Conceptual · Article 7.2.7

Ayushman Bharat PM-JAY.

Q: My family is middle-class — are we eligible for PM-JAY?

Under the SECC-2011 category, eligibility rests on specific deprivation indicators, not income alone, so many salaried or asset-owning middle-class families will not qualify. However, if any family member is aged 70 or above, that person is now eligible under the October 2024 senior-citizen expansion regardless of family income, through the Ayushman Vaya Vandana Card. Check status on pmjay.gov.in using your Aadhaar, ration card, or registered mobile number.

Q: My family already has PM-JAY. Does my 72-year-old father get extra cover under the 70+ expansion?

Yes. A senior aged 70+ inside a family already covered under the SECC-based PM-JAY receives an additional ₹5 lakh per year reserved exclusively for their own use, on top of the family's existing ₹5 lakh floater — effectively doubling the cover available to that senior. The benefit is delivered through the separate Ayushman Vaya Vandana Card.

Q: My PM-JAY card is registered in UP but I live in Delhi — can I use it there?

Yes. PM-JAY offers full pan-India portability. An Ayushman Card issued in Uttar Pradesh is valid at any PM-JAY-empanelled hospital anywhere in the country, including Delhi. Present the card at the hospital's PM-JAY help desk; eligibility is verified in real time on the national portal and cashless treatment proceeds as normal. Beneficiaries are not restricted to their home state.

Q: Can I use PM-JAY at any private hospital near me?

Only at empanelled private hospitals. Not every private hospital participates in PM-JAY. Use the hospital locator on pmjay.gov.in or the Ayushman Bharat app to find empanelled facilities near you before scheduling admission. In West Bengal and Telangana, which have not formally implemented PM-JAY, private-hospital access for cardholders is limited, though public hospitals remain accessible on a portability basis.

Q: Does PM-JAY cover cancer treatment?

Yes. Oncology is among the 27 medical specialties covered under PM-JAY's 1,929 Health Benefit Packages. Cancer surgeries, chemotherapy and radiation procedures listed in the package framework are covered cashless at empanelled hospitals, with no co-payment or balance billing. Very advanced or experimental treatments outside the defined packages may fall beyond cover, and the ₹5 lakh annual ceiling can be exhausted by prolonged treatment.

Q: I am a central government employee with CGHS — can I also use PM-JAY for my 73-year-old mother?

Your 73-year-old mother is eligible under the 70+ expansion. But a beneficiary cannot draw from two government health schemes simultaneously: a senior enrolled in CGHS, ECHS or Ayushman CAPF must choose between that scheme and PM-JAY. Weigh the coverage, hospital network and convenience of each before deciding which to retain for her care.

India's Largest Government-Funded Health Cover, Explained.

Published as on 22 July 2026

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is the government's health guarantee to India's most vulnerable — often called the world's largest scheme of its kind. It provides ₹5 lakh per family per year of cashless hospitalisation for secondary and tertiary care at any empanelled hospital in the country, at zero cost to the beneficiary. There is no premium, no co-payment and no deductible; the cost is borne entirely by the Centre and states. Launched in September 2018 for families identified through the SECC-2011 database — about 55 crore people — it was widened on 29 October 2024 to cover every citizen aged 70 and above, whatever their income, through a dedicated Ayushman Vaya Vandana Card. This is public health financing, paid for by the exchequer — not a personal insurance policy you buy.

₹5 lakh

Per Family / Year

~55 crore

People Covered

29,000+

Empanelled Hospitals

Zero Premium

No 80D Deduction

Executive Summary · Page 2

Executive Summary · 6 Findings

PM-JAY answers one question for a family that cannot absorb a hospital bill: who pays when serious illness strikes? The state does — up to ₹5 lakh a year, cashless, at empanelled hospitals, with no premium ever charged. That single design choice is its power and its limit. Because it is tax-financed rather than premium-funded, there is nothing to deduct under Section 80D — and nothing to top up beyond the annual ceiling. Understand it as a floor of protection, not a full policy.

