Ayushman Bharat PM-JAY Health Insurance in Delhi

Source: Pradhan Mantri Jan Arogya Yojana (PM-JAY), 2018 — Central Government Scheme; Ayushman Bharat — Health and Wellness Centres (AB-HWC)

Reviewed by the Commoner Law Editorial Team. 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

Indian Central Law

What is this right?

PM-JAY is the world's largest publicly funded health insurance scheme, providing coverage of up to ₹5 lakh per family per year for secondary and tertiary hospitalisation.

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.

Delhi Law

How Delhi differs from central law

Delhi has a unique relationship with Ayushman Bharat PM-JAY, having initially opted out before eventually implementing the scheme.

The Delhi Government initially declined to implement PM-JAY, arguing that its own free healthcare system (Mohalla Clinics + government hospitals) already provided universal coverage to Delhi residents.
PM-JAY was later implemented in Delhi, providing health insurance cover of Rs 5 lakh per family per year for eligible beneficiaries listed in the Socio Economic Caste Census (SECC) database.
In Delhi, both government and empanelled private hospitals accept PM-JAY cards. The scheme covers hospitalisation, surgery, diagnostics, and post-hospitalisation expenses for over 1,500 medical packages.
Delhi residents who are not eligible for PM-JAY can still access free treatment at all Delhi Government hospitals and at Central Government hospitals (AIIMS, Safdarjung, RML) which treat patients from across India.
The Delhi Arogya Kosh functions as a supplementary scheme for Delhi residents who need financial assistance for treatment costs not fully covered by PM-JAY or who are not PM-JAY eligible.

Additional Steps in Delhi

Check PM-JAY eligibility at pmjay.gov.in or any Common Service Centre in Delhi. Create your Ayushman Bharat Health Account (ABHA) card with Aadhaar and ration card. For treatments not covered by PM-JAY, apply to the Delhi Arogya Kosh through the treating government hospital's Medical Superintendent. For denial of treatment at empanelled hospitals, call the PM-JAY helpline at 14555.

Relevant Law: Ayushman Bharat (PM-JAY) implementation notification for Delhi; Delhi Arogya Kosh scheme, GNCTD; National Health Authority guidelines

Common Questions

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.