Hospital expenses can become difficult to manage when a family member needs surgery or specialised inpatient care. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is designed to provide eligible families with cashless hospital treatment through an approved network.
The scheme can be valuable, but an Ayushman card is not the same as an unlimited medical insurance policy. Eligibility, hospital empanelment, treatment packages and pre-authorisation rules all matter. This practical guide explains how to check your name, create or download a card, find an empanelled hospital and avoid common scams.
What Is Ayushman Bharat PM-JAY?
AB PM-JAY is a Government of India health-assurance scheme implemented by the National Health Authority in coordination with states and Union Territories. It provides eligible beneficiaries with cashless access to specified secondary and tertiary hospitalisation packages at empanelled public and private hospitals.
The standard cover is up to ₹5 lakh per eligible family per year for listed hospitalisation packages. There is generally no restriction on family size, age or gender within an eligible beneficiary family. Coverage is portable, so a beneficiary may use an empanelled hospital outside the home state, subject to the scheme's rules and package availability.
Official information and beneficiary services are available through the PM-JAY website and the National Health Authority's beneficiary platform. Never depend only on an advertisement or agent to decide eligibility.
Ayushman Card vs ABHA Card: They Are Different
| Card | Main purpose | Does it itself pay hospital bills? |
|---|---|---|
| Ayushman card | Identifies an eligible PM-JAY beneficiary for scheme benefits | It enables access to covered packages after verification and approval |
| ABHA card | Creates a digital health account number for linking and sharing health records with consent | No |
Having an ABHA number does not automatically make a person eligible for PM-JAY. Similarly, creating an Ayushman card does not mean every medical expense will be covered.
Who May Be Eligible?
PM-JAY eligibility is based on the beneficiary databases and rules adopted under the programme. The safest method is to search the official beneficiary portal or ask an Ayushman Mitra at an empanelled hospital. Do not assume eligibility merely because a person has a ration card, Aadhaar card, low income or an ABHA number.
Senior citizens aged 70 years and above
The programme has been extended to citizens aged 70 years and above regardless of economic status. Seniors who are already part of a PM-JAY-covered family may receive an additional cover intended for members aged 70 and above, while other eligible senior-citizen households receive coverage under the applicable family-based rules.
Existing public health schemes, state arrangements and private insurance can affect how benefits are used. A senior citizen should check the live portal or official helpdesk before cancelling any existing cover.
State-specific coverage can differ
Some states run PM-JAY together with their own health scheme or include additional beneficiary groups. The programme name, card process, packages and helpdesk route may therefore differ by state. The result shown in the official system is more reliable than a generic online eligibility list.
How to Check Ayushman Card Eligibility
- Open the official beneficiary portal at beneficiary.nha.gov.in or use the official Ayushman App published by the National Health Authority.
- Select the beneficiary login option and complete mobile-number authentication.
- Select your state and the available search method.
- Search using accurate details such as name, family ID, ration-card information or another identifier offered by the portal.
- Compare the displayed family details carefully before proceeding.
- If no record appears, contact the official helpline or visit an authorised facility. Do not pay an agent to “add” a name privately.
A search result is not a promise that every future treatment will be approved. The hospital must still verify identity, diagnosis, package eligibility and required authorisation.
How to Create or Download an Ayushman Card
The exact screen can change, but the general process is as follows:
- Sign in to the official beneficiary portal or Ayushman App.
- Locate the eligible beneficiary record.
- Complete the identity-verification method displayed by the official system.
- Check the spelling, age, gender and family details before submission.
- Submit the e-KYC or verification request.
- After approval, download the digital card or obtain assistance from an authorised centre or empanelled hospital.
Use your own mobile number wherever possible. Never reveal an OTP, banking PIN or password to a caller. If biometric or Aadhaar-based verification is required, complete it only on the official platform or through an authorised operator.
What Does PM-JAY Normally Cover?
Coverage applies to specified hospitalisation packages rather than every health-related purchase. Depending on the approved package, benefits may include consultation during admission, diagnostic tests, medicines, implants, room charges, food, surgery, intensive care and limited pre- and post-hospitalisation expenses.
Common package groups may cover areas such as cardiology, orthopaedics, oncology, general surgery, neurosurgery and other specialised care. Actual availability depends on the patient's diagnosis, package rules and the services for which the hospital is empanelled.
What May Not Be Covered?
