Pradhan Mantri Jan Arogya Yojana (PM-JAY): How to Apply, Benefits, Documents & More

30^th Nov 2025...

Published By : Team 811

Latest News (2025)

AB-PMJAY scheme continues to provide health coverage to over 10.74 crore families (~50 crore beneficiaries) across India.
Services are completely cashless and paperless now for immediate access to treatment.
PM-JAY operates under a three-tier grievance redressal mechanism to be efficient in timely resolution of complaints.

Key Takeaways

Cashless hospitalisation cover of ₹5,00,000 per family per year for secondary and tertiary care.
Pre- and post-hospitalisation expenses, medicines, diagnostics, implants, accommodation, and food.
No enrollment or premium payment required; families are automatically eligible in light of the SECC data.
Ayushman Bharat PMJAY benefits include newborn care, coverage for pre-existing illnesses, and treatment across all empanelled hospitals.
Beneficiaries receive a dedicated family identification number and an e-card.
Grievance redressal is ensured through district, state, and national committees.

One of the Ayushman Bharat initiatives of the Government of India is popularly known as Pradhan Mantri Jan Arogya Yojana (PM-JAY). Its launch date is 23rd September 2018 in Ranchi, Jharkhand.

It is designed to provide universal health coverage (UHC) to India’s most vulnerable populations. It aims to “leave no one behind.” PM-JAY addresses the financial burden of secondary and tertiary healthcare. This becomes effortless through cashless hospitalisation benefits to poor and vulnerable families.

The scheme is part of a comprehensive health reform. At different levels, it covers:

Prevention
Promotion
Treatment

Health and Wellness Centres under Ayushman Bharat work in line with this scheme.

What is Pradhan Mantri Jan Arogya Yojana (PM-JAY)?

The health cover scheme, PM-JAY, gives each family an amount (up to ₹5,00,000) every year for hospital treatment. Families use this amount for secondary and advanced (tertiary) care.

Key aspects:

Coverage of over 10.74 crore families (around 50 crore beneficiaries)
The type of coverage is family floater, i.e., one or all family members can use the amount.
No cap on family size or age.
Pre-existing medical conditions are covered from day one.
The Central Government funds it completely, and the State Governments share the implementation costs.
The identification of the beneficiaries according to the SECC 2011 data with the help of deprivation and occupational criteria.

Who It Benefits

The PMJAY beneficiary list helps you to have a clearer picture of the people who can gain.

Rural Beneficiaries

Households qualifying under any of the six deprivation criteria or automatic inclusion categories:

One room with kutcha walls and roof
No adult member between the ages of 16-59
Female-headed households with no adult male aged 16-59
Households with a disabled member and no able-bodied adult
SC/ST households
Landless households deriving most income from manual casual labour

Automatic inclusion also applies to:

Destitute/living on alms
Manual scavenger households
Primitive tribal groups
Legally released bonded labourers

Urban Beneficiaries

Eligibility is based on occupational categories, including:

Ragpickers, beggars, domestic workers
Street vendors, cobblers, hawkers, service providers
Construction workers, plumbers, masons, labourers, painters, welders, security guards, coolies
Sweepers, sanitation workers, gardeners
Home-based workers, artisans, handicraft workers, tailors
Transport workers (drivers, conductors, helpers, cart/rickshaw pullers)
Shop workers, assistants, peons, delivery staff, attendants, waiters
Electricians, mechanics, assemblers, repair workers
Washermen, chowkidars

Key Features & Benefits of PM-JAY

Financial Coverage: ₹5,00,000 per family per year for hospitalisation.
Cashless & Paperless: All services are direct, with no out-of-pocket expenses.
Pre-Existing Conditions: Covered from day one.
Hospitalisation Services Covered:
- Medical examination, treatment, consultation
- Pre-hospitalization care
- Medicines and consumables
- ICU and general care
- Diagnostics and lab tests
- Medical implants
- Accommodation and food
- Complications during treatment
- Post-hospitalisation follow-up for 15 days
Family Floater Scheme: Full coverage available to all family members.
Newborn Care: Included; new members can be added to the family.
Public & Private Empanelled Hospitals: Nationwide network of service providers.
Free Services: No payment required for eligible beneficiaries.
Arogya Mitras: Dedicated personnel assist with identification, claim submission, and hospital coordination.
Grievance Redressal: District, state, and national committees ensure complaints are resolved.

