Free hospital treatment under Ayushman Card has changed how crores of Indian families deal with a medical emergency. A single card now covers hospitalisation costs of up to Rs 5 lakh per family every year at thousands of government and private hospitals across the country.
Most families still do not know how much the scheme actually covers, which hospitals accept the card, and what happens at the admission counter when a patient walks in. This guide explains the complete process in plain language, from checking eligibility and downloading the card to getting cashless admission, understanding what is excluded, and planning for the medical costs the card does not pay for. Whether you are applying for the first time or helping an elderly parent use the new senior citizen card, everything you need is covered below.
Ayushman Card at a Glance
The Ayushman Card is issued under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), the central government’s flagship health assurance scheme launched in September 2018. The card is the physical or digital proof that a family is registered under the scheme and can claim cashless treatment.
The table below summarises the key features so you can see the full picture before going into the details.
| Feature | Details |
|---|---|
| Scheme Name | Ayushman Bharat PM-JAY |
| Coverage Amount | Rs 5 lakh per family per year |
| Type of Cover | Cashless and paperless hospitalisation |
| Family Size Limit | No cap on family members |
| Age Limit | No age limit; separate card for citizens aged 70 and above |
| Pre-existing Diseases | Covered from day one |
| Hospitals Empanelled | Over 30,000 public and private hospitals |
| Treatment Packages | More than 1,900 medical and surgical procedures |
| Portability | Valid in any empanelled hospital in any state |
| Card Cost | Free of charge |
| Helpline | 14555 (toll-free) |
The Rs 5 lakh limit is a family floater. That means any member of the registered family can use the full amount, and the balance resets every financial year. There is no premium, no enrolment fee, and no waiting period, which is what separates this scheme from a regular health insurance policy.
Who Can Get the Ayushman Card
Eligibility is not based on income tax returns or salary slips. The scheme identifies beneficiaries through the Socio-Economic Caste Census (SECC) 2011 data, the older Rashtriya Swasthya Bima Yojana (RSBY) list, and additional categories added by state governments over the years.
You are likely eligible if your household falls into one of the following groups.
- Rural families listed under any of the SECC deprivation criteria, such as households with only one room and kutcha walls, no adult member between 16 and 59, female-headed households with no adult male earner, or households with a disabled member and no able-bodied adult
- SC and ST households identified in the SECC database
- Landless households earning most of their income from manual casual labour
- Urban families working in listed occupations such as ragpickers, domestic workers, street vendors, construction workers, plumbers, masons, painters, security guards, sweepers, sanitation workers, home-based artisans, transport workers, shop assistants, delivery staff, and mechanics
- Families that were previously enrolled under RSBY
- Every citizen aged 70 years or above, regardless of income, under the Ayushman Vay Vandana card introduced in October 2024
- Additional categories notified by individual states, such as ration card holders, ASHA and Anganwadi workers, and registered building and construction workers
Because states have expanded the list in different ways, many families who assume they are not eligible actually are. The fastest way to know is to check your name on the official beneficiary portal or through the Ayushman App using your mobile number or Aadhaar.
What Treatment Is Free Under the Card
The scheme is built around what are called Health Benefit Packages. Each package has a fixed rate that the hospital receives from the government, and the patient pays nothing for anything included in that rate.
The major treatment categories covered are listed below.
- Cardiology and cardiac surgery, including angioplasty, stenting, and bypass surgery
- Oncology, including chemotherapy, radiotherapy, and cancer surgeries
- Orthopaedics, including knee and hip replacement, fracture management, and spine procedures
- Neurosurgery and treatment of stroke and head injuries
- Nephrology, including dialysis and kidney-related procedures
- General surgery, including hernia, appendix, gallbladder, and abdominal operations
- Obstetrics and gynaecology, including caesarean delivery and high-risk pregnancy care
- Paediatric and neonatal intensive care
- Ophthalmology, including cataract surgery
- Burns, trauma, and emergency care
- Mental health inpatient treatment
- Treatment of infectious diseases requiring admission, including dengue, malaria, and tuberculosis complications
Expenses Included in Every Package
Once a patient is admitted under an approved package, the hospital cannot bill separately for the routine components of that treatment. The package rate is designed to cover the entire episode of care.