- Routine outpatient consultations not included in a package
- Medicines bought independently without a covered admission
- Treatment at a hospital that is not empanelled
- A procedure outside the approved package list
- Non-medical personal expenses
- Treatment obtained without the required verification or authorisation
- Services excluded under current national or state rules
Ask the hospital's Ayushman desk to identify the exact package before admission whenever the situation is not an emergency.
How to Find an Empanelled Hospital
- Use the hospital-search facility linked from the official PM-JAY website.
- Select state, district and medical specialty.
- Confirm that the hospital is empanelled for the required specialty, not merely listed for an unrelated service.
- Call the hospital using a number independently obtained from its official page.
- Ask whether the relevant package and specialist are currently available.
- At the hospital, go to the Ayushman Mitra or scheme helpdesk before paying a large deposit.
An empanelled hospital cannot necessarily provide every PM-JAY package. Capacity, specialty and authorisation status must be checked for the particular treatment.
Documents to Keep Ready
- Ayushman card, if already issued
- Government-issued identity document requested by the system
- Ration card or family identifier when applicable
- Mobile number linked to the beneficiary process
- Doctor's prescription, test reports and referral documents
- Previous medical records relevant to the admission
The hospital may request additional documents for identity matching or clinical approval. Do not send complete identity documents to unknown WhatsApp numbers.
Before Admission: A Simple Checklist
| Check | What to confirm |
|---|---|
| Beneficiary status | Name appears correctly in the official system |
| Hospital | Empanelled for the required specialty |
| Package | Diagnosis and procedure match an available package |
| Authorisation | Pre-authorisation has been requested or approved when required |
| Charges | Which items are covered and whether any written non-covered estimate exists |
| Records | Keep admission papers, discharge summary and complaint reference |
What to Do If a Hospital Demands Money
First ask for a written explanation. A charge may relate to an item outside the approved package, but a verbal demand should not be accepted without clarification.
- Speak to the Ayushman Mitra or scheme helpdesk inside the hospital.
- Request the package name, approval status and written breakup of any proposed payment.
- Do not pay to a personal UPI ID or an employee's private account.
- Keep bills, receipts, screenshots and the names of staff involved.
- Use the official PM-JAY grievance channel or helpline 14555 when appropriate.
- For an emergency, prioritise immediate medical care and preserve documents for later review.
A complaint does not automatically guarantee a refund. The authority will examine the package, authorisation and facts of the case.
Ayushman Card Scam Warning Signs
- A promise to make anyone eligible after payment
- A demand for a registration or activation fee through a personal account
- A caller asking for an OTP, PIN or remote access to your phone
- A fake website using “Ayushman” in its name but not an official government domain
- A guaranteed claim approval before the diagnosis is reviewed
- A demand to share Aadhaar, card and bank details over an unknown messaging account
- A person selling a “premium” version of the Ayushman card
The official app is published by the National Health Authority. Check the developer name and avoid downloading APK files from forwarded links.
Frequently Asked Questions
Is the Ayushman card available to every Indian?
No. General PM-JAY eligibility depends on the programme's beneficiary rules and official database. Citizens aged 70 years and above have a separate universal age-based extension, subject to current verification procedures.
Does the card provide ₹5 lakh in cash?
No. It provides cashless access to approved hospital packages up to the applicable cover. Money is not paid directly to the beneficiary as a general cash benefit.
Can I use the card in another state?
PM-JAY is designed to be portable across India at empanelled hospitals, although state participation and operational arrangements should be checked.
Can a hospital refuse the card?
A hospital may not offer the required specialty or package, and approval can depend on clinical and scheme rules. Ask for a clear reason and contact the official helpdesk if an eligible covered service appears to be wrongly denied.
Is ABHA compulsory for PM-JAY eligibility?
An ABHA number and PM-JAY eligibility serve different purposes. Follow only the identity and verification requirements displayed by the official beneficiary system.
Conclusion
The Ayushman card can reduce the financial burden of eligible hospital treatment, but it works through defined packages, empanelled hospitals and verification rules. Check your beneficiary record through the official portal, confirm the hospital's specialty and obtain package clarity before admission whenever possible.
Keep documents and receipts, reject anyone asking for an OTP or private payment, and use official grievance channels when a covered service is disputed.
Important: This article provides general public information, not medical, legal or insurance advice. Eligibility, package lists, hospital participation and verification procedures can change. Confirm current details through the National Health Authority or your State Health Agency before relying on them.
Official Sources
- Ayushman Bharat PM-JAY official website
- National Health Authority beneficiary portal
- Official Ayushman App listing
