This Govt Scheme gives 5 Lakh rupees free health insurance to families, check how to apply, eligibility criteria

The scheme will benefit approximately 4.5 Crore families with six (6) crore senior citizens with 5 Lakh rupees free health insurance cover on a family basis.

The Union Cabinet on Wednesday approved the health coverage to all the senior citizens aged 70 years and above irrespective of income under the flagship scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).

The decision is taken to benefit approximately 4.5 Crore families with six (6) crore senior citizens with 5 Lakh rupees free health insurance cover on a family basis.

Pradhan Mantri Jan Arogya Yojana (PM-JAY) provides health insurance coverage of up to ₹ 5 lakh per family annually for secondary and tertiary care hospitalisation.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana: Eligibility Criteria

SC/ST
Lower Income Group
Economically Weaker Sections (EWS)

Rural Eligibility: (AB PM-JAY)

• Scheduled caste and scheduled tribe households
• Beggars and those dependent on alms
• Families without members aged 16 to 59 years
• Households with at least one physically challenged member and no able-bodied adult
• Landless households reliant on casual manual labor
• Primitive tribal communities
• Legally released bonded laborers
• Families residing in one-room makeshift houses lacking proper walls or roof
• Manual scavenger families

Urban Eligibility: (AB PM-JAY)

• Families of urban workers in occupational categories listed in the Socio-Economic Caste Census 2011
• Families registered under the Rashtriya Swasthya Bima Yojana (RSBY)

How to Check Eligibility Online:

1. Visit the official website
2. Go to the “Am I Eligible” section
3. Enter your mobile number and captcha code, then click “Generate OTP”
4. Input the OTP and click “Verify OTP”
5. Provide the necessary information and click “Submit”

How to Apply for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana:

1. Visit the official website
2. Verify your Aadhaar card or ration card at a PMJAY kiosk
3. Provide family identification proofs
4. Print your e-card with a unique AB-PMJAY ID

Benefits of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana:

• Beneficiaries receive annual health coverage of ₹5 lakh, including expenses like hospitalisation, treatment, diagnostics, medicines, surgery, and post-treatment care
• Cashless services are provided at public and private hospitals, minimising out-of-pocket expenses
• No restrictions on family size, age, or gender
• Coverage includes 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses, such as diagnostics and medicines
• Services are accessible across India at any empanelled hospital
• Pre-existing conditions are covered from the first day of enrollment
• The scheme helps alleviate the financial strain caused by serious illnesses and hospitalisation, preventing families from falling into poverty
• It covers nearly 1,929 procedures, including physician fees, room charges, diagnostics, ICU care, and medical implants

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana Coverage Details:
The scheme covers the following expenses:

• Medical examinations, treatment, and consultations
• Pre-hospitalisation care up to three days before admission
• Medicines and medical consumables
• Intensive and non-intensive care services
• Diagnostic and laboratory tests
• Medical implants, if needed
• Accommodation and meals during hospitalisation
• Complications arising during treatment
• Post-hospitalisation care, up to 15 days after discharge