Three beliefs keep people out of this scheme, and the Government’s own publications contradict all three. “We have private health insurance, so we are not eligible.” Wrong. The Ministry’s own release says holders of private health insurance are eligible — and so are ESI members. Neither disqualifies anybody. “We are not poor enough.” For anyone seventy or above, income is not part of the test at all. The Ayushman Vay Vandana card, launched on 29 October 2024, covers every citizen of that age irrespective of socio-economic status. “Our family already has a card, so my father gets nothing extra.” He does. A senior citizen in an already-covered family gets an additional top-up of up to ₹5 lakh a year for himself — not a share of the family floater. And the scheme now runs in Delhi. The Ministry records PM-JAY being extended to Delhi and Odisha in 2025. A great deal of advice still circulating was written when they were outside it. The one group with a real decision is those already on CGHS, ECHS or Ayushman CAPF — they must choose between that and this. And the whole thing is free. No fee for eligibility, none for the card, none for treatment at an empanelled hospital. Anybody charging a family for the card itself is charging for nothing.
The card is a piece of identification. It says that the person holding it is a beneficiary of a Government scheme which pays hospitals directly for certain treatment.
Notice what that means. The card does not create the entitlement. The entitlement comes from being eligible, and eligibility is decided by criteria the scheme sets, not by whether anybody has made you a card. A family can be fully entitled for years and never have one.
What the card does is make the entitlement usable. A hospital admitting a patient needs to confirm, quickly, that this person is covered. The card is how that happens. Without it, the entitlement exists in principle and is very difficult to exercise at a counter at midnight.
That gap between being entitled and being able to prove it is the whole subject of this page. Almost everything that goes wrong lives in it.
Two different things. Being eligible is decided by the scheme's criteria. Having a card is how a hospital confirms it in two minutes. Families are regularly the first without the second, and discover the gap at the worst possible moment.
The cover is five lakh rupees per family per year for secondary and tertiary care hospitalisation, and each part of that sentence is doing work.
Per family, not per person. It is a floater, shared across everybody covered. One member using four lakh in a year leaves one lakh for the rest of the household until the year resets.
Per year, so it renews rather than depleting permanently. A family that used the whole amount last year starts the next year with the whole amount again.
Secondary and tertiary hospitalisation, which is the part people read past. This is cover for being admitted to hospital for conditions that need specialist or advanced care. It is not a general health budget and it is not for ordinary illness managed at home.
Within that scope it is substantial. Five lakh covers a great deal of what actually bankrupts households in India, which is a surgery, an intensive care admission, or a cardiac or cancer episode.
Place Order — no advance, pay after work
People reason about this scheme as though it were a policy, and that framing causes several specific errors worth clearing up.
There is no premium. Nobody pays anything to be covered, there is no annual renewal payment, and a household cannot lapse out of it by failing to pay. Eligibility is a status, not a contract.
There is no underwriting, no medical examination and no proposal form. Nobody assesses your risk, because the scheme is not pricing you.
There is no exclusion for pre-existing conditions. On the Authority's own statement they are covered from the first day, with no waiting period, which is a sharper difference from commercial cover than almost anything else about the scheme.
And there is no claim to you. Payment goes to the hospital. You do not pay and get reimbursed; the treatment is cashless at the point of service, which is the single most useful feature for a family that does not have money on the night.
One consequence of that is worth stating, because families assume otherwise from experience of other Government schemes. Because the money never passes through you, this is not a benefit-transfer scheme and you do not need a bank account seeded for direct transfer in order to use it. That requirement belongs to schemes that pay the beneficiary; this one pays the hospital. If somebody has told you to sort a bank account before you can have an Ayushman card, they have confused this with something else.
Four differences from a policy. No premium and no lapsing. No underwriting or medical test. No pre-existing exclusion and no waiting period. And no reimbursement claim — the hospital is paid directly and you pay nothing.
The original design targeted the households least able to absorb a hospital bill, and the way they were identified explains a good deal of what confuses people now.
The Authority describes the base as the bottom forty per cent of poor and vulnerable families, identified using deprivation criteria for rural households and occupational categories for urban households drawn from the 2011 socio-economic census. It puts that at roughly twelve crore families, about fifty-five crore people.
Two consequences follow. First, inclusion was largely automatic rather than applied for — families were identified from existing data, which is why so many eligible households have never done anything about it and do not know they are in.
Second, the base rests on a census now well over a decade old. A household's circumstances may have changed in either direction since, and a family's intuition about whether they "look like" beneficiaries is a poor guide to what the data says.
Which is the practical point: eligibility here is something to check, not to estimate. Later additions have widened it further, and the next section deals with the largest of those.
Mostly identified, not applied for. The original base came from census data rather than from applications, which is why large numbers of eligible families have never acted on it. Your impression of whether you qualify is not the test.
This is the most significant change to the scheme in years and the one least understood by the people it was written for.
On 29 October 2024 the Prime Minister launched the Ayushman Vay Vandana card. It extends the benefits of the scheme to senior citizens aged seventy and above irrespective of their socio-economic status. The Ministry estimated it would reach about 4.5 crore families, roughly 6 crore individuals.
Read the qualifying phrase carefully, because it removes the entire question that keeps most people from applying. For a person of seventy or above, income is not a criterion. Occupation is not a criterion. Whether the household is poor is not a criterion. The test is age.
That is a deliberately universal entitlement for a group whose medical costs rise sharply and whose access to commercial cover falls away at exactly the same time. A seventy-three-year-old who cannot buy a policy at any sensible price, and who was previously too well-off for the scheme, is now inside it.
If there is one paragraph on this page worth repeating to a relative, it is this one.
Across the families who come to us believing they do not qualify, the reasoning falls into three shapes, and the Government's own publications answer all three.
“We have private health insurance.” This disqualifies nobody. The Ministry's release states that people with private health insurance are eligible, and that members of the Employees State Insurance scheme are eligible too. Having bought cover does not remove an entitlement.
“We are not poor enough.” For anybody seventy or above this is simply irrelevant, as the previous section sets out. For everybody else it is a question to check rather than to judge by appearance, because the criteria are specific and the data is a decade old.
“Somebody at a counter told us no.” This is the one we see most and it is the weakest of the three. One person's reading of one screen on one day is not a determination, and the scheme publishes a free way to check independently.
A fourth belief is rarer and worth answering too: that some other certificate decides it. An EWS certificate, a disability certificate or a caste certificate each establishes something for its own purposes, and none of them is the test here. They may be useful evidence when a household record has to be corrected, which is a different job from establishing entitlement.
The common thread is that all three are conclusions, reached without a check that costs nothing. Doing the check is the single most useful action available on this subject.
Three conclusions, none of them a check. Private insurance does not disqualify. For seventy-plus, income is irrelevant. And a counter clerk's "no" is one reading of one screen. All three are answered by a free eligibility check.
Place Order — no advance, pay after work
This deserves its own section because it stops more eligible people than any other single belief, and because the reasoning behind it feels so sensible.
The intuition is that a benefit for those who cannot afford care should not go to somebody who has bought cover. It is a reasonable instinct and it is not what the scheme says. The Ministry's release of 9 December 2024 states that people having private health insurance policies are eligible to avail the benefits, and that members of the Employees State Insurance scheme are eligible as well.
It is worth seeing why that makes sense. A commercial policy has a sum insured that can be exhausted, exclusions, waiting periods and, very often, an age limit that leaves exactly the oldest members of a household uncovered. The scheme sits alongside it rather than duplicating it.
