Ayushman Bharat PM-JAY: ₹5 Lakh Cover, 70+ Card & Eligibility

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) gives eligible families ₹5 lakh of cashless hospitalisation cover every year for secondary and tertiary care — and since October 2024, every Indian citizen aged 70 or above qualifies regardless of income through the Vay Vandana card. With roughly 55 crore beneficiaries and 29,000+ empanelled hospitals, it is the world’s largest publicly funded health assurance scheme. Here is what it covers, who qualifies and how to get the card.

What the ₹5 Lakh Cover Includes

The cover works on a family floater basis: ₹5 lakh per family per year, with no cap on family size, age or gender, and no restriction on how many hospitalisations use the amount. It funds secondary care (specialist consultations and hospital treatment) and tertiary care (advanced procedures such as cardiac surgery, cancer treatment and joint replacement) across about 2,000 packaged procedures.

• Package rates include pre-hospitalisation expenses (up to 3 days) and post-hospitalisation follow-up (up to 15 days), diagnostics, medicines and implants.
• Treatment is cashless and paperless at empanelled public and private hospitals — the hospital claims payment from the scheme, not the patient.
• Cover is portable across India: a beneficiary from any state can walk into any empanelled hospital in the country.

The 70+ Extension: Vay Vandana Card

Announced in October 2024, the extension brings all citizens aged 70 and above into PM-JAY irrespective of income, existing insurance or employment status. A 70+ member receives an additional ₹5 lakh top-up cover even where the household is already a PM-JAY beneficiary, and the entitlement is individual to each senior, not pooled with the family floater. Seniors enrol with Aadhaar-based verification and receive the distinctive Vay Vandana card for cashless treatment at the same empanelled network.

Scale: Hospitals and Beneficiaries

The scheme operates through 29,000+ empanelled hospitals — a mix of government facilities and private hospitals that agree to the package-rate schedule. Around 55 crore beneficiaries, corresponding to the bottom segments identified through the rural and urban SECC criteria and earlier deprivation data, are covered under the general track, with the 70+ extension adding income-agnostic enrolment. Because private hospitals participate, beneficiaries can access tertiary care that would otherwise cost several lakhs upfront.

Eligibility and How to Check It

• Check online: visit pmjay.gov.in or use the Ayushman App and enter your mobile number and Aadhaar details to see whether your family appears in the beneficiary database.
• Check at a CSC: Common Service Centres run the eligibility check and e-KYC with your Aadhaar — the practical route for households without smartphones.
• e-KYC is compulsory: the card is issued only after Aadhaar-based verification, so keep Aadhaar, a mobile number and, where applicable, ration or income documents handy; if identity paperwork needs fixing first, the PAN card service guide explains the corrections.
• 70+ seniors: verify with Aadhaar and date of birth; no income test applies to this category.

If your name does not appear despite qualifying, raise it with the district PM-JAY cell or the Arogya Mitra desk at empanelled hospitals, which handles enrolment disputes and data corrections.

What PM-JAY Does Not Cover

The scheme funds hospitalisation, not everyday medicine. OPD consultations and outpatient medicines are generally not covered, nor are cosmetic procedures, and a small negative list excludes treatments of limited medical value. Drug prices outside hospitalisation, personal comfort items and documentation charges also fall outside the packages. For regular outpatient needs, beneficiaries still rely on state OPD programmes, Jan Aushadhi stores or private insurance riders — and where a private policy is involved, the premium may earn a deduction under Section 80D (Section 126 of the Income-tax Act, 2025) in the old regime, which you can test with the income tax calculator.

ABHA Card vs PM-JAY Card: Don’t Confuse Them

The two cards serve different purposes. The ABHA (Ayushman Bharat Health Account) is a digital health identifier under the Ayushman Bharat Digital Mission — it stores your health records and is open to everyone. The PM-JAY card is an entitlement document proving ₹5 lakh cover for eligible families. An ABHA ID does not by itself create hospitalisation cover; conversely, a PM-JAY beneficiary benefits from linking records to an ABHA for continuity of care.

Key Takeaways

• PM-JAY provides ₹5 lakh per family per year of cashless secondary and tertiary care, with about 2,000 procedures including 3-day pre and 15-day post-hospitalisation costs.
• Everyone aged 70+ now qualifies regardless of income via the Vay Vandana card, with a top-up ₹5 lakh for seniors in existing PM-JAY families.
• Nearly 55 crore beneficiaries use 29,000+ empanelled hospitals, with treatment portable across India.
• Check eligibility on pmjay.gov.in or the Ayushman App, complete Aadhaar e-KYC at a CSC or hospital desk, and remember OPD and cosmetic care are excluded.
• ABHA is a digital health record ID; the PM-JAY card is the actual ₹5 lakh entitlement.

Frequently Asked Questions

Is the Ayushman card free, and does anyone charge for it?

Yes, the card and the cover are free for eligible beneficiaries. Enrolment, e-KYC and card generation carry no fee at CSCs, empanelled hospitals or the district cell, so refuse anyone demanding payment beyond the printed package cost-sharing rules.

Can a 72-year-old with a good income get the Vay Vandana card?

Yes. The October 2024 extension covers all citizens aged 70 and above regardless of income, insurance ownership or employment. The senior gets an individual ₹5 lakh cover, additional to any family floater the household already holds.

Does PM-JAY cover OPD consultations and medicines?

Generally no. The scheme funds hospitalisation packages for secondary and tertiary care, including defined pre and post-hospitalisation windows. Routine outpatient care, outpatient medicines and cosmetic procedures are outside its scope.

How is PM-JAY different from ABHA?

ABHA is a voluntary digital health ID for storing and sharing medical records under the Ayushman Bharat Digital Mission. PM-JAY is the ₹5 lakh hospitalisation entitlement — only eligible beneficiaries get it, and only the PM-JAY card pays hospital bills.

Can I use my PM-JAY card in another state?

Yes, the cover is fully portable across India. Any empanelled hospital, public or private, in any state must provide cashless treatment against a valid PM-JAY card after verifying identity.

Disclaimer: Tax laws change frequently. Verify current rates and deadlines on the official portals (incometax.gov.in, gst.gov.in) or consult a qualified professional before acting.