Covers what PM-JAY is and how it is funded, the two eligibility pathways (SECC-2011 deprivation criteria and the October 2024 expansion for all seniors aged 70+), what the ₹5 lakh floater includes and excludes across 1,929 Health Benefit Packages, how to obtain and use the Ayushman Card at empanelled hospitals with pan-India portability, why no tax deduction arises, state participation as of FY 2025-26, and six questions Indian families ask.

Key Findings

A tax-financed health guarantee, not a policy you buy.

PM-JAY provides ₹5 lakh per family per year of cashless hospitalisation at empanelled hospitals, at zero cost to the beneficiary. It is funded by the Centre and states — typically 60:40, and 90:10 for North-Eastern and special-category states. No premium, co-payment or deductible is ever charged for treatment within the defined package rates.

Two doors in: deprivation criteria, or age 70+.

The original list was drawn from the SECC-2011 database using deprivation markers — about 12.34 crore families, 55 crore people. On 29 October 2024 the scheme opened a second door: every citizen aged 70 and above, regardless of income, via the Ayushman Vaya Vandana Card — roughly 6 crore more seniors across 4.5 crore families.

A family floater with pre-existing cover from day one.

The ₹5 lakh is shared across any family members, any number of hospitalisations, no cap on family size. It spans 1,929 Health Benefit Packages across 27 specialties — cardiac, oncology, neurosurgery and more — with pre- and post-hospitalisation expenses and no waiting period for pre-existing conditions. OPD, most dental, cosmetic, fertility and de-addiction care are excluded.

Zero premium means zero Section 80D deduction.

Because the beneficiary pays no premium, there is nothing to claim under Section 80D of the Income Tax Act. Section 80D rewards premiums paid on qualifying health policies; PM-JAY involves none. Treat it as public health protection you receive — not a personal tax-saving instrument. The saving is the avoided hospital bill, not a deduction.

Cashless, portable, and verified at the help desk.

Confirm eligibility on pmjay.gov.in via Aadhaar, ration card or mobile number, generate the Ayushman e-Card, and present it at any empanelled hospital's PM-JAY help desk. Treatment proceeds without deposit; the hospital bills the government directly. Full pan-India portability means a card issued in one state works in another. Report demands for payment on helpline 14555.

A safety net — not a full substitute for private cover.

The ₹5 lakh ceiling, the absence of OPD, and the restriction to empanelled hospitals mean a serious, prolonged illness can exhaust the cover. For families who can afford it, PM-JAY plus a supplementary private policy provides the most complete protection. As of FY 2025-26, 34 states and UTs have implemented the scheme.

At A Glance

Metric	Value	Detail
Cover	₹5 lakh / family / yr	Family floater
Cost to you	Zero	Fully state-funded
Care type	Secondary & tertiary	In-patient
Packages	1,929 HBPs	27 specialties
Pre-existing	Covered day 1	No waiting period
Network	29,000+ hospitals	Pan-India portable
Tax benefit	None (80D N/A)	No premium paid
Best use	Base safety net	Not a full policy

Exhibit 01: Who Qualifies, and For How Much

Pathway	Who	Cover
SECC-2011	Deprivation criteria	₹5L floater
Age 70+	All incomes	₹5L / year
70+ in SECC family	Senior member	+₹5L top-up
Middle-class <70	Usually not eligible	—

Position around FY 2025-26. A senior aged 70+ inside an SECC-covered family receives an additional ₹5 lakh reserved for their own use, on top of the family's ₹5 lakh floater. Middle-class families under 70 with no deprivation marker typically fall outside eligibility.

The Opening · Page 3

The Opening

For tens of millions of Indian families, a single hospitalisation has long been a financial catastrophe — the moment savings vanish, land is sold, or care is simply refused. PM-JAY exists to break that link between illness and ruin. It is not insurance in the everyday sense: no one signs a proposal form, pays a premium, or renews a policy. Eligibility flows from a national database and, since 2024, from age. When an eligible person needs secondary or tertiary hospital care, the state pays the bill — up to ₹5 lakh a year — directly to the hospital, and the family pays nothing.

