Ayushman Bharat PM-JAY Health Insurance in Karnataka
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
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.
How Karnataka differs from central law
Karnataka implements Ayushman Bharat through the merged Ayushman Bharat-Arogya Karnataka (AB-ArK) scheme, which provides wider coverage than the central PMJAY alone.
- AB-ArK (merged scheme): Karnataka merged the Suvarna Arogya Suraksha Trust (SAST) scheme and the central PMJAY into AB-ArK. All families holding a valid ration card (both BPL and above BPL) are eligible, covering a significantly larger population than PMJAY's national criteria.
- Coverage: Up to Rs 5 lakh per family per year for secondary and tertiary hospitalisation at empanelled hospitals. The scheme covers approximately 1,950+ medical and surgical procedures.
- Empanelled hospitals: Over 1,000 hospitals across Karnataka are empanelled under AB-ArK, including government and private hospitals. The list is available on arogya.karnataka.gov.in.
- Arogya Mitra: Every empanelled hospital has an Arogya Mitra (health assistant) who helps patients with eligibility verification, documentation, and claim processing.
- Pre-existing conditions: AB-ArK covers pre-existing conditions from day one — there is no waiting period. Cancer treatment, cardiac surgery, joint replacement, dialysis, and other high-cost procedures are included.
Additional Steps in Karnataka
Check your eligibility at arogya.karnataka.gov.in or by visiting the Arogya Mitra at any empanelled hospital with your ration card and Aadhaar card. If an empanelled hospital refuses treatment or demands extra payment for a covered procedure, file a complaint at the AB-ArK helpline (104) or the District Health Officer.
Relevant Law: Ayushman Bharat PMJAY (central scheme); Government of Karnataka Order establishing AB-ArK; Suvarna Arogya Suraksha Trust (SAST) scheme (now merged into AB-ArK)
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.
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