Where the two do overlap, that is a question of which to use for a given admission rather than whether you are allowed to hold both. The section later on this page dealing with your other policy takes that further.
The one genuine exception is not private insurance at all, and it is the subject of the section after next.
Holding a policy is not a disqualification. Private health insurance and Employees State Insurance membership both leave the entitlement intact. The two sit alongside each other, and a commercial policy's age limits are precisely where the scheme matters most.
The cover is a floater, which means the five lakh belongs to the family rather than to each member. That is the ordinary rule and most households understand it.
The exception is not widely known and it matters. On the Ministry's release, a senior citizen aged seventy or above who belongs to a family already covered under the scheme receives an additional top-up of up to five lakh rupees a year for themselves.
So a covered household with a seventy-three-year-old parent does not have five lakh between them. It has the family's five lakh, plus up to five lakh belonging to that parent alone.
The practical importance of this is hard to overstate, because the elderly member is statistically the one most likely to need an expensive admission, and under an ordinary floater a single such admission would exhaust the cover for everybody else in the household. This provision prevents exactly that.
Households with more than one person over seventy should work through what that means for them, with the same logic applied to each.
There is a single group facing a genuine either-or, and for them it is a real decision rather than a formality.
On the Ministry's release, senior citizens already covered under CGHS, ECHS or Ayushman CAPF must choose between that scheme and this one. They cannot hold both.
This deserves to be weighed properly instead of settled on a hunch. The existing schemes have their own hospital networks, their own entitlements and their own limits, and whether this scheme is better for a particular person depends on where they live, which hospitals are accessible to them under each, and what their likely needs are.
What we can say is that it should be an informed comparison and not a guess, and that it is not a decision a documentation service should make for anybody. Where somebody is in one of those schemes, the right step is to establish precisely what their existing cover gives them before deciding.
Note too what this does not include. Private insurance is not on that list. Employees State Insurance membership is not on that list. The choice applies to those three Government schemes and nothing else.
Three schemes, one choice. CGHS, ECHS and Ayushman CAPF require a senior citizen to pick between that cover and this. Private policies and ESI membership are not on that list and require no choice at all.
Place Order — no advance, pay after work
This is a national scheme that does not operate automatically across the whole country, and the distinction catches people out badly.
Implementation rests on an agreement between a State and the Centre. Where a State has entered into that arrangement, the scheme runs there, with the State sharing in the cost and the delivery. Where it has not, the scheme does not reach residents of that State however eligible they would otherwise be.
That is a political and administrative matter rather than anything about you, and it is the one obstacle on this page that no amount of paperwork overcomes. A family in a non-participating State is not failing a test; there is simply nothing there to join.
Which is why this page starts every assessment with the State rather than with the household. It is the fastest way to establish whether there is a conversation to have at all.
Check the State first, always. Implementation depends on a State agreement, not on national coverage. Where there is no arrangement, no amount of eligibility or paperwork helps, and establishing that takes one question.
The map changed recently, and a great deal of advice still circulating was written before it did.
The Ministry of Health and Family Welfare's compilation of its initiatives and achievements for 2025 records that PM-JAY was expanded to Delhi and Odisha in 2025, following memoranda of understanding with those States. Government broadcasting reported Odisha's implementation in January 2025.
For anybody in either State this is the whole story, because until then residents were outside the scheme entirely. Families who asked two years ago and were correctly told no have had no reason to ask again, and nobody writes to tell them the position changed.
It also explains a particular and avoidable failure we see: a person at a counter repeating what was true when they last looked. That is not dishonesty. It is an answer that has aged, given with confidence, and taken as final by somebody with no reason to doubt it.
Which is the argument for checking at the source rather than accepting a verbal no — and for checking again if the last time you asked was more than a year ago.
When a State implements the scheme, several things follow, and knowing them helps you understand what you are dealing with locally.
A State health agency takes responsibility for running it there: empanelling hospitals, processing claims, handling grievances. The scheme is national in design and State-operated in practice, which is why the experience of using it genuinely differs from one State to another.
States may also go beyond the national scheme at their own cost, extending it to additional families or adding to what it covers. So the version of the scheme available to a household is the national one plus whatever its State has added.
A practical consequence worth holding on to: where the question is about eligibility or the scheme's design, the national material answers it. Where the question is about a particular hospital, a particular claim or a particular grievance, the answer is with the State agency. Taking the second kind of question to the wrong place wastes weeks.
National in design, State in operation. Eligibility and the shape of the cover come from the national scheme. Empanelment, claims, grievances and any State-funded extension come from the State health agency. Match your question to the right one.
This is one of the strongest features of the scheme and it is underused because people do not know it exists.
The cover is portable. On the Authority's own description, a beneficiary may use any empanelled public or private hospital in India, not only one in the State where the card was made.
Think about who that serves. A family whose card was made in a village in Bihar, with a son working in Surat. A student in another State. A parent who falls ill while visiting a daughter in another city. Under a State-bounded scheme each of those is a problem; here none of them is.
It also matters for planned treatment. Where the specialist care somebody needs is not available locally, the cover travels with them to a hospital that has it, provided that hospital is empanelled.
The condition is empanelment, not geography. The question to ask of a hospital is never whether it is in your State; it is whether it is in the scheme.
The cover travels with the person. A card made in one State works at any empanelled hospital in India. For migrant families, students and anyone needing care not available locally, this is the feature that matters most.
Place Order — no advance, pay after work
Empanelment is the mechanism by which a hospital agrees to treat beneficiaries under the scheme and be paid for it. A hospital is either in or out, and nothing else about its reputation or size changes that.
The Ministry records 32,574 empanelled hospitals as at 1 December 2025, of which 15,532 are private. We give the date with the figure deliberately, because empanelment changes continually in both directions and an undated number on this subject is close to useless.
The scale is worth pausing on, because it answers a scepticism people often bring: that this is a scheme on paper with nowhere to use it. Thirty-two thousand hospitals is not a pilot.
But the national figure tells you nothing about your own district, which is the only number that matters to a family. A State may have many empanelled hospitals and few near you, or the nearest one may not perform the treatment you need.
So treat the national figure as reassurance about the scheme and the local list as the actual research task, dealt with two sections below.
A national figure is not a local answer. 32,574 hospitals as at 1 December 2025 tells you the scheme is real. It tells you nothing about what is empanelled within reach of your house, which is the only question that matters on the night.
A persistent assumption is that this is a Government-hospital scheme and that the card buys you a place in a queue you were already in. The figures say otherwise.
Of the 32,574 empanelled hospitals the Ministry records as at 1 December 2025, 15,532 are private. Nearly half. The scheme deliberately brought private capacity in, because public capacity alone could not carry the caseload.
For a family that changes the practical meaning of the card considerably. It is not only access to a Government hospital; it is access to a private hospital that has agreed to treat scheme beneficiaries at scheme rates, cashless.
Two cautions, though. A private hospital being empanelled does not mean every private hospital is, and the well-known one near you may not be. And empanelment can be for particular specialities rather than everything the hospital does.
Which returns to the same discipline: check the specific hospital, not the category.
Nearly half the network is private. 15,532 of 32,574 empanelled hospitals as at 1 December 2025. The card is not only a queue in a Government hospital — but the particular private hospital you have in mind still has to be checked.
This is the single most useful hour a family can spend on this subject, and almost nobody spends it.