- Doctor and surgeon fees
- Room charges, general ward accommodation, and ICU charges where required
- Operation theatre costs and anaesthesia
- Medicines and consumables used during the stay
- Diagnostic tests and imaging linked to the treatment
- Implants such as stents, lenses, and joint prostheses within the approved package
- Food for the patient during admission
- Up to 3 days of pre-hospitalisation investigations and up to 15 days of post-hospitalisation medicines and follow-up
What the Card Does Not Cover
Understanding the exclusions matters just as much as knowing the benefits, because this is where families end up paying out of pocket.
- Outpatient consultations and OPD visits that do not lead to admission
- Routine diagnostic tests done without hospitalisation
- Cosmetic and aesthetic procedures
- Fertility treatment such as IVF
- Organ transplants in most states, unless specifically included by the state scheme
- Drug and alcohol de-addiction programmes in several states
- Private or deluxe room upgrades beyond the entitled ward
- Treatment at hospitals that are not empanelled under the scheme
The OPD gap is the biggest one in practice. Regular doctor visits, monthly medicines for diabetes or blood pressure, and standalone lab tests are not paid by the card. Families with chronic conditions should plan for these costs separately, which is discussed later in this guide.
Hospitals Where the Card Is Accepted
The card works only at hospitals that have signed an empanelment agreement with the National Health Authority or the respective State Health Agency. All government hospitals at the district level and above are automatically included, along with a large and growing network of private hospitals.
You can find an empanelled hospital in three ways.
- Search the hospital locator on the official PM-JAY portal by state, district, and speciality
- Use the hospital finder inside the Ayushman App
- Call the toll-free number 14555 and ask for empanelled hospitals near your location
Every empanelled hospital has an Ayushman Mitra help desk near the reception or admission area. This desk is the first point of contact for verifying your card, checking your available balance, and starting the pre-authorisation process. Look for the PM-JAY branding board at the entrance, which is mandatory for all empanelled facilities.
One point often missed is that empanelment can be speciality-specific. A private hospital may be empanelled for orthopaedics but not for cardiac surgery. Always confirm at the help desk that the specific treatment you need is covered at that hospital under the scheme.
How to Apply for the Ayushman Card
The application process has become almost entirely digital, and most eligible people can now complete it from a mobile phone in under 15 minutes. The steps below cover the self-registration route through the Ayushman App, which is the fastest option.
Step 1: Check your eligibility. Open the beneficiary portal or the Ayushman App and select the option to check eligibility. Enter your mobile number, verify with the OTP, and search using your Aadhaar number, ration card number, or name and district. If your family appears in the list, you are eligible.
Step 2: Download the Ayushman App. Install the official app from the Google Play Store. Log in as a beneficiary using your mobile number. Do not use third-party apps that ask for a fee, as the official process is completely free.
Step 3: Locate your family record. Select your state and scheme, then search your family using Aadhaar, family ID, or the PMJAY ID. The app will display all family members linked to the record and their card status.
Step 4: Complete Aadhaar e-KYC. Select the member whose card needs to be created and choose the Aadhaar OTP option. An OTP will be sent to the mobile number linked with that Aadhaar. Face authentication is also available for members whose mobile number is not linked.
Step 5: Upload a live photograph. The app will ask for a photo of the beneficiary taken through the phone camera. Make sure the face is clear and the background is plain, as the system compares this with the Aadhaar photograph.
Step 6: Fill in the remaining details. Enter or confirm the mobile number, category, pin code, and relationship to the head of the family. Review every field carefully before submitting, because corrections after approval take longer.
Step 7: Wait for approval. If the Aadhaar match score is high, the card is auto-approved within minutes. If manual verification is required, the state health agency reviews the request, which usually takes a few days.
Step 8: Download and save the card. Once approved, download the PDF from the app or portal. Save a copy on your phone and keep a printed copy at home. The digital version is fully valid at hospitals, so a physical print is only a backup.
