Health InsuranceGovt / PSU BackedAll IndiaEst. 2018

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

India's national flagship health assurance program providing ₹5 Lakh annual cashless treatment for secondary and tertiary care.

Sum Insured / Cover

₹5 Lakh per family per year

Annual Premium

100% Free (Central & State funded)

Claim Settlement

98.5% (Direct Cashless Settlement)

Network / Scope

29,850 Empaneled

✦ Key Benefits & Policy Coverage

Cashless hospitalization up to ₹5,00,000 per family per year across 29,000+ empaneled public and private hospitals nationwide. Covers 1,949 medical and surgical procedures, including ICU, pre-hospitalization (3 days), post-hospitalization (15 days), medicines, and diagnostics. No capping on family size, gender, or age.

What is Missing: Critical Policy Exclusions & Limitations

Eligo disclosure: Private insurance agents and official ads rarely mention these limitations. Verify before relying on this coverage.

Outpatient (OPD) clinic consultations and daily routine medications are NOT covered. General ward only; private ward admissions are excluded. Routine dental and cosmetic procedures are strictly excluded. Strict biometric pre-authorization required before planned surgeries.

✦ Eligibility Requirements

Families classified as deprived or occupational categories in the Socio-Economic and Caste Census (SECC 2011) database, active NFSA Antyodaya Anna Yojana (AAY) and Priority Household (PHH) ration card holders, and all senior citizens aged 70+ irrespective of family income.

✦ Application, Enrollment & Claims Process

1. Check family eligibility on beneficiary.nha.gov.in or via the Ayushman App. 2. Complete Aadhaar e-KYC online or visit nearest CSC/Arogya Mitra at empaneled hospital. 3. Download the Ayushman PVC Card or digital Ayushman Card. 4. Present card at hospital Ayushman Helpdesk during admission for cashless treatment.

Official Government / PSU Portal

Apply or verify on the official administrative domain

Official Portal