Find out which hospitals within reach of your home are empanelled. Not in general terms — by name. Write the list down, with addresses and telephone numbers, and put it somewhere another member of the household could find it without you.
Do it because the moment the information is needed is the moment nobody is in a state to look for it. Somebody is being taken to hospital, the family is frightened, and the decision about which hospital gets made in a car on the basis of whichever is nearest or whichever somebody has heard of. That decision determines whether the scheme is usable at all for that admission.
It is also worth refreshing. Empanelment changes, and a list made three years ago may include a hospital that has left the scheme and omit one that has joined.
If you do one thing after reading this page and never contact anybody, do this one.
An hour, no cost, enormous value. List the empanelled hospitals within reach, by name, with addresses and numbers. Put the list where a relative could find it without you. Refresh it yearly. The night it matters is not a night for research.
This happens, and the first thing to establish is which of two quite different situations you are in.
If the hospital is not empanelled, it is not refusing anything. It has no arrangement with the scheme, it will not be paid under it, and it cannot treat you as a beneficiary. There is no grievance here, only a hospital outside the scheme. The answer is a different hospital, where that is clinically possible.
If the hospital is empanelled and is declining to treat an eligible beneficiary under the scheme, that is a different matter entirely and there are channels for it: the scheme's own grievance mechanism and its helpline, and the State health agency that runs empanelment in that State.
Those two situations look identical from the reception desk and they are not. Establishing which one you are in is the first question, and it is answerable in a minute.
What we would say plainly is that we have no standing in either. No one outside the scheme can oblige a hospital to admit a patient under it. Where that is being offered in exchange for money, the influence being sold does not exist.
Two situations that look the same. A hospital outside the scheme is not refusing you — there is nothing to refuse. An empanelled hospital declining an eligible beneficiary is a grievance, with channels. Establish which before you argue.
Place Order — no advance, pay after work
Cashless is the feature that makes this scheme useful to the households it was built for, and it is worth being precise about.
On the Authority's description, treatment is cashless at the point of service. The beneficiary does not pay the hospital and then seek reimbursement; the hospital is paid under the scheme. For a family without money on the night, that difference is the whole point — a reimbursement scheme is of no use to somebody who cannot pay the bill in the first place.
Where it stops is at the boundary of what the scheme covers. Treatment within the covered packages is cashless. Anything outside them is not, and that is where families get an unexpected bill: an item, a service or a period of care that falls outside what the scheme pays for.
So the question to ask at admission, and to keep asking, is not whether the hospital accepts the card. It is whether this treatment is being provided under the scheme. Those are different questions and the second is the one that determines what you pay.
Ask it early, ask it of somebody who deals with the scheme at that hospital rather than at the reception desk, and ask again if the treatment plan changes.
Ask the second question, not the first. “Do you accept the card?” is answered yes while a bill accumulates. “Is this treatment being provided under the scheme?” is the question that decides what you pay.
Place Order — no advance, pay after work
This is the design feature that disappoints more cardholders than anything else, and it is better understood in advance than at a clinic.
The scheme covers secondary and tertiary care hospitalisation. It is built around being admitted. A card does not pay for a doctor's appointment, a routine test taken on its own, or ongoing medication for a condition managed at home.
People reasonably expect a health card to do those things, because a commercial policy with outpatient cover does, and because the phrase "five lakh of health cover" sounds general. It is not general; it is specific to admission.
Seen in the light of what the scheme was for, the logic is clear. It targets the events that destroy household finances — surgery, intensive care, a cancer or cardiac episode — rather than the ordinary cost of being unwell.
Knowing this prevents a particular kind of disappointment: a family that treats the card as a general health benefit, finds it does not pay for a consultation, and concludes the scheme is useless. It is not useless. It is aimed at something else.
An admission is not an isolated event, and the scheme recognises that with two windows around it.
On the Authority's description, cover extends to pre-hospitalisation expenses for up to three days before admission and post-hospitalisation expenses for up to fifteen days after discharge, including diagnostics and medicines within those periods.
Those windows are more useful than they first appear. The tests that establish the need for admission frequently happen in the days immediately before it, and the medicines and follow-up after discharge are a real cost that families often pay without realising they did not have to.
The practical instruction is simple: keep everything. The diagnostic reports and bills from the days before admission, and the prescriptions and bills from the fortnight after. Families routinely discard these and then cannot claim the part of the cost that was covered.
And note the asymmetry. Three days before is short, which means a test done a week earlier sits outside. Fifteen days after is longer, which covers most immediate follow-up but not a course of treatment running for months.
Keep the paperwork from both windows. Three days before admission: the diagnostics that led to it. Fifteen days after discharge: the medicines and follow-up. Both are within cover and both are routinely paid for by families who did not know.
Of everything in this scheme, this provision is the one that most clearly separates it from a commercial policy, and it is the reason the scheme matters to exactly the people commercial cover fails.
The Authority states that pre-existing conditions are covered from the first day. There is no waiting period, no exclusion for a condition that existed before the card, and no declaration process by which somebody decides whether to accept your risk.
Consider who that serves. A person with diabetes or a heart condition approaching seventy is, in commercial terms, close to uninsurable: either refused, or offered cover at a price that makes no sense, or offered cover that excludes the one thing likely to put them in hospital. Here the condition is covered immediately.
This is also why the argument that a household "already has insurance" misses so badly. The existing policy frequently excludes the pre-existing condition, or has a waiting period still running, or excludes the eldest member entirely. The scheme has none of those gaps.
If somebody in your household has been told they are difficult to insure, that is a reason to check this entitlement, not a reason to assume it will be the same answer.
Covered from the first day, with no waiting period. The people commercial insurers refuse, price out, or cover with the one relevant condition excluded are precisely the people this provision is for.
Place Order — no advance, pay after work
The Authority states that there is no limit on family size, age or gender. Each of those three has a practical consequence.
Family size. Commercial cover prices by head and most floater policies cap the number of members. A household of nine is an expensive proposition commercially and is not treated differently here. For joint families this is a substantial difference.
Age. There is no upper age at which a member falls out, which is the opposite of the commercial position, where the oldest members become uninsurable precisely when they most need cover.
Gender. Stated expressly, and worth stating because in practice the person most often left off a household's arrangements is a woman — a daughter-in-law, an elderly mother, an unmarried daughter.
Which turns the real question around. It is not how many people are allowed on the card. It is who is actually recorded as a member of the household, and that is a records question that this page returns to at length, because it is where the failures are.
The scheme does not pay an open-ended bill. It pays defined packages: specified treatments and procedures, each with a rate attached.
The Ministry's material on the senior citizen entitlement refers to cover for around two thousand medical procedures, which gives a sense of the breadth without being a list anybody should plan around.
Two consequences follow for a family. First, what is covered in a given case depends on which package the treatment falls into, and that is determined by the scheme and the treating hospital rather than by the patient. Second, the rate for a package is the rate; a hospital treating under the scheme is treating at scheme rates.
We deliberately do not reproduce any package list on this page. They are long, they are revised, and a stale package list is actively dangerous because a family may plan a treatment around a rate that no longer applies.
Where the question is whether a specific procedure is covered, the answer comes from the hospital's scheme desk, before the treatment, in writing if possible.
No package list appears on this page, on purpose. They run to thousands of entries and they are revised. A family planning a treatment around a rate copied from an old list is planning around a number that may no longer exist.
