Ayushman Bharat PM-JAY Health Insurance in Tamil Nadu

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.

Tamil Nadu Law

How Tamil Nadu differs from central law

Tamil Nadu has its own Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS) which predates and operates in parallel with — and is now converged with — the central Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

Tamil Nadu was one of the last states to join AB-PMJAY. In 2022, the state converged CMCHIS with AB-PMJAY, meaning eligible families now get coverage under both schemes with a combined benefit.
Coverage: Families identified under the Socio-Economic Caste Census (SECC) 2011 and additional categories identified by the state government receive up to Rs 5 lakh per family per year for hospitalisation at empanelled hospitals.
CMCHIS covers over 1,000 medical and surgical procedures, including heart surgery, cancer treatment, organ transplants, burns treatment, and joint replacement. It goes beyond the standard AB-PMJAY package by including additional state-specific procedures.
The scheme is cashless — beneficiaries show their smart card or Aadhaar at empanelled hospitals. No money changes hands at the hospital.
Tamil Nadu has empanelled both government and private hospitals. The government network ensures access even in remote districts where private empanelled hospitals may be scarce.

Additional Steps in Tamil Nadu

Check your eligibility on the CMCHIS portal or the AB-PMJAY website (pmjay.gov.in). Obtain your smart card from any government hospital or Common Service Centre (CSC). For treatment, visit any empanelled hospital with your smart card and Aadhaar. Call 14555 (AB-PMJAY helpline) or 104 (Tamil Nadu health helpline) for assistance.

Relevant Law: Ayushman Bharat PM-JAY guidelines (central); CMCHIS Government Orders (Tamil Nadu); Tamil Nadu CMCHIS-PMJAY convergence G.O. (2022)

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

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