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Objectives of the PMJAY Scheme: Healthcare Coverage for Every Family

The Ayushman Bharat Yojana is built on one promise: no family left behind. As a Government Healthcare Scheme, PMJAY brings cashless Health Insurance to the families who need it most.

Financial protection

Financial protection

Hospital bills push millions of families into debt. The Pradhan Mantri Jan Arogya Yojana Scheme removes that burden by covering treatment up to ₹5 lakh per family per year, so one medical emergency never becomes a lifelong financial crisis.

Universal Healthcare Coverage

Universal Healthcare Coverage

Millions of families could never afford a private policy. PMJAY Health Insurance extends Healthcare Coverage to them at zero premium, bringing the Ayushman Bharat Yojana closer to universal health coverage for every eligible household across India.

Access to quality care

Access to quality care

Quality treatment shouldn’t depend on income. This Government Health Scheme opens empanelled private hospitals to beneficiaries, not only government facilities, and the PMJAY Hospital Search helps families find the right hospital for their treatment needs.

Lower out-of-pocket spend

Lower out-of-pocket spend

Paying upfront delays treatment. The PMJAY Scheme makes care cashless and paperless at the point of admission, so eligible patients show their Ayushman card, get treated at empanelled hospitals and avoid out-of-pocket spending on covered procedures.

Stronger health infrastructure

Stronger health infrastructure

Better access needs more hospitals. The PMJAY Health Scheme encourages public and private hospitals to join its network, expanding the PMJAY Hospital List and strengthening healthcare capacity in districts where quality facilities were once limited.

Inclusion for vulnerable families

Inclusion for vulnerable families

The Ayushman Bharat Health Scheme prioritises those most at risk, from deprived rural households and urban workers to senior citizens aged 70 and above, making sure the people who need care most are never left out.

Transparent, digital claims

Transparent, digital claims

PM-JAY runs on a digital backbone. Beneficiary checks, pre-authorisation and claims move through online systems, giving hospitals faster settlements and families a Government Healthcare Scheme that stays transparent, trackable and easier to audit at every step.

Records That Follow the Patient

Records That Follow the Patient

With DHIS, health records stop living in files and start travelling with the patient. Each record created on ABDM-enabled software links to the patient’s ABHA, so prescriptions, reports, and summaries can be shared with consent anywhere in India. The Digital Health Incentive Scheme rewards healthcare providers for building that continuity.

Powered by ABDM-Enabled Software

Powered by ABDM-Enabled Software

DHIS is powered by software. Hospital management systems, lab systems, and pharmacy platforms that follow ABDM standards generate the records that earn incentives, and the companies building them are rewarded too. That is why the right ABDM-enabled HIMS makes it easier to claim DHIS incentive consistently, without extra manual work.

Healthcare Coverage Under PMJAY: Key Benefits at a Glance

From cashless treatment to nationwide portability, the PMJAY Scheme packs complete Healthcare Coverage into one Ayushman card. Here is everything this Government Health Scheme offers eligible families, explained simply, in one place.

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₹5 lakh cover per family, per year
The PMJAY Scheme gives every eligible family health insurance cover of up to ₹5 lakh per year. This amount is shared across all family members, so one Pradhan Mantri Jan Arogya Yojana card protects the whole household financially every year
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Cashless and paperless
PMJAY Health Insurance means no upfront payment at empanelled hospitals. Eligible patients simply show their Ayushman card, get admitted and receive covered treatment without paying, while hospitals handle approvals and claims digitally behind the scenes under this Government Health Scheme.
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Pre-hospitalisation cover
Treatment doesn't start at the hospital bed. The PMJAY Healthcare Scheme covers consultation and diagnostic tests up to 3 days before admission, so eligible families don't pay anything out of pocket for the tests and scans that lead to hospitalisation.
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Post-hospitalisation cover
Recovery has costs too. Under the PMJAY Health Scheme, follow-up expenses are covered for up to 15 days after discharge, including medicines and check-ups, so families can focus on healing instead of worrying about bills once the hospital stay ends.
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Pre-existing conditions covered
Existing illness is no barrier. The Pradhan Mantri Jan Arogya Yojana Scheme covers pre-existing conditions from day one of enrolment, so families never face a waiting period before getting treatment for heart disease, kidney failure or other long-term health problems.
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Nationwide portability
Move anywhere, stay covered. Your Ayushman Bharat Yojana card works at any empanelled hospital in India, so families who travel or migrate for work can use the PMJAY Hospital List to find trusted nearby care without losing their Healthcare Coverage.
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No cap on family size or age
Large families and elderly members are not left out. The Ayushman Bharat Health Scheme has no cap on family size or age, so every eligible member, from newborns to grandparents, is covered under the same shared ₹5 lakh family limit.
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Senior citizen cover
Healthcare shouldn't get harder with age. All citizens aged 70 and above are eligible for PMJAY cover under the Vay Vandana extension, giving older adults dependable cashless treatment at empanelled hospitals through this Government Healthcare Scheme, whatever their income level.
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Choice of public and private hospitals
Families aren't limited to government facilities. The PMJAY Healthcare Scheme lets eligible patients choose between empanelled public and private hospitals, and the PMJAY Hospital Search makes it easy to compare nearby options by state, district and speciality before planned admission.
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Who Is Eligible for the PMJAY Scheme?