Being clear about the boundaries is more useful than listing everything inside them, and three boundaries account for most of the surprises.
Outpatient care. The scheme is built around admission. Consultations, routine tests outside the pre-admission window and ongoing medication at home are outside it, and the next section says where they sit instead.
Anything outside the packages. A treatment that does not correspond to a package the scheme pays for is not covered, whatever the card says and however ill the patient is.
Treatment at a hospital that is not empanelled. No empanelment, no cover. This is absolute and it is the reason the hospital list matters so much.
We are not going to attempt an exhaustive exclusions list, for the same reason we do not print packages: it would be long, it would be partly wrong, and a family would rely on it. What we can say is that the three boundaries above explain nearly every unexpected bill we see.
Three boundaries, and most surprises sit on one of them. Outpatient care. Treatment outside the scheme's packages. And any treatment at a hospital that is not empanelled, which is absolute.
Having said what the scheme does not do, it is fair to say where the rest of it was meant to go, because this is a design and not an omission.
The Authority places outpatient and preventive care with Health and Wellness Centres rather than with this scheme. The broader Ayushman Bharat programme has two arms: one aimed at primary and preventive care close to where people live, and this one, aimed at the expensive hospital episode.
Knowing that answers the complaint fairly. It is not that nobody thought about outpatient care; it is that it was put in a different place, delivered differently, rather than funded through a five lakh hospitalisation cover.
For a household the practical upshot is to stop expecting one card to do both jobs. The card is for admission. Ordinary care has a different route, and a family's commercial policy, where it has one, may well cover more of it than this does.
Two arms, one programme. Primary and preventive care sits with Health and Wellness Centres; the hospital episode sits here. Expecting one card to do both jobs is the source of the complaint, not a gap in the design.
Medicines and diagnostics are covered, and the limit is not what they are but when they happen.
Inside an admission they form part of the treatment. In the three days before admission and the fifteen days after discharge they are covered within those windows. Outside those windows they are not, however directly they relate to the same condition.
That timing rule produces a specific and common disappointment. A patient discharged after a cardiac admission is often on medication for months or years. The first fortnight is within cover. Month three is not, and the condition has not changed.
The same applies to monitoring. Follow-up tests inside fifteen days are within the window; the same test at six weeks is not.
So the practical advice is to collect and claim everything inside the windows, and to budget honestly for the ongoing cost outside them. Families who assume the card carries a chronic condition indefinitely are planning on something that was never offered.
The limit is timing, not category. Medicines and tests are covered inside the admission and inside the two windows around it. The same medicine in month three is not, and the condition has not changed. Budget for that honestly.
A household holding both this entitlement and a commercial policy has a decision to make at each admission, and it is worth thinking about before one happens.
They are not mutually exclusive. As set out earlier, holding private cover does not disqualify anybody. What has to be decided, in a given case, is which to use.
Some considerations point one way. The scheme is cashless at the point of service and does not exhaust a commercial sum insured, and using it preserves a no-claim position on the policy. Where the treatment falls squarely inside a covered package at an empanelled hospital, it is frequently the obvious choice.
Others point the other way. A commercial policy may allow a hospital that is not empanelled, or cover a treatment the scheme's packages do not reach, or avoid the scheme's rate constraints where a family wants a standard of accommodation the scheme does not fund.
This is not a decision we make for anybody, and it is one where the hospital's scheme desk and the insurer both have information you need. Where the policy's own nomination and documentation side needs attention, our insurance nomination page deals with it.
Not either-or, but a choice per admission. The scheme preserves your policy's sum insured and is cashless. The policy may reach a hospital or a treatment the scheme does not. Decide per admission, with both the hospital desk and the insurer consulted.
Place Order — no advance, pay after work
People picture a plastic card and treat obtaining it as the whole task. It is better understood as a record with a printable representation.
What matters is that you exist in the scheme's records as a beneficiary, with your details recorded correctly and verifiable against an identity document. The printed or downloaded card is how that record is carried about and shown.
That distinction has a practical consequence. A card that has been lost is a nuisance and not a catastrophe, because the underlying record is intact and the card can be produced again. A record that is wrong is a real problem, and reprinting the card does nothing about it.
So when something fails, the question is always whether the card is missing or the record is defective. Those have completely different fixes, and families spend weeks reprinting a card when the record underneath it was never right.
The card is a representation; the record is the thing. A lost card is reprintable. A wrong record is not fixed by reprinting, and that is the mistake families make for weeks before anybody tells them.
Before any attempt to make a card, establish whether the entitlement exists, because everything after that depends on it.
The scheme publishes its own way to do this: a citizen portal, the Ayushman application, and a helpline on 14555. All three are free and none requires going anywhere.
Check each member of the household separately. This is the instruction people most often ignore and it matters more than any other on this page, because the answer genuinely differs within one family — most obviously where one member is seventy or above and qualifies on a basis that has nothing to do with the rest.
Record what each check returned and when. If you later need to argue that somebody is eligible, or to work out what changed, a note of the result and the date is worth having.
And treat a negative result as the beginning of a question rather than the end of one. The next sections are largely about why a check returns nothing when the entitlement is in fact there.
Member by member, not household by household. The answer differs inside a family, particularly where somebody is seventy or above. Check each person, note the result and the date, and treat a no as a question rather than an answer.
On the Ministry's own account there are three routes, and which is easiest depends almost entirely on the state of your identity records.
At an empanelled hospital. Useful because the people there do this constantly and because it is the route available when somebody is already being admitted. It is also the route that requires travelling to a hospital.
Through the Ayushman application, which offers self-verification. Convenient where the verification completes cleanly, and frustrating where it does not, because a failure gives you very little to work with.
Through the beneficiary portal at the scheme's own address, which is the same exercise in a browser.
There is also, in practice, assisted help at common service centres, and that is where families are most often overcharged — so if you use one, remember that the card is free and that anything charged is for assistance rather than for the card.
Our advice for a straightforward case is to try the self-service route first, because it costs nothing and tells you within minutes whether your records are in order. If it fails, you have learned something useful.
Three routes. An empanelled hospital, which is also the emergency route. The scheme's application, with self-verification. The beneficiary portal. Try the free self-service route first — a failure there tells you the records need attention.
Place Order — no advance, pay after work
The Ministry records that the National Health Authority launched the Ayushman application, offering self-verification and several modes of authentication.
Self-verification is a genuine improvement, because the old pattern required a trip to somebody with access to the system. It also moves the failure point: instead of a clerk telling you something is wrong, an application tells you nothing much at all.
Several authentication modes exist, and where one fails another may succeed. A household that gives up after the first failure frequently had an alternative available.
Two practical points. The identity record the verification works against has to be in a usable state, and the next section is about what that means. And an elderly applicant may find the process difficult for reasons that have nothing to do with eligibility — which is precisely the group with the strongest entitlement, so it is worth a younger relative sitting with them.
If one authentication mode fails, try another. Several exist, and households regularly abandon the attempt after the first failure. And sit with an elderly applicant — the group with the strongest entitlement has the hardest time with the process.
Verification is where applications stall, and understanding what it is doing makes the failures intelligible.
It is matching you, as a person presenting yourself, against a record the scheme already holds or can reach. That match depends on your identity record being accessible and on the details agreeing.
So the things that break it are the things that break any identity match: a name recorded differently in two places, a date of birth that disagrees, a mobile number that is no longer yours so a one-time password goes nowhere, biometrics that will not read.