"PM-JAY guarantees that a hospital bill will not bankrupt an eligible family. It does not guarantee that ₹5 lakh will cover every illness, that every hospital participates, or that a middle-class household qualifies at all. Read the guarantee for exactly what it promises."
A Floor, Not a Ceiling

The mechanics. The cover is a family floater — ₹5 lakh shared across all members, for any number of hospitalisations, with no restriction on family size. It reimburses through 1,929 fixed-rate Health Benefit Packages, so an empanelled hospital receives a government-set amount and cannot bill the patient a rupee more. Pre-existing conditions are covered from day one, and there is no co-payment or advance deposit.

The 2024 turn. For six years, PM-JAY was strictly a scheme for the poor and vulnerable. The 29 October 2024 expansion changed its character: every citizen aged 70 and above now qualifies regardless of wealth, receiving a dedicated Ayushman Vaya Vandana Card. A well-off senior and a landless labourer can now hold cover under the same programme — through different doors.

The Honest Boundary: PM-JAY is NOT a tax-saving product — with no premium paid, no Section 80D deduction arises. It is NOT a comprehensive substitute for private health insurance — ₹5 lakh, no OPD, empanelled hospitals only. It is NOT open to most middle-class families under 70 who lack a deprivation marker. It IS a genuine sovereign safety net for the eligible, and now for every senior aged 70 and above.

Structure

Part I

What PM-JAY Is, How It's Funded & Where It Fits

Part II

Who Qualifies, What's Covered & Why No 80D

Part III

The Card, Empanelled Hospitals, Portability & States

Part IV

The Verdict: A Safety Net, Used Correctly

You Likely Qualify If

✓ Listed under SECC-2011 deprivation criteria

✓ Any family member is aged 70+

✓ Urban informal-sector worker category

✓ Your state has implemented PM-JAY

Don't Rely On It If

✕ Middle-class, under 70, no deprivation marker

✕ You need OPD or day-to-day cover

✕ Costs may exceed ₹5 lakh a year

✕ Your preferred hospital isn't empanelled

Part I

What PM-JAY Is, How the Government Funds It, and Where It Fits

The cashless ₹5 lakh floater and its fixed-rate package mechanics; how the Centre and states split the bill so beneficiaries pay nothing; and where this scheme sits in a family's protection — a public floor beneath, not a replacement for, private cover.

Part I · Page 4

The Cover at a Glance

Element	PM-JAY Provision
Sum insured	₹5 lakh / family / year
Basis	Family floater, unlimited size
Pre-hospitalisation	Up to 3 days before
Post-hospitalisation	Up to 15 days after
Pre-existing	Covered from day 1

Cover applies to secondary and tertiary in-patient care — a minimum 24-hour stay, bar specified day-care procedures. It spans room, nursing, surgeon and doctor fees, ICU, diagnostics, medicines, implants and prosthetics used during the stay. Because each treatment is billed at a fixed package rate, the hospital cannot add a co-payment or demand a deposit.

How the Government Pays

A Shared Central–State Bill

PM-JAY is a Centrally Sponsored Scheme. For most states the cost is split 60% Centre : 40% state; for North-Eastern and special-category states (Himachal, Uttarakhand, J&K and similar) it is 90:10. States deliver claims through an insurance model, a trust/society model, or a hybrid of both. Whichever the route, the beneficiary sees none of it — treatment is cashless and the money flows from government to hospital.

Where PM-JAY Fits

Layer	Cover	Role
Public floor	PM-JAY	Catastrophe cover
Base policy	Private ₹5–10L	OPD, wider network
Top-up	Super top-up	Large-bill buffer
Emergency fund	Cash / liquid	Gaps & excesses
Employer cover	Group policy	Ends with the job

For an eligible household, PM-JAY is the foundation — the layer that absorbs a catastrophic hospital bill at no cost. The guiding principle is layering: use the public floor first, then build private cover on top for what it does not reach, rather than treating either as the whole answer.

Appropriate framing: a landless rural family relying on PM-JAY as its sole realistic cover; a 72-year-old parent adding a ₹5 lakh Vaya Vandana top-up on top of the family's floater; a household using PM-JAY for the big bills and a modest private policy for OPD and network breadth. Misframing: a salaried, under-70 family assuming PM-JAY has them covered — most do not qualify, and none get an 80D deduction.

Part II

Who Qualifies, What the ₹5 Lakh Covers, and Why There Is No 80D

The two eligibility doors — SECC-2011 deprivation criteria and the October 2024 rule that admits every senior aged 70+; what the 1,929 packages include and pointedly exclude; and why a tax-financed scheme yields no personal tax deduction.