If you are not comfortable with the app, the same process can be completed free of cost at any Common Service Centre (CSC), at the Ayushman Mitra desk of an empanelled hospital, or through your local ASHA worker during enrolment drives. Carry your Aadhaar card, ration card, and a mobile phone for OTP verification.
Getting Cashless Admission Step by Step
Having the card is only half the job. Knowing exactly what to do at the hospital ensures that the treatment actually goes through as cashless rather than turning into a reimbursement fight later.
- Go to the Ayushman Mitra desk before admission and show your card along with Aadhaar
- The desk staff will verify your identity through biometric or OTP authentication and check the family’s remaining balance for the year
- The treating doctor identifies the appropriate package, and the hospital raises a pre-authorisation request on the scheme’s transaction system
- For most packages, approval is automatic or comes within a few hours; complex cases may take up to 24 hours
- In emergencies, hospitals are permitted to start treatment first and complete the pre-authorisation afterwards
- During the stay, do not sign any document agreeing to pay extra charges without asking why the amount is not covered
- At discharge, the hospital submits the claim, and you should receive an SMS confirming the amount debited from your family limit
- Collect the discharge summary and keep it safely, as it is needed for post-hospitalisation medicines and any follow-up
If a hospital demands money for a covered procedure, you can call 14555 from the hospital itself. Complaints are recorded against the hospital, and repeated violations lead to de-empanelment. Many patients have received refunds simply by escalating on the spot.
Documents You Should Keep Ready
The scheme is designed to be paperless, but a few documents make the process smoother, especially when the family record has errors or a member is missing.
- Aadhaar card of every family member seeking a card
- Ration card or family ID issued by the state
- Mobile number linked with Aadhaar for OTP verification
- RSBY card, if the family was covered under the older scheme
- Caste certificate or occupation proof, in cases where the state requires it for category verification
- Birth certificate for adding a newborn to the family record
- Marriage certificate when adding a spouse who was previously listed under another family
Newborns can be added to an existing family record and treated under the scheme almost immediately, which is important for families expecting a child. Visit the Ayushman Mitra desk at the hospital of delivery to complete the addition.
Planning for Costs the Card Does Not Pay
The Rs 5 lakh cover is generous for a single major hospitalisation, but it is not a complete financial safety net. Families that rely on it alone often face three gaps: OPD and medicine costs, treatments that cross the annual limit, and hospitals outside the network.
Building a Second Layer of Protection
For working families with some regular income, a low-cost private health insurance policy works well as a supplement. Insurers such as Star Health, Niva Bupa, HDFC ERGO, and Care Health offer family floater plans and super top-up plans where the premium is much lower if you choose a high deductible.
A super top-up with a Rs 5 lakh deductible, for example, is priced very affordably because the insurer only pays after the first Rs 5 lakh, which the Ayushman Card already handles. This combination gives a family coverage of Rs 10 lakh to Rs 15 lakh for a small annual outlay.
Premiums paid for such policies also qualify for deduction under Section 80D of the Income Tax Act, up to Rs 25,000 for the family and an additional Rs 50,000 for senior citizen parents under the old tax regime. For a household with taxable income, this brings the effective cost down further.
Emergency Funds and Medical Loans
Keeping an emergency fund of at least Rs 25,000 to Rs 50,000 in a savings account with SBI, HDFC Bank, or ICICI Bank covers OPD visits, transport, an attendant’s food and stay, and the first few days of medicines after discharge. These are the expenses that hit families hardest during a hospital stay because nobody plans for them.
For larger uncovered costs, most banks now offer pre-approved personal loans to existing customers with disbursal within hours. This should be a last resort, but it is far safer than borrowing from informal lenders at high interest during a crisis.
Support for Salaried and Organised Sector Workers
Workers earning up to Rs 21,000 per month in a covered establishment are usually enrolled under ESIC, which provides its own hospital network and cash benefits during sickness. Such workers can use both ESIC and the Ayushman Card depending on which network has the better facility nearby.
Members of the Employees Provident Fund can also make a partial withdrawal from their EPF balance for the medical treatment of self or family without any lock-in condition. This is a useful fallback when a treatment crosses the scheme limit.