None of those is about eligibility. All of them produce an outcome that feels like a refusal.
Which is the argument for getting the identity record into a usable state before attempting this rather than discovering its defects here. Our Aadhaar update page sets out what can be changed, how often, and the limits worth knowing before you spend one of them.
Where self-service does not work, assisted help is the fallback, and the two main kinds behave differently.
An empanelled hospital does this routinely and has staff whose job includes it. The advantage is competence and the ability to resolve problems on the spot; the disadvantage is that you have to go there, and it is busy.
A common service centre is more convenient and more variable. Some are excellent. Some will tell you confidently that your State is not in the scheme when it is, as the Delhi position in 2025 showed. And some will charge for something free.
On charging, be clear with yourself about what is being paid for. A centre may legitimately charge a small assistance fee for its time where one is prescribed. It cannot charge you for the card, because the card has no price.
If a figure is quoted that feels like a service price rather than a small fee, that is the moment to ask what exactly it is for, and to remember that the alternative is a free attempt from your own phone.
A fee for assistance is not a fee for the card. The card costs nothing. Where a centre quotes a figure that sounds like a price rather than a small charge for help, ask precisely what it is for — and remember the free alternative.
This group has the strongest entitlement and frequently the hardest time exercising it, which is an unfortunate combination worth planning around.
The entitlement itself is simple: seventy or above, covered, irrespective of economic status. What has to be established is age and identity, and in principle nothing else.
The practical difficulties are not legal. Biometric verification is harder for older people, whose fingerprints degrade. The registered mobile number on an identity record is frequently a son's or daughter's old number. And the application process assumes a comfort with a smartphone that many in this group do not have.
So the realistic approach for a family is for a younger member to do this with the elderly person present, rather than for the elderly person to be handed a leaflet. And where biometric authentication fails repeatedly, assisted enrolment at a hospital is usually the better route than persisting.
One more thing to check at the outset: whether that person is already in CGHS, ECHS or Ayushman CAPF, because if so the choice discussed earlier arises before anything else does. The senior citizen card page deals with the other entitlements that attach to this age group.
Plan around the practical, not the legal. The entitlement is simple. Degraded fingerprints, an old mobile number on the identity record and unfamiliarity with the app are the real obstacles — so a younger relative should run it, with the elderly person present.
Place Order — no advance, pay after work
Making the card is not the end of the task, and the five minutes after it is issued are the most valuable five minutes in this whole exercise.
Read it. Check the name, character by character, against the identity document it will be presented with. Check the date of birth. Check the address if one appears. And above all, check who is listed — every member of the household who is supposed to be covered.
Then store it where it can be found by somebody other than you. A card on one person's phone is a card unavailable when that person is the patient. Keep a printed copy somewhere the household knows about, and a digital copy somewhere a relative can reach — a DigiLocker account is a sensible place.
And repeat the check after anything changes: a marriage, a birth, a death, a move, a change of name. Each of those alters the household and the card may not follow automatically.
A death deserves a line of its own, because families are dealing with a great deal at that point and this is not where their attention is. The household record should be brought up to date, and separately the paperwork a death generates runs on its own documents — the death certificate first, and then, depending on what has to be claimed or transferred, a legal heir certificate or a survivor certificate. Those pages deal with each. None of it is an Ayushman question, but all of it tends to arrive at the same moment.
Five minutes, immediately. Read the name against the identity document. Check the date of birth. Check every member who should be on it. Store it where somebody other than you can reach it. Repeat after any change in the household.
The commonest obstacle on this entire subject is not eligibility. It is a name recorded two different ways.
It happens for ordinary reasons: a spelling that shifted between a school record and an identity record, an initial expanded in one place and not another, a transliteration between scripts, a surname taken or dropped after a marriage, an operator's typing error at an enrolment camp a decade ago.
None of that is anybody's fault and all of it stops a verification, because the system is matching strings and two strings that differ do not match.
The fix is to make the records agree, and the decision about which record to change is the important one. It is not automatically the identity record, and easiest is the wrong basis for choosing. A few fields on that record move only a handful of times before the door shuts for good, and burning one of them to get past a portal check is a bargain you will still be living with when nobody remembers why it was made.
If the two records at odds are a tax one and an identity one, that particular pair has its own trap and its own page: see PAN and Aadhaar mismatch. If the name was changed lawfully at some point, the name change page lays out which record to move and in what order.
Do not change whichever record is easiest. Work out which one is actually wrong. Some identity fields move only a limited number of times in a lifetime, and a scheme verification is a poor reason to spend one.
Beyond names, the identity record causes three other failures here, and all three are invisible from the scheme's side.
The mobile number. Verification frequently depends on a one-time password, and a record carrying a number the household no longer has is a closed door. This affects elderly applicants disproportionately, because the number registered is often a relative's old one.
Biometrics. Fingerprints degrade with age and manual work, and a record whose biometrics will not read cannot be used to authenticate the person it belongs to. That is circular and genuinely difficult.
A locked record. Some holders have security settings switched on, sometimes years ago and forgotten, which prevent authentication entirely without any useful error.
All three are fixed at the identity authority rather than at the scheme, and all three are worth checking before anybody attempts a card. Our Aadhaar update page covers each.
Three invisible blockers. A mobile number nobody holds any more. Biometrics that will not read. A security setting switched on years ago and forgotten. None of them reports itself clearly, and all three are fixed somewhere other than the scheme.
This failure is quiet, it is common, and it surfaces at the worst possible time.
The scheme works on households. Where the household record it relies on does not list somebody — a daughter-in-law who joined after it was compiled, a child born since, an elderly parent who moved in, a member simply omitted — that person is not covered, even though the family is.
Nothing announces it. The card exists, the family believes everybody is covered, and the gap is discovered when the uncovered person is the one being admitted.
So the instruction is the one in the section above: read the card and check every name, and do it when the card is made rather than later. Where somebody is missing, that is corrected through the scheme's own process, and the evidence of the relationship is what the correction runs on.
What proves a relationship varies, but the documents usually in play are the ones that establish a household: a ration card, a birth certificate for a child, a marriage certificate for a spouse. Those pages deal with obtaining each.
A card that omits somebody fails silently for them. Nothing warns the family. The discovery happens at admission, for the one person it was most needed for. Read every name the day the card is made.
This is the most dispiriting result and the most misread, so it is worth separating what it can mean.
It can mean you are genuinely outside the scheme's beneficiary base. It can mean the scheme is not implemented in your State. It can mean your details do not match the record. It can mean the household record does not include you. Or it can mean the particular search you ran was not the one that would have found you.
Only the first two are real exclusions. The remainder are matching problems, and they are fixable.
So the sequence is: confirm the State is in the scheme; try the other search criteria the portal offers, since households are findable by more than one identifier; check the details you are entering against the identity record exactly rather than from memory; and only then treat it as a possible exclusion.
What a not-found result is not is a determination. Nobody has assessed you. A search failed, which is a different event, and treating it as a verdict is how eligible families end up outside a scheme they belong to.
Place Order — no advance, pay after work
Occasionally a card exists with somebody else's details attached, or a household member's card carries particulars belonging to a different person. It is uncommon and it needs dealing with immediately.
Two things can produce it. A data error in the underlying records, where two people have been conflated — frequently a shared name within an extended family. Or an enrolment done carelessly, with details taken from the wrong document.
Either way it is corrected through the scheme's own process rather than by ignoring it, and ignoring it is the tempting option because the card appears to work.