Eligibility under the Pradhan Mantri Jan Arogya Yojana Scheme depends on socio-economic deprivation data, not age or family size. Check whether your family qualifies for this Government Health Scheme today.

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Rural families

Rural families qualify under the PMJAY Scheme on deprivation criteria, including kutcha housing, no working-age adult, disabled members, SC/ST status and landless manual labour households.

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Urban families

Urban families qualify by occupation. This Government Health Scheme covers street vendors, domestic workers, sanitation staff, mechanics and rickshaw pullers needing dependable PMJAY Healthcare Coverage.

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Senior citizens

Citizens aged 70 and above can access PMJAY Health Insurance under the Vay Vandana extensio

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Running a PMJAY-empanelled hospital? Get claims right the first time.

Streamline PMJAY claim submissions, minimize errors and rejections, simplify documentation, track claim status efficiently, and improve coordination between hospital departments for faster, more accurate, and hassle-free claim processing.

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Check PMJAY Eligibility and Apply for the Ayushman Card

  1. Check eligibility: Use the "Am I Eligible" tool on the official PMJAY portal, or the Ayushman app, with your mobile number and name or ration card details.
  2. Verify identity: Keep Aadhaar and family documents ready for e-KYC.
  3. Visit a kiosk: Go to any empanelled hospital's PMJAY help desk or a Common Service Centre (CSC).
  4. Meet the Arogya Mitra: The Pradhan Mantri Arogya Mitra verifies your details and creates your e-card.
  5. Get your card: Download the Ayushman card for free and carry it, digital or printed, to every visit.

PMJAY Healthcare Coverage: What's Included

PMJAY pays hospitals through pre-defined Health Benefit Packages (HBPs). Each package bundles the cost of a procedure so the patient pays nothing.

Cover includes

Common treatment areas

How to Use PMJAY Hospital Search

The PMJAY Hospital List includes both public and private hospitals that accept the Ayushman card.

  1. Open the official PMJAY portal and select "Find Hospital".
  2. Choose your state and district.
  3. Pick hospital type: public or private.
  4. Select the speciality you need.
  5. Enter the captcha and tap search.

Confirm with the hospital's PMJAY help desk that your required package is active before admission.

What if a hospital refuses your card? You can register a complaint through the grievance channel on the official portal.

How PM-JAY Works: The Treatment Journey from Registration to Settlement 

From beneficiary check to claim payment, every PMJAY Scheme case follows a clear digital path. See how this Government Health Scheme delivers cashless hospital treatment. 

  1. Identification: The Arogya Mitra verifies the patient’s PMJAY beneficiary status using the Ayushman card, so eligible families get cashless Healthcare Coverage.
     
  2. Registration: The hospital registers the case on the Transaction Management System (TMS), linking the patient to the PMJAY Health Scheme digitally.
     
  3. Pre-authorisation: The treating doctor submits clinical details for approval where the package requires it, so this Government Health Scheme approves treatment.
     
  4. Treatment: Eligible patients receive cashless treatment at the empanelled hospital, with PMJAY Health Insurance covering all procedures, medicines and bed charges.
     
  5. Discharge: The hospital documents the discharge with the discharge summary and required reports, keeping every Ayushman Bharat Yojana case fully claim-ready.
     
  6. Claim submission: The hospital files the claim on the portal with complete documents and correct package codes, helping PMJAY claims avoid rejection.
     
  7. Settlement: The State Health Agency reviews the claim and pays the hospital, completing the cashless PM-JAY cycle from registration to settlement.

PMJAY Government Healthcare Scheme: What Hospitals Need to Know

For a hospital, PMJAY means steady patient volume and guaranteed government payments, if the paperwork is right.

Getting started

Why claims get rejected

Clean documentation at every stage is the difference between a quick settlement and a rejected claim.