Ayushman Vay Vandana Card for Senior Citizens
In October 2024, the scheme was expanded to cover every Indian citizen aged 70 and above, irrespective of income or social category. This is a significant change because senior citizens are the group most likely to need hospitalisation and least likely to get affordable private insurance.
Key points about the senior citizen card are given below.
- Every person aged 70 or above gets a separate Rs 5 lakh cover in their own name
- If the senior is part of a family already covered under PM-JAY, they receive an additional Rs 5 lakh top-up shared among the 70-plus members of that family
- Seniors already covered under CGHS, ECHS, or other central schemes can choose either their existing scheme or the Vay Vandana card, but not both
- Seniors holding private health insurance can still enrol and use both
- Only Aadhaar is required for enrolment, as age is verified from the Aadhaar record
- Enrolment can be done through the Ayushman App, the beneficiary portal, or any CSC
Children helping their parents enrol should complete the process on the parent’s own Aadhaar-linked mobile number where possible. If the number is not linked, face authentication in the app or a visit to a CSC resolves it.
Important Points to Remember
- The card is free; anyone charging a fee for enrolment is committing fraud
- Coverage starts immediately with no waiting period for any illness, including pre-existing conditions
- The Rs 5 lakh limit resets every financial year and is shared across the entire family
- Treatment is available in any state, not just the state where the card was issued
- Emergency treatment cannot be refused by an empanelled hospital for want of pre-authorisation
- Always check the remaining balance before a planned surgery so that you know if a top-up will be needed
- Keep your mobile number updated in the family record to receive claim SMS alerts
- Package rates are fixed, so a hospital cannot ask you to pay the difference for a covered procedure
Fraud Alert and Common Mistakes
The popularity of the scheme has led to a rise in fake websites, agents, and phone calls targeting beneficiaries. Knowing the warning signs protects both your money and your personal data.
- Never pay anyone to make or renew the card; there is no renewal fee because the card does not expire
- Do not share your Aadhaar OTP with anyone claiming to be from the Ayushman office; genuine enrolment uses the OTP only on your own device
- Ignore SMS or WhatsApp links promising instant cards or claim money; the official channels are the app, the portal, CSCs, and the 14555 helpline
- Do not accept a hospital’s suggestion to be treated as a paying patient for faster admission when the procedure is covered
- Avoid leaving the family record incomplete; a member not added to the record cannot use the cover in an emergency
- Check that the hospital has actually raised a pre-authorisation rather than assuming the card was used, and ask for the claim confirmation SMS
- Do not sign blank consent forms or estimates at private hospitals without reading them
If you suspect fraud or a hospital has charged you wrongly, register a grievance on the scheme’s grievance portal or through the helpline. Each complaint receives a reference number that you can track.
Why the Card Matters for Every Eligible Family
Medical bills remain one of the leading reasons households in India fall into debt or sell assets. A single heart surgery or cancer treatment at a private hospital can cost more than an average family earns in several years, and until recently the only options were government hospitals with long waiting lists or borrowing at high interest.
The Ayushman Card changes that equation by giving families access to private hospitals at no cost for major treatments. It also gives the family bargaining power, because the hospital is paid a fixed package rate and cannot inflate the bill.
For the scheme to work, however, families must enrol before they need it, keep records updated, and know how to use it at the counter. Families that combine the card with a small emergency fund, an affordable top-up policy, and existing benefits like ESIC or EPF are in a strong position to face almost any medical situation without financial ruin.
Conclusion
Free hospital treatment under Ayushman Card is one of the most practical benefits available to Indian families today, covering up to Rs 5 lakh a year across more than 30,000 hospitals with no premium and no waiting period. The process of checking eligibility, completing e-KYC through the Ayushman App, and getting cashless admission at the Ayushman Mitra desk is simple once you know the steps, and the expansion to all citizens above 70 has brought elderly parents into the safety net as well.
Enrol every family member now rather than waiting for an emergency, keep the digital card on your phone, and plan separately for OPD costs and treatments that may cross the limit. With the card in place and a small supporting financial cushion, a hospital visit no longer needs to become a financial crisis.