It does not work when it matters. At admission the hospital verifies the beneficiary against the record, and a mismatch between the patient in front of them and the record behind the card is exactly the situation that stops an admission under the scheme.
Raise it as soon as it is noticed, through the scheme's grievance channel or the helpline, and keep a note of when you raised it and with whom.
A wrong card appears to work until it matters. The mismatch between the patient and the record behind the card is found at admission, which is the one moment there is no time to correct it. Raise it the day you notice.
Knowing the shape of this in advance removes a great deal of fear, and lets a family do the right things in the right order.
At an empanelled hospital, the patient is identified as a scheme beneficiary, the hospital's scheme desk verifies that against the records, and the treatment is taken forward under the scheme where it falls within a covered package. Payment goes to the hospital rather than through the family.
Two things are worth doing as early as possible. Tell the hospital at the outset that the patient is a beneficiary, rather than mentioning it later when a bill is forming — a hospital that begins treatment on a paying basis does not always convert it afterwards. And ask specifically whether this treatment is being provided under the scheme, which as set out earlier is a different question from whether the card is accepted.
Carry the card and the identity document it was made against. A family arriving with neither, asking a hospital to find a record from a name, is making a simple step difficult at the worst moment.
And identify who at the hospital handles the scheme. Reception is not that person, and the answers that matter come from the scheme desk.
Four things at the door. Say the patient is a beneficiary before treatment starts, not after a bill forms. Carry the card and the identity document. Ask whether this treatment is under the scheme. And find the hospital's scheme desk, which is not reception.
If an empanelled hospital declines to treat an eligible beneficiary under the scheme, there are routes, and it is worth knowing them before you are standing there.
First establish the facts rather than arguing. Is this hospital empanelled, and is the refusal about the scheme generally or about this particular treatment not being in a covered package? Those produce different conversations and the second is frequently the real answer.
If it is a genuine refusal to honour the scheme, the channels are the scheme's grievance mechanism and its helpline on 14555, and the State health agency that handles empanelment in that State. Use them at the time rather than afterwards, because a complaint made during an admission can be acted on and one made a month later usually cannot.
Record what was said, by whom and when. That record is the whole of your evidence and nobody will create it for you.
We have no standing here and we will not pretend otherwise. Nobody outside the scheme can compel a hospital, and where that is offered in exchange for money, what is on sale does not exist.
Complain during, not after. A grievance raised while the admission is live can be acted on; the same grievance a month later usually cannot. Record who said what and when, because that record is your only evidence.
Grievances here go to the scheme, and knowing which part of it saves time.
The helpline on 14555 is the general entry point and is the right first call for most things: an eligibility question, a card problem, a refusal at a hospital.
The State health agency administers the scheme in your State, which means empanelment, claims and conduct of hospitals there. A complaint about a particular hospital belongs with them.
And the scheme operates its own grievance mechanism for matters requiring a formal response.
What belongs nowhere in that list is a complaint about the standard of medical treatment. That is a wholly different subject with a different forum and different evidence, and our medical negligence complaint page is where it is dealt with. Sending a clinical complaint to a scheme helpline wastes months, and the distinction is worth getting right at the outset.
Match the complaint to the body. The 14555 helpline for eligibility, cards and refusals. The State health agency for a particular hospital's empanelment and conduct. The scheme's grievance mechanism for a formal response. And a clinical complaint belongs to none of these.
Place Order — no advance, pay after work
Place Order — no advance, pay after work
This page has been positive about the scheme because the facts warrant it. It would be dishonest to leave the limits out.
Nobody can promise that a particular treatment will be covered. That depends on the scheme's packages and on the treating hospital's assessment, and neither is within the control of any documentation service.
Nobody can promise a hospital will admit a patient under the scheme. Empanelment creates an arrangement; it does not create a right enforceable at a reception desk by a third party.
Nobody can promise a timeline. Card issue depends on verification, and verification depends on records none of us controls.
And nobody can promise eligibility. We can establish what the published criteria say and find out what the records show. We cannot make somebody eligible who is not, and anyone saying otherwise is describing a service that does not exist.
Four promises nobody can honestly make. That a treatment will be covered. That a hospital will admit under the scheme. That a card will arrive by a date. And that somebody not eligible can be made eligible.
A distinction worth stating because the two get tangled in families' minds under stress.
What treatment somebody needs is a clinical question answered by doctors. Whether that treatment is paid for under the scheme is an administrative question answered by the scheme's packages and the hospital's scheme desk. They are separate, and the second never determines the first.
We mention it because a family under financial pressure can start reasoning backwards — asking what is covered and letting that shape what treatment is sought. That is an understandable instinct and a bad one.
The right order is to establish what is clinically needed and then find out how it is paid for. If a gap appears, that is a real problem to be solved, and it is solved better by knowing its true size than by quietly narrowing what is asked for.
Our work on this subject is documentation and entitlement. It stops well short of anything medical, and the boundary is not a formality.
We do not advise on what treatment to seek, which hospital is better clinically, whether a proposed procedure is appropriate, or whether a diagnosis is right. We are not qualified to and we will not be drawn into it, including by a family who would like somebody to tell them what to do.
What we can do is establish entitlement, sort the records, get the card made, and explain how the scheme works so that a family can make their decisions knowing what is available to them.
Where a clinical question needs answering, it needs a doctor, and ideally a second opinion where the stakes are high. Where a complaint about care needs making, it needs the proper forum and proper evidence.
If somebody is seriously unwell right now, this page is not the thing to be reading, and we would rather say so plainly than have it read as though it were.
Get the person to a hospital. Treatment is the priority and no hospital will decline emergency care while somebody works out a card. The documentation can be sorted alongside, and an empanelled hospital is itself one of the routes by which a card can be made.
What a family can usefully do in that situation is tell the hospital at the outset that the patient may be a scheme beneficiary, so that the hospital's scheme desk is involved from the beginning rather than after a bill has formed.
Everything else on this page is for a quiet week. That is the whole argument of the final section: this is easy work done early and very hard work done late, and the difference is entirely a matter of when it is started.
If somebody is seriously unwell, stop reading and go. Treatment first. Tell the hospital at the outset that the patient may be a beneficiary so its scheme desk is involved early. The rest of this page is for an ordinary week.
Every figure on this page is one the Government published, with the date it attached to it, and that restriction is deliberate.
We have not printed a list of participating States, a list of empanelled hospitals, a package list, or any figure for what a given treatment costs or recovers. Each of those changes, and on a scheme this size they change constantly.
We have also not printed figures from the large secondary literature on this subject, much of which is published by parties with an interest in selling health insurance or in charging for a free enrolment. A number without a source and a date, on this topic, is worth nothing.
Where we could not establish something from Government material, we have left it out rather than guessing. There are gaps in this page for that reason and we would rather have them than fill them badly.
Four things deliberately absent. A list of States. A list of hospitals. A package list. And any figure for what a treatment costs. All four change, and a stale version of any of them sends a family somewhere expecting something that is not there.
The scale figures in this page — cards created, hospitals empanelled, admissions authorised — are worth reading carefully rather than as reassurance.
What they do establish is that this is a functioning scheme at national scale. Roughly 42.48 crore cards created and 10.98 crore admissions authorised, as at 1 December 2025, is not a programme that exists on paper.
What they do not establish is anything about your district, your nearest hospital, or your admission. A national total is an average over enormous variation, and the experience of using the scheme differs by State and by hospital.
