Ayushman Bharat PM-JAY Health Insurance in Uttar Pradesh
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 Uttar Pradesh differs from central law
Uttar Pradesh is the largest beneficiary of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in terms of total beneficiaries, with crores of families enrolled across the state. Eligibility is based on the Socio-Economic Caste Census (SECC) 2011 data. Families meeting specified deprivation criteria are automatically eligible for coverage of up to Rs. 5 lakh per family per year for secondary and tertiary hospitalization.
The UP government has supplemented PM-JAY with the Mukhyamantri Jan Arogya Yojana, which extends coverage to additional families holding ration cards who may not be covered under the SECC criteria. The combined scheme covers a wide range of medical and surgical procedures at empanelled government and private hospitals across the state.
Cashless treatment is available at empanelled hospitals. Patients do not need to pay anything upfront for covered procedures. UP has empanelled thousands of hospitals across its 75 districts. The State Health Agency (SHA), UP manages the scheme's implementation and handles grievances related to denial of treatment or empanelled hospital misconduct.
Additional Steps in Uttar Pradesh
Check your eligibility at mera.pmjay.gov.in using your Aadhaar or ration card number. Get your Ayushman card at any empanelled hospital, CSC, or the district hospital. AB-PMJAY helpline: 14555. For the list of empanelled hospitals, visit the PM-JAY website or contact the Chief Medical Officer (CMO) of your district. For grievances, call 14555 or contact the State Health Agency, UP in Lucknow.
Relevant Law: Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana guidelines; UP Mukhyamantri Jan Arogya Yojana Government Order
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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