Part II · Page 6

The Two Pathways

Pathway 1 — SECC-2011 Deprivation Criteria

Eligibility rests on deprivation markers, not a simple income line. Rural households qualify on conditions such as a single kuccha room, no adult male aged 16–59, a disabled member with no able-bodied adult, SC/ST status, or landless casual labour. Urban households qualify through 11 informal-occupation categories — rag pickers, domestic workers, street vendors, construction and sanitation workers and similar. About 12.34 crore families, 55 crore people.

Pathway 2 — Every Citizen Aged 70+

From 29 October 2024, all citizens aged 70 and above qualify irrespective of income — roughly 6 crore seniors across 4.5 crore families — via the Ayushman Vaya Vandana Card. A senior already inside an SECC-covered family gets an additional ₹5 lakh reserved for their own use, on top of the family floater. Seniors in CGHS, ECHS or Ayushman CAPF must choose one scheme; benefits cannot be drawn from two at once.

What's Excluded

OPD consultations, medicines and diagnostics without hospitalisation; cosmetic procedures (unless reconstructive after accident or burns); most dental care; drug de-addiction; fertility treatment including IVF; organ-procurement cost (the transplant itself is covered); and self-inflicted or conflict-zone injuries.

What's Covered

1,929 Packages, 27 Specialties

Treatment is delivered through 1,929 fixed-rate Health Benefit Packages spanning cardiac surgery, oncology, neurosurgery, orthopaedics, renal transplant, mental health and more. Each package pays the hospital a set government rate — no balance billing, no co-payment, no advance deposit. Pre-existing conditions carry no waiting period.

Tax Treatment (FY 2025-26)

Public Financing, Not a Tax Shelter

PM-JAY is funded by the exchequer. The beneficiary pays no premium — so no Section 80D deduction arises. Section 80D rewards premiums paid on qualifying health policies; with none paid here, there is nothing to claim. The benefit is the avoided hospital bill, not a line on your tax return.

Don't Confuse It With Private Cover

A private health policy costing ₹25,000 a year can earn an 80D deduction (up to ₹25,000, or ₹50,000 for senior citizens). PM-JAY earns none — but it also costs nothing. The two are not substitutes on tax grounds: one is a product you buy, the other a protection you receive.

PM-JAY vs Private Health Insurance

Factor	PM-JAY	Private
Premium	Zero	You pay
Cover	₹5L / family	₹3L–₹1cr+
Pre-existing	Day 1	1–4 yr wait
80D benefit	None	Up to ₹25/50k

Position around FY 2025-26. PM-JAY excludes OPD and works only at empanelled hospitals; private plans offer wider networks and add-ons at a premium. For the eligible, the two together give the fullest protection.

Part III

Getting the Ayushman Card, Using It Cashless, and Which States Are In

The eligibility check and e-Card on pmjay.gov.in; the step-by-step cashless process at an empanelled hospital's help desk; how pan-India portability lets a card travel; and where the scheme is — and isn't — live as of FY 2025-26.

Part III · Page 8

Check & Get the Card

Channel	Does
pmjay.gov.in	Check via Aadhaar / ration / mobile
Ayushman app	Eligibility, hospital search, e-Card
CSCs (3 lakh+)	Verify & issue cards
Hospital help desk	Verify at admission

The Cashless Process, Step by Step

Find an empanelled hospital via the locator, go to its PM-JAY help desk, and present the Ayushman Card. The desk verifies eligibility live on the national portal; once confirmed, admission and treatment proceed with no deposit and no extra payment. At discharge the hospital files the claim electronically and is paid by the government. If a hospital demands out-of-pocket payment for a covered procedure, that breaches scheme rules — report it on helpline 14555.

Pan-India Portability

Feature	What It Means
Card issued in	Any implementing state
Valid at	Any empanelled hospital, nationwide
Ideal for	Migrant workers, travellers
Verified by	QR code + portal check

State Participation (FY 2025-26)

34 States & UTs In

PM-JAY needs active state implementation. Odisha became the 34th to formally join in early FY 2025-26, folding in its earlier Biju Swasthya Kalyan Yojana. Delhi also joined, extending cover to eligible families and seniors — around 6.54 lakh families. West Bengal (Swasthya Sathi) and Telangana remain outside; their public hospitals are reachable on portability, but private-hospital access for cardholders there is limited.