Nor does a card figure tell you how many of those cards are correct, or list every household member, or belong to people who know they have one. Our own experience is that a material share of the problems we see involve cards that exist and do not work.
So read the numbers as evidence the scheme is real, and do your own local work anyway.
What a national total proves and does not. It proves the scheme functions at scale. It says nothing about your district, your nearest hospital, or whether the card in your drawer lists everybody it should.
This is worth saying directly, because it is true of everything written about a scheme and rarely admitted.
A programme of this size changes continually. States join. Hospitals are empanelled and removed. Packages are revised. Entitlements are extended, as the seventy-plus expansion in October 2024 shows. Processes change, as the launch of the application did.
Which means a page like this one is accurate as at the material it cites and will drift afterwards. We have attached dates to the figures precisely so that a reader can see how old each is and judge for themselves.
The practical instruction that follows is the same one running through this page. Where something matters to a decision, check it at the scheme's own source on the day. And in particular, if you were refused more than a year ago, ask again, because a refusal that was correct then may not be correct now — which is exactly what happened to households in Delhi and Odisha.
There is a line on this work and it is worth stating before anybody asks.
We will not state a household composition that is not accurate, add a person to a family record who does not belong to it, or present circumstances as other than they are in order to bring somebody inside the criteria.
The temptation exists and we understand where it comes from: a family just outside the criteria, facing a cost they cannot meet, with a neighbour inside. That is a genuinely hard situation and it is not solved this way.
It is a Government health scheme with verification at admission. An application resting on something untrue fails at the point it is most needed, which is the worst possible place for it to fail, and the consequences attach to the family rather than to anybody who helped them.
Where a household is genuinely outside the scheme, the useful work is finding what they are entitled to instead — a State scheme, another welfare route, the labour card or e-Shram entitlements where the work qualifies. That is a better use of everyone's time than a claim that will not hold.
An untrue application fails at admission. That is the one moment a family cannot afford a failure, and the consequence lands on them. Where a household is genuinely outside, the useful work is finding what it is actually entitled to.
Place Order — no advance, pay after work
The people who reach us about this fall into a small number of groups, and recognising which one you are in saves a conversation.
The largest is a family that has been told they are not eligible and suspects that is wrong. Usually they are right to suspect it, because the three misconceptions set out earlier in this page account for most of those refusals.
The second is somebody with a parent over seventy who has heard there is now something for them and does not know where to begin. That group has the strongest case of anyone, because the entitlement there does not depend on income at all.
The third is a family whose card exists but will not work: the name does not match, a member is missing, the system does not find them. That is a records problem rather than an eligibility problem and it is fixed somewhere other than the scheme.
And the fourth, which we would rather not receive, is somebody whose relative is already in hospital. We help where we can, but this is the one category where the honest answer is that the work should have been done earlier.
Four kinds of file. Told they are not eligible and probably are. A parent over seventy and nobody knows where to start. A card that exists and will not work. And somebody already admitted, which is the hardest of the four.
Place Order — no advance, pay after work
Four, and all of them are made long before anybody is ill.
The first is accepting a refusal without checking it. Somebody at a counter says the family is not eligible, and that is treated as the answer. It is one person's reading of a screen, and the published eligibility is checkable independently.
The second is leaving the card until it is needed. Everything on this page is easy in an ordinary week and hard in a bad one. A family making a card while a relative is being admitted is doing the hardest version of a simple task.
The third is making the card and never checking who is on it. A card that exists for the head of the household and omits two members is a card that will fail for those two, and nobody finds out until one of them needs it.
The fourth is assuming the hospital will sort it out. The hospital will do its part, which is at the point of admission. Everything before that — the eligibility, the card, the records agreeing — is the family's, and no hospital will do it retrospectively at two in the morning.
Four errors, all made in advance. Accepting a counter's refusal as the answer. Leaving the card until somebody is ill. Making a card and never checking who is listed on it. And assuming the hospital will handle what should have been done months earlier.
Three questions decide whether there is any work in this at all, and they come before everything.
Which State, and is anybody in the household over seventy. Those two facts between them decide most cases. The State decides whether the scheme operates where you live at all, and the age opens a door that income does not.
What exactly were you told, and by whom. There is a real difference between a search on a portal that returned nothing and a person at a desk saying you do not qualify. The first is usually a records problem. The second is frequently just wrong.
Does the household already have a card for anybody. Families often discover that one exists, made years ago, listing some members and not others. That changes the work from an application into a correction, which is a different and usually shorter job.
Three answers and we know the route. The State, and whether anyone in the household is over seventy. What was actually said, and by whom. And whether a card already exists for anybody in the family.
Before anything else, and before paying anybody for anything, check eligibility yourself. The scheme publishes a way to do it, there is a helpline number, and it costs nothing.
Do it for each member of the household separately rather than assuming the answer is the same for everybody, because it frequently is not — particularly where somebody is over seventy and the rest of the family is not.
If it comes back positive, you know the entitlement exists and the remaining work is the card. If it comes back negative, that is still useful, because the next question is whether the record is wrong rather than whether the entitlement is absent, and those have different answers.
What this check does not need is money, an agent or an office visit. Anybody charging to tell you whether you are eligible is charging for something the scheme gives away.
No cost, no visit, no agent. Check each household member separately through the scheme's own channels or its helpline. A positive answer settles the entitlement. A negative one tells you to look at the record rather than give up.
Place Order — no advance, pay after work
We begin with eligibility, member by member, because that is the question everything else depends on and because it is the one most often answered wrongly by somebody at a counter.
Where the entitlement exists, we establish why the card has not been made or why it is not working. Most of the time the obstacle is identity records rather than the scheme: a name spelled differently in two places, a member missing from a household record, a verification that will not complete.
We then prepare what is needed, get the card made through the proper channel, and check it afterwards — that it exists, that it names the right people, and that the details on it match the documents a hospital will ask for.
And we tell you where the limits are, which on this subject matters more than usual. There is a great deal we cannot promise here, and the section after next sets out what.
What you get. Eligibility established for each member rather than assumed for the household. The real obstacle identified, which is usually a records problem. The card obtained through the proper channel. And a check afterwards that it names the right people with the right details.
Our work ends when the card exists and is correct. It does not extend into the hospital.
We do not decide what treatment is covered, because that is determined by the scheme's own package list and by the treating hospital, not by us and not by any agent. We do not intervene in an admission. And we have no standing at all in a dispute between a patient and a hospital about what should have been treated as cashless.
Where something has gone wrong at the hospital, the routes that exist are the scheme's own grievance channels and its helpline, and the page has pointed at them rather than at us.
Where a complaint concerns the quality of treatment rather than the billing, that is a different matter entirely, with its own forum and its own evidence, and our medical negligence complaint page is where that belongs. It is not an Ayushman question and should not be approached as one.
Court work is for your advocate, whose fee is engaged and paid by you directly; we do not quote, collect or share it
Start with the part that matters most: the scheme itself is free. There is no fee for being eligible, no fee for the card, and no fee for treatment at an empanelled hospital. Anybody asking a family for money to make an Ayushman card is charging for something the Government provides at no cost.
Our charge is ₹499, over a working period of 3 – 15 days, and it is for the work around the card rather than for the card. It covers checking eligibility properly for each member, finding out why it has not worked where it has not, sorting the records that are blocking it, getting the card made through the proper channel, and verifying it afterwards.
