Ayushman Bharat PM-JAY Health Insurance in Gujarat

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.

Gujarat Law

How Gujarat differs from central law

Gujarat was one of the early states to integrate its existing state health insurance (Mukhyamantri Amrutam/MA) with the central Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). The integrated scheme provides annual health coverage up to Rs. 5 lakh per family for secondary and tertiary hospitalizations at empaneled hospitals across the state and country.

Eligibility in Gujarat is determined based on the Socio-Economic Caste Census (SECC) 2011 data for the PMJAY component and state-defined criteria for the MA component. Beneficiaries receive a single MA+PMJAY card. Gujarat has empaneled over 1,500 hospitals (both government and private) for cashless treatment. The scheme covers over 1,500 procedures including surgeries, medical treatments, and day-care procedures.

Gujarat also runs the MA Vatsalya scheme for middle-income families not covered under MA+PMJAY, offering similar hospital benefits at a subsidized annual premium. This ensures broader coverage beyond the below-poverty-line population.

Additional Steps in Gujarat

To check your eligibility, visit the MA card counter at a government hospital or use the AB-PMJAY beneficiary identification system at pmjay.gov.in. To get your MA+PMJAY card, visit a Common Service Centre (CSC) or a designated government counter with your Aadhaar card and ration card. Helpline: 14555 (AB-PMJAY national helpline).

Relevant Law: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY); Mukhyamantri Amrutam (MA) Yojana; MA Vatsalya Yojana

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.