Reading the Map

Status	States
Newly joined	Odisha (34th), Delhi
Implementing	34 states & UTs
Outside PM-JAY	West Bengal, Telangana
In those states	Public hospitals via portability

The practical point: before you rely on PM-JAY, confirm three things — that you are eligible (SECC or age 70+), that your state has implemented the scheme, and that a suitable hospital near you is empanelled. Generate the e-Card in advance rather than at the hospital gate; verify the empanelled-hospital list on pmjay.gov.in for the specialty you may need; and keep helpline 14555 to hand in case a hospital wrongly asks for payment.

Part IV

The Verdict

A floor of protection. Not a full policy — and not a tax break.

Part IV: The Verdict · Page 10

30-Second Summary

Ayushman Bharat PM-JAY gives eligible families ₹5 lakh a year of cashless secondary and tertiary hospitalisation at empanelled hospitals, at zero cost, funded by the Centre and states. Two doors admit you: the SECC-2011 deprivation criteria that identified about 55 crore people, and the October 2024 rule that admits every citizen aged 70 and above regardless of income, via the Ayushman Vaya Vandana Card. Pre-existing conditions are covered from day one, across 1,929 packages, with full pan-India portability.

Because it is tax-financed and premium-free, there is no Section 80D deduction to claim — the payoff is the hospital bill you never pay, not a line on your return. Treat PM-JAY as the base layer of protection: essential for those who qualify, but bounded by a ₹5 lakh ceiling, no OPD, and the empanelled-hospital network. Where affordable, pair it with a private policy. As of FY 2025-26, 34 states and UTs are in; West Bengal and Telangana are not.

"PM-JAY answers the question that keeps a vulnerable family awake — who pays if we land in hospital? The state does, up to ₹5 lakh, cashless. It does not answer every question after that: the bill beyond ₹5 lakh, the OPD visit, the hospital that isn't empanelled. Use it for exactly what it guarantees, and build the rest around it."
The Final Orientation

The Bottom Line: If you are eligible — through SECC-2011 or as a senior aged 70+ — generate the Ayushman Card now, before you need it, and know your nearest empanelled hospitals. Expect a genuine catastrophe floor of ₹5 lakh, cashless and portable, with pre-existing cover from day one. But do not mistake it for a complete policy: there is no OPD, no cover beyond the ceiling, and no Section 80D deduction, since you pay no premium. For families who can afford it, layer a private policy on top. And if a hospital ever demands payment for a covered procedure, call 14555.

ADWIZR · July 2026

Decision Rules

Use Correctly As

✓ A catastrophe floor for the eligible

✓ A ₹5L top-up for a 70+ parent

✓ Cashless cover for big in-patient bills

✓ A portable card for migrant families

Don't Treat It As

✕ A tax-saving instrument (no 80D)

✕ A full replacement for private cover

✕ OPD or day-to-day medical cover

✕ Guaranteed at any hospital you choose

Three Misconceptions

What Families Get Wrong

(1) "I can claim it under 80D." No premium is paid, so no deduction exists. (2) "₹5 lakh covers anything." A prolonged cancer or cardiac course can exhaust it; OPD isn't covered at all. (3) "It works at every hospital." Only at empanelled facilities — and in West Bengal and Telangana private access is limited.

vs Private Health Insurance

Public Floor vs Private Policy

PM-JAY: zero premium, ₹5 lakh, empanelled hospitals, pre-existing from day one, no 80D. Private cover: you pay a premium, choose higher sums and wider networks, add OPD, and earn an 80D deduction — after waiting periods. Different tools; layer them where you can.

₹5 lakh

Per family / yr

Cashless, zero premium

70+

Now covered

All incomes, Oct 2024

No 80D

Tax benefit

No premium paid

Family FAQ

Questions Indian Families Ask

Six questions, answered directly.

Family FAQ · Page 12

Frequently Asked Questions

Q1 My family is middle-class — are we eligible for PM-JAY?