If all you need is the eligibility check, do it yourself through the scheme's own channels. We would rather say that than take a fee for a lookup.
Outside our charge is anything needed to correct an underlying record at the authority that issued it, which is work at that authority and is charged by them if at all.
The scheme costs nothing. Ever. No fee for eligibility, the card, or treatment at an empanelled hospital. A family being asked to pay for the card itself is being charged for something free, and that is worth saying out loud in a village as much as in a city.
Place Order — no advance, pay after work
Every number on this page comes from material the Government publishes itself, and each is dated, because on a scheme like this an undated figure is worse than none.
That restriction is deliberate and it is worth explaining. This subject attracts an enormous volume of writing by people selling health insurance, by agents charging for free services, and by sites reproducing figures that were current three years ago. A family planning around one of those is planning around something that may never have been right.
So the figures here are the scheme's own, with their dates attached, and nothing else has been added. Where we could not establish something from a Government source, we have left it out rather than filled the gap.
And the dates are not decoration. A scheme of this size changes continually — States join, hospitals are added and removed, packages are revised. Every figure below should be read as true on the date given and checked if it matters to a decision.
For a household in unorganised work there is a second register worth being on, and it is the route through which several schemes including this one are now reached from a single platform. It costs nothing and it carries no renewal. Our guide to e-Shram card assistance covers who qualifies, the upper age limit that people quote and that does not exist, and why the card by itself pays nothing.
Everything on this page is a quiet-week task that becomes very hard in a bad week, and that is the whole of the practical advice.
Check whether your household is eligible. Check separately for anybody over seventy, because the answer there is different and does not depend on income. If the entitlement exists, make the card now, for every member, and look at it afterwards to confirm the names and the details are right.
Then find out which hospitals near you are empanelled, and keep that list somewhere a family member could find it without you. The moment it matters is the moment nobody is in a state to research anything.
None of this costs money and none of it takes long. It is simply the kind of task that never feels urgent until it is far too late to begin.
Place Order — no advance, pay after work
Tell us the State, who is in the household and what you were actually told. You will get an honest answer on eligibility for each person, and on whether the obstacle is the scheme or your records.
What the scheme is. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana provides, on the National Health Authority's own description, a cover of five lakh rupees per family per year for secondary and tertiary care hospitalisation. It operates as a family floater, so the sum is shared across the family rather than allotted per person. Treatment is cashless at the point of service and portable, meaning a beneficiary may use any empanelled public or private hospital in India rather than only one in their own State. The Authority states that there is no limit on family size, age or gender and that pre-existing conditions are covered from the first day. Eligibility for the original beneficiary base is described as the bottom forty per cent of poor and vulnerable families, identified using the deprivation criteria for rural households and occupational categories for urban households under SECC 2011, which the Authority puts at about twelve crore families, roughly fifty-five crore people. Eligibility can be checked through the scheme's citizen portal or its helpline, 14555.
★ The 2024 expansion that removed income from the question for one group. On 29 October 2024 the Prime Minister launched the Ayushman Vay Vandana card. Per the Ministry of Health and Family Welfare, it extends all benefits of the scheme to senior citizens aged seventy years and above irrespective of their socio-economic status, an estimated 4.5 crore families, about 6 crore individuals. Three features of it are repeatedly misreported and all three come from the Ministry's own release of 9 December 2024. First, a senior citizen in a family already covered under the scheme receives an additional top-up of up to five lakh rupees a year for themselves, rather than sharing the family floater. Second, holders of private health insurance are eligible, and so are members of the Employees State Insurance scheme — neither disqualifies anybody. Third, those already covered by CGHS, ECHS or Ayushman CAPF must choose between that scheme and this one; that is the only group facing a genuine either-or. The release records cover for around 2,000 medical procedures, pre-existing diseases covered from day one with no waiting period, and enrolment by visiting an empanelled hospital, through the Ayushman application, or at beneficiary.nha.gov.in, with a toll-free line on 14555 and a missed-call number 1800110770. Enrolment reached 25 lakh within two months of launch; the Ministry's later compilation records 94,19,515 enrolled.
★ The scheme now operates in Delhi and Odisha. The Ministry of Health and Family Welfare's compilation of initiatives and achievements for 2025, published in January 2026, records that PM-JAY was expanded to Delhi and Odisha in 2025 following memoranda of understanding with those States. Government broadcasting reported Odisha's implementation in January 2025 as the thirty-fourth State or Union Territory to join. This matters because implementation rests on a State agreement rather than applying automatically across the country, and because a great deal of advice still in circulation was written when these States were outside the scheme. Anyone relying on this page should confirm the current position for their own State rather than on a list, for the same reason this page does not print one.
The scale, as the Ministry states it, with its own date. As at 1 December 2025: approximately 42.48 crore Ayushman cards created; 32,574 empanelled hospitals, of which 15,532 are private; and 10.98 crore hospital admissions worth about 1.60 lakh crore rupees authorised. The same compilation records the launch by the National Health Authority of the Ayushman application, offering self-verification and several modes of authentication, and notes the earlier inclusion of ASHA and Anganwadi workers and helpers, about 37 lakh people, from February 2024.
What the cover reaches, and where it stops. The Authority describes cover for pre-hospitalisation expenses for up to three days before admission and post-hospitalisation expenses for up to fifteen days after discharge, including diagnostics and medicines within those windows. Outpatient care is not part of this cover; the Authority places outpatient and preventive care with Health and Wellness Centres rather than with this scheme. That single distinction — hospitalisation yes, consultation no — is the most common source of disappointment among people who hold a card, and it is a design feature rather than a refusal.
What this page deliberately does not state. There is no list of States, because implementation changes and a stale list sends a family to a hospital expecting something that is not there. There is no list of empanelled hospitals, because empanelment changes continually and the only reliable list is the scheme's own on the day you need it. There is no package or procedure list, because what is covered in a given case is determined by the scheme's own packages and by the treating hospital. And there is no statement about what any particular treatment will or will not attract, because that is a clinical and administrative question and not one any documentation service can answer.
Why only Government figures appear here. This subject carries an unusual volume of secondary writing, much of it published by parties selling health insurance or charging for a free enrolment. Figures circulate that were correct years ago, and some that were never correct. Everything above is taken from the Ministry of Health and Family Welfare and from the National Health Authority, each figure carrying the date the Government attached to it, so that any of it can be checked at source rather than taken on our word.
What sits on other pages. Where the obstacle is an identity record rather than the scheme, the correction belongs with that record and not here: our Aadhaar update page sets out the limits on changing those fields, and the pages on the income certificate, caste certificate, domicile certificate and ration card deal with the documents a household's status is usually evidenced by. A complaint about the standard of treatment rather than about coverage is a different matter with its own forum.
Court work is for your advocate, whose fee is engaged and paid by you directly; we do not quote, collect or share it
Two doors, both free. Clients search a factual directory of enrolled advocates. Advocates apply to be listed on it — no fee, no commission, nothing paid in either direction.
Search Bar Council enrolled advocates by what your matter is about, by court, or by city. Searching and sending a request are both free.
Enrolled advocates anywhere in India can apply to be listed. Your entry is published only after we verify your enrolment number with your State Bar Council.
Would rather not pick anybody? Tell us the matter instead — one form goes to every advocate at once, and the first to take it up calls you.
This directory carries no ratings, no reviews, no rankings and no fees — only the factual particulars the Bar Council of India permits, published at each advocate's own request. Browse the network · Terms for Advocates