PM-JAY Top-Up Insurance — Beyond ₹5 Lakh Coverage

PM-JAY and State Top-Up Health Insurance

PM Jan Arogya Yojana (PM-JAY) under Ayushman Bharat provides ₹5 lakh per family per year health insurance for BPL and socially vulnerable families. Many states have expanded this coverage with their own top-up schemes — increasing total coverage to ₹7 lakh, ₹10 lakh, or even ₹25 lakh.

This guide explains:

1. How PM-JAY works and who is eligible
2. State top-up schemes that go beyond ₹5 lakh
3. How to use your Ayushman card at empanelled hospitals

PM-JAY Core Benefits

State Top-Up Schemes (Beyond ₹5 Lakh)

Rajasthan's Chiranjeevi scheme is particularly notable — ₹25 lakh coverage per family per year for all registered families.

Who is Eligible for PM-JAY?

Eligibility is based on SECC 2011 (Socio-Economic Caste Census) data. You are eligible if:

• Your family is listed in SECC 2011 as a deprived rural or urban household
• You belong to one of 8 occupational categories (rickshaw pullers, domestic workers, construction workers, etc.)
• You are covered under a state government's integrated scheme (many states have expanded beyond SECC)

Check your eligibility immediately: Visit beneficiary.nha.gov.in or call 14555 (toll-free).

How to Get Your Ayushman Card

Option 1 — Ayushman App / Portal

1. Download Ayushman App from Play Store / App Store
2. Enter your mobile number (registered with Aadhaar)
3. Enter OTP
4. If eligible, download your Ayushman Card (e-card)

Option 2 — Common Service Centre (CSC)

1. Visit nearest CSC/Jan Seva Kendra
2. Provide Aadhaar number and mobile number
3. CSC operator verifies eligibility and prints the Ayushman card (free of cost)

Option 3 — At the Hospital

At any PM-JAY empanelled hospital, the PMJAY Help Desk can verify your eligibility and issue an e-card on the spot.

How to Use PM-JAY at a Hospital

1. Visit any PM-JAY empanelled hospital (look for the green Ayushman Bharat board)
2. Go to the PM-JAY Help Desk / Arogya Mitra
3. Show your Aadhaar + Ayushman card (e-card on phone is fine)
4. The Arogya Mitra verifies your eligibility in real-time via the PMJAY portal
5. For eligible procedures, you are admitted cashless — no money required
6. Hospital sends a pre-authorization request → NHA approves → treatment proceeds → hospital bills NHA directly

Frequently Asked Questions

1. I am eligible for PM-JAY but my name is not showing on the portal. What do I do?

Call the PM-JAY helpline: 14555 (toll-free). You can also visit your state health agency office or the CSC with your Aadhaar to verify and link your record.

2. My card shows ₹5 lakh. Is there a state top-up I can use?

Check with your state health department. In Rajasthan (Chiranjeevi), all families can register for ₹25 lakh coverage. In Chhattisgarh, state-linked coverage goes up to ₹20 lakh for serious conditions. These are handled separately from PM-JAY.

3. Can I use my PM-JAY card in another state?

Yes. PM-JAY is fully portable across India. You can get cashless treatment at any empanelled hospital in any state using your PM-JAY card.

4. Which diseases are NOT covered under PM-JAY?

PM-JAY does not cover: outpatient (OPD) expenses, cosmetic surgery, fertility treatments, organ transplant costs for the donor, and some rare conditions. Check the full package list at pmjay.gov.in.

5. I already had surgery this year. Can I use the ₹5 lakh again?

The ₹5 lakh limit is per family per year. If your total family's claims in the year exceed ₹5 lakh, additional expenses are out of pocket unless your state has a top-up scheme.

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