Under the SECC-2011 category, eligibility rests on specific deprivation indicators, not income alone, so many salaried or asset-owning middle-class families will not qualify. However, if any family member is aged 70 or above, that person is now eligible under the October 2024 senior-citizen expansion regardless of family income, through the Ayushman Vaya Vandana Card. Check status on pmjay.gov.in using your Aadhaar, ration card, or registered mobile number.

Q2 My family already has PM-JAY. Does my 72-year-old father get extra cover under the 70+ expansion?

Yes. A senior aged 70+ inside a family already covered under the SECC-based PM-JAY receives an additional ₹5 lakh per year reserved exclusively for their own use, on top of the family's existing ₹5 lakh floater — effectively doubling the cover available to that senior. The benefit is delivered through the separate Ayushman Vaya Vandana Card, obtained through the same channels after age verification.

Q3 My PM-JAY card is registered in UP but I live in Delhi — can I use it there?

Yes. PM-JAY offers full pan-India portability. An Ayushman Card issued in Uttar Pradesh is valid at any PM-JAY-empanelled hospital anywhere in the country, including Delhi. Present the card at the hospital's PM-JAY help desk; eligibility is verified in real time on the national portal and cashless treatment proceeds as normal. Beneficiaries are not restricted to their home state — the feature is designed for exactly this migrant-worker situation.

Q4 Can I use PM-JAY at any private hospital near me?

Only at empanelled private hospitals. Not every private hospital participates in PM-JAY. Use the hospital locator on pmjay.gov.in or the Ayushman Bharat app to find empanelled facilities near you before scheduling admission. In West Bengal and Telangana, which have not formally implemented PM-JAY, private-hospital access for cardholders is limited, though public hospitals remain reachable on a portability basis.

Q5 Does PM-JAY cover cancer treatment?

Yes. Oncology is among the 27 medical specialties covered under PM-JAY's 1,929 Health Benefit Packages. Cancer surgeries, chemotherapy and radiation procedures listed in the package framework are covered cashless at empanelled hospitals, with no co-payment or balance billing. Very advanced or experimental treatments outside the defined packages may fall beyond cover, and because the ₹5 lakh annual ceiling can be exhausted by prolonged treatment, supplementary cover is worth considering.

Q6 I'm a central government employee with CGHS — can I also use PM-JAY for my 73-year-old mother?

Your 73-year-old mother is eligible under the 70+ expansion. But a beneficiary cannot draw from two government health schemes simultaneously: a senior enrolled in CGHS, ECHS or Ayushman CAPF must choose between that scheme and PM-JAY for the same treatment. Weigh the coverage, hospital network and convenience of each before deciding which to retain for her care.

Key Terms & Definitions

PM-JAY

Pradhan Mantri Jan Arogya Yojana, the health-assurance arm of Ayushman Bharat. A government-funded scheme providing ₹5 lakh per family per year of cashless secondary and tertiary hospitalisation at empanelled hospitals, at zero cost to the beneficiary. Launched 23 September 2018.

Family Floater

A single sum insured shared across all members of a family rather than allotted per person. PM-JAY's ₹5 lakh is available in any combination across members, for any number of hospitalisations in the year, with no restriction on family size.

SECC-2011

The Socio-Economic and Caste Census of 2011, whose deprivation and occupation markers identify PM-JAY's original beneficiary families — about 12.34 crore families, some 55 crore people. Eligibility follows these criteria, not a simple income threshold.

Ayushman Vaya Vandana Card

The dedicated card issued under the October 2024 expansion to citizens aged 70 and above, regardless of income. For a senior inside an SECC-covered family it carries an additional ₹5 lakh reserved for their own use, on top of the family floater.

Health Benefit Package (HBP)

One of 1,929 fixed-rate treatment packages across 27 specialties. The empanelled hospital receives the government-set rate for a covered procedure and cannot charge the beneficiary anything extra — no balance billing, no co-payment, no deposit.

Empanelled Hospital

A public or private hospital contracted to deliver PM-JAY treatment cashless and bill the government directly. Only empanelled facilities accept the Ayushman Card; the network exceeds 29,000 hospitals and is searchable on pmjay.gov.in.