Ayushman Bharat PM-JAY Health Insurance in Maharashtra
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 Maharashtra differs from central law
In Maharashtra, Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has been merged with the state's existing Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) to create a combined scheme. This means eligible families in Maharashtra get the benefit of both schemes, with coverage up to Rs. 5 lakh per family per year under AB-PMJAY plus additional coverage under MJPJAY.
Eligibility in Maharashtra is based on the Socio-Economic Caste Census (SECC) 2011 data (for AB-PMJAY) and ration card categories (for MJPJAY). Families holding yellow (Antyodaya) and orange (priority) ration cards are automatically covered. The combined scheme covers hospitalization at over 1,500 empanelled hospitals across Maharashtra, including both government and private facilities.
Maharashtra has been one of the better-performing states in implementing the scheme, with high utilization rates particularly in Mumbai, Pune, and Nagpur. Cashless treatment is available at empanelled hospitals, and you do not need to pay anything upfront for covered procedures.
Additional Steps in Maharashtra
Check your eligibility at mera.pmjay.gov.in using your Aadhaar or ration card number. Get your e-card at any empanelled hospital or Common Service Centre. MJPJAY helpline: 155388. AB-PMJAY helpline: 14555. For the list of empanelled hospitals, visit jeevandayee.gov.in.
Relevant Law: Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana guidelines; Mahatma Jyotirao Phule Jan Arogya Yojana, Government Resolution dated 2 July 2012
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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