medical procedures and packages.
- Cashless treatment: Treatment is cashless at empanelled public and private hospitals (over 28,000 empanelled hospitals across India). The patient pays nothing at the point of care.
- Portability: A beneficiary can use PM-JAY at any empanelled hospital anywhere in India — the scheme is portable across states.
- How to check eligibility: Visit pmjay.gov.in, enter your name and mobile number or Ration Card number to check if you are a beneficiary.
When does it apply?
- You are from a family identified under the SECC database and require hospitalisation for surgery or serious illness.
- You want to check whether you are eligible for PM-JAY coverage.
- A hospital is refusing to admit you on PM-JAY or demanding cash payment for a covered procedure.
What to Do If an Empanelled Hospital in India Refuses to Accept Your PM-JAY Coverage
- Check eligibility at pmjay.gov.in or the PM-JAY helpline: 14555.
- At the hospital, show your Ayushman Card (printable from the PM-JAY portal after e-KYC) at the hospital's PM-JAY desk — the hospital must register and treat you cashlessly.
- If an empanelled hospital refuses PM-JAY or demands extra payment beyond the package rate, call the PM-JAY helpline 14555 — fraudulent hospitals can be de-empanelled.
- Generate your Ayushman Card in advance (before hospitalisation) at any Common Service Centre (CSC) using your Aadhaar and mobile number.
What should you NOT do?
- Do not pay cash to empanelled hospitals for procedures covered under PM-JAY — the treatment is meant to be cashless. Report any demand for out-of-pocket payment for covered procedures.
- Do not allow hospitals to falsify your PM-JAY claim (billing for procedures not performed) — PM-JAY fraud affects the entire scheme; report suspected fraud to 14555.
- Do not miss the 15-day post-discharge follow-up coverage — medicines and consultations related to the same episode of illness within 15 days of discharge are covered.
About Healthcare Rights in India
Under Article 21 of the Constitution and Paschim Banga Khet Mazdoor Samity (1996), no hospital — public or private — can refuse to stabilise an emergency patient because you can't pay. Ayushman Bharat (AB-PMJAY) covers up to ₹5 lakh per family per year, and ESIC covers organised-sector workers. Patient rights — informed consent, records access, confidentiality — sit in the NMC Professional Conduct Regulations, 2023. Mental health runs under the Mental Healthcare Act, 2017; disability under the Rights of Persons with Disabilities Act, 2016. Negligence claims go to consumer commissions under the Consumer Protection Act, 2019.
Common Questions
What is the ayushman bharat pm-jay health insurance right in India?
PM-JAY is the largest publicly funded health-insurance scheme in the world by population covered. Up to ₹5 lakh per family per year, family-floater basis, for secondary and tertiary hospitalisation, cashless at over 28,000 empanelled hospitals, portable across India.Eligibility: Approximately 12 crore families (about 55 crore individuals) identified based on the Socio-Economic Caste Census (SECC), 2011 — primarily BPL families, rural families in specified occupational categories, and urban families in specified categories.Coverage: Up to ₹5 lakh per family per year (family-floater basis) for...
When does ayushman bharat pm-jay health insurance apply?
You are from a family identified under the SECC database and require hospitalisation for surgery or serious illness.You want to check whether you are eligible for PM-JAY coverage.A hospital is refusing to admit you on PM-JAY or demanding cash payment for a covered procedure.
What should I do if a hospital is refusing to treat me under Ayushman Bharat PM-JAY or demanding cash payment in India?
Check eligibility at pmjay.gov.in or the PM-JAY helpline: 14555.At the hospital, show your Ayushman Card (printable from the PM-JAY portal after e-KYC) at the hospital's PM-JAY desk — the hospital must register and treat you cashlessly.If an empanelled hospital refuses PM-JAY or demands extra payment beyond the package rate, call the PM-JAY helpline 14555 — fraudulent hospitals can be de-empanelled.Generate your Ayushman Card in advance (before hospitalisation) at any Common Service Centre (CSC) using your Aadhaar and mobile number.
What mistakes should I avoid with ayushman bharat pm-jay health insurance?
Do not pay cash to empanelled hospitals for procedures covered under PM-JAY — the treatment is meant to be cashless. Report any demand for out-of-pocket payment for covered procedures.Do not allow hospitals to falsify your PM-JAY claim (billing for procedures not performed) — PM-JAY fraud affects the entire scheme; report suspected fraud to 14555.Do not miss the 15-day post-discharge follow-up coverage — medicines and consultations related to the same episode of illness within 15 days of discharge are covered.
Ayushman Bharat PM-JAY Health Insurance in other states
Same topic, different jurisdiction. Pick the one that applies to you.
- MaharashtraAyushman Bharat PM-JAY Health Insurance
- Uttar PradeshAyushman Bharat PM-JAY Health Insurance
- Tamil NaduAyushman Bharat PM-JAY Health Insurance
- KarnatakaAyushman Bharat PM-JAY Health Insurance
- West BengalAyushman Bharat PM-JAY Health Insurance
- DelhiAyushman Bharat PM-JAY Health Insurance
- KeralaAyushman Bharat PM-JAY Health Insurance
- GujaratAyushman Bharat PM-JAY Health Insurance