Run PMJAY Cases Smoothly with ZYNO HIMS

Treating Ayushman Bharat patients shouldn't mean double entry and claim chasing. ZYNO HIMS brings PMJAY into your normal hospital workflow.

Beneficiary check at registration

ZYNO HIMS lets front-desk staff confirm PMJAY beneficiary status at registration, so eligible Ayushman Bharat Yojana patients move to admission faster, without delays, repeat forms or confusion about Healthcare Coverage.

Package-based billing

Map hospital services to the right PMJAY packages and rates in ZYNO HIMS, so every PMJAY Scheme bill uses correct codes and avoids manual lookups, costly errors and claim rejections.

Claim-ready documentation

ZYNO HIMS captures discharge summaries, investigation reports and consent forms in one patient record, keeping every Government Health Scheme case complete, organised and ready for fast, accurate PMJAY claim submission.

One system for every patient type

Manage PMJAY, TPA and private patients in one billing flow. ZYNO HIMS applies the right rules automatically, so PMJAY Health Insurance cases never disrupt regular hospital billing or finance accounts.

Scheme-wise reports

 Track PMJAY utilisation, pending claims and settlements in ZYNO HIMS dashboards, giving management visibility of Ayushman Bharat Health Scheme revenue, rejection reasons and payments awaiting from State Health Agency.

Pre-authorisation tracking

Track every pre-authorisation request from submission to approval inside ZYNO HIMS, so doctors and billing teams know the status instantly and PMJAY Healthcare Scheme treatment starts without any avoidable delays.

Pre-submission claim checks

ZYNO HIMS flags missing documents, wrong package codes and incomplete fields before submission, helping hospitals reduce PMJAY claim rejections and speed settlements under Pradhan Mantri Jan Arogya Yojana Scheme.

ABHA-linked records

Link patient records to ABHA health IDs in ZYNO HIMS, so PM-JAY beneficiaries carry verified, shareable health histories across hospitals and every treatment stays connected to India’s digital health ecosystem.

PMJAY and India's Digital Health Ecosystem

PMJAY is increasingly connected with India's digital health infrastructure.

Together, these make the Ayushman Bharat Health Scheme faster, more transparent and easier to audit.

Frequently Asked Questions

faq

PMJAY, or Pradhan Mantri Jan Arogya Yojana, is the Government Health Scheme under Ayushman Bharat Yojana. This PMJAY Health Insurance gives eligible families cashless hospital treatment of up to ₹5 lakh per family per year at empanelled hospitals across India.

Yes, partly. PM-JAY is the health insurance component of the Ayushman Bharat Health Scheme. The other component is the network of Health and Wellness Centres, which focus on primary care and prevention. Together they form a complete Government Healthcare Scheme.

No. The PMJAY Scheme is fully government-funded, with costs shared between central and state governments, so eligible families pay no premium. This zero-cost PMJAY Health Insurance makes Healthcare Coverage accessible to families who could never afford a private health policy.

Use the “Am I Eligible” tool on the official PMJAY portal or app. You can also visit an empanelled hospital’s PMJAY help desk or a Common Service Centre to quickly confirm eligibility under the Pradhan Mantri Jan Arogya Yojana Scheme.

Open the official portal, select PMJAY Hospital Search, then choose your state, district, hospital type and speciality. The PMJAY Hospital List shows empanelled public and private hospitals accepting the Ayushman card, helping eligible families quickly find the right care nearby.

Yes. The PMJAY Hospital List includes both public and private empanelled hospitals, so eligible patients can choose where to be treated. Simply show your Ayushman card at any listed hospital to receive cashless, paperless care under this Government Healthcare Scheme.

The PMJAY Healthcare Scheme covers hospitalisation, surgery, medicines, diagnostics and bed charges. It also covers up to 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses, giving families complete Healthcare Coverage without upfront payment at empanelled hospitals across India.

Yes. The Pradhan Mantri Jan Arogya Yojana Scheme covers pre-existing conditions from the first day of enrolment, with no waiting period. Eligible families can get treatment for existing illnesses immediately, with PMJAY Health Insurance protecting them financially from day one.

Stay calm. Ask the hospital’s PMJAY help desk to resolve it first, then register a grievance through the official portal. Authorities will follow up, because empanelled hospitals are expected to treat eligible Ayushman Bharat Yojana beneficiaries cashlessly under the scheme.

Common PMJAY claim rejection reasons are incomplete documentation, wrong package codes, beneficiary mismatch, late submission and missing pre-authorisation. Hospitals avoid them with correct package mapping, clean records and timely filing, keeping this Health Insurance Scheme payment cycle smooth and predictable.

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