Zero-Balance Savings Account

The Ayushman Bharat PMJAY benefits are cashless. So, one can link a Kotak811 Zero-Balance Savings Account to it. That can help beneficiaries manage reimbursements for ancillary expenses or availed loans for treatment.

Advantages:

Secure, direct, and transparent fund transfers
Mobile banking convenience
Easy tracking of claims and reimbursements

Eligibility Criteria for PM-JAY

Rural or urban households identification according to the SECC 2011 data.
Belong to deprivation or occupational categories.
RSBY cardholders as of 28th February 2018 are automatically included.
No age, gender, or family size restrictions.

Exclusions

Ownership of motorised vehicles (2/3/4-wheeler) or mechanised boats
Mechanised agricultural equipment
Kisan Credit Cards with a limit of ≥ ₹50,000
Government employment
Employment in government-managed non-agricultural enterprises
Monthly income > ₹10,000
Ownership of refrigerators, landlines, or solid pucca houses
Agricultural land ownership ≥5 acres

Documents Required

Age & Identity Proof: Aadhaar Card / PAN Card
Proof of Address
Contact Details: Mobile number, e-mail
Caste Certificate
Income Certificate
Family Status Proof: Joint/Nuclear family documents
Aadhaar number is optional but recommended

Application Process

The offline process of PM Jan Arogya Yojana apply via Arogya Mitra is as follows:

Beneficiary Search: Operator (Arogya Mitra) searches using name, location, ration card, mobile number, or RSBY URN.
Search in BIS Application: Verified against SECC, RSBY, State Health Scheme, or Additional Data Collection databases.
Individual Identification: Upload Aadhaar or government ID and ration card for validation.
Family Identification: Family records linked and submitted.
Approval or Rejection: Health insurance company/trust verifies; final approval by State Health Agency (SHA).
E-card Issuance: Upon approval, the PM-JAY e-card is issued to the family.

Check Status

Beneficiaries can track the status of approval through SHA portals, hospital kiosks, or by contacting their Arogya Mitra.
Claim submissions must be approved within 15 days by the SHA after document verification.

Benefit Disbursal

All services under PM-JAY are cashless, with claims settled directly with hospitals.
Coverage includes hospitalisation, medicines, diagnostics, post-hospitalisation care, and treatment of pre-existing conditions.
Beneficiaries pay nothing out-of-pocket for empanelled services.

Conclusion

PMJAY registration becomes easy if you follow the above method of application. The health coverage scheme ensures that India’s poor and vulnerable populations have access to quality healthcare. They can get secondary and tertiary level treatment with no financial burden. The scheme strengthens the Universal Health Coverage and helps deal well with healthcare disparities, through:

Cashless hospitalisation
Total medical coverage
e-card identification

With dedicated Arogya Mitras and empanelled hospitals nationwide, PM-JAY ensures smooth access, grievance redressal, and timely claim settlements, empowering beneficiaries to focus on their health rather than finances.

FAQs

1. Who is eligible?

Families identified through SECC 2011 based on deprivation (rural) or occupational criteria (urban), including RSBY cardholders as of 28 Feb 2018.

2. Is there any premium or fee?

No. All eligible beneficiaries get cashless treatment at empanelled hospitals.

3. Are pre-existing conditions covered?

Yes. All existing medical conditions are covered from the day of enrollment.

4. Do beneficiaries get a card?

Yes. Families receive a dedicated family identification number and an e-card.

5. Where can services be availed?

At all public hospitals and empanelled private hospitals across India.

6. Can newborns avail benefits?

Yes. Newborns can be added to the family and receive treatment under PM-JAY.

7. Who is an Arogya Mitra?

You will find a certified health professional at hospitals and kiosks. They assist with beneficiary identification and documentation. They also help in claim processing.

8. How long does claim approval take?

15 days maximum from submission to SHA for verification and payment processing.

9. Is Aadhaar mandatory?

No. Aadhaar is optional, though recommended for verification.