Himachal Pradesh · Health
Coverage check
Ayushman Bharat PM-JAY: is your family covered?
A guide check of who PM-JAY covers: families from the SECC 2011 lists, RSBY families, and every person aged 70 or above whatever the income. It tells you where you stand and what to check next.
How PM-JAY decides who is covered
Ayushman Bharat PM-JAY pays for hospital treatment of up to Rs. 5 lakh per family per year at empanelled hospitals. Families are not chosen by an application form: they are covered because they appear in the scheme's lists, drawn from the deprivation and occupation data of the Socio Economic and Caste Census 2011 and from the earlier RSBY scheme. In September 2024 the Cabinet extended the scheme to every person aged 70 or above, whatever the family's income.
This checker follows those rules to tell you where you probably stand. It cannot see the official list, so it is a guide, not a promise: the National Health Authority's beneficiary search, by name or ration card, has the final answer. Many States also cover more families under their own health scheme run together with PM-JAY.
The rules this checker uses
- Cover: up to Rs. 5 lakh per family per year for secondary and tertiary care hospitalisation.
- There is no cap on family size for an eligible household.
- Rural households in SECC 2011 are covered if they meet any of the inclusion parameters (no shelter, destitute or living on alms, manual scavenger family, primitive tribal group, legally released bonded labourer) or one of the deprivation criteria D1, D2, D3, D4, D5 or D7.
- D1: only one room with kuccha walls and kuccha roof. D2: no adult member between 16 and 59. D3: no adult male member between 16 and 59. D4: a disabled member and no able-bodied adult member. D5: SC or ST household. D7: landless household earning mainly from manual casual labour.
- Urban households are covered by the main earner's work in 11 occupational groups, from rag pickers, domestic workers and street vendors to construction, sanitation, transport, shop and repair workers.
- Families enrolled under RSBY but not in the SECC data are covered too.
- Since September 2024, every person aged 70 or above is covered whatever the income: up to Rs. 5 lakh a year on a family basis where the family was not covered, or an extra top-up of up to Rs. 5 lakh a year for the members aged 70 and above where it already was.
- People aged 70 or above in CGHS, ECHS or the CAPF scheme may keep their scheme or choose PM-JAY; those with private health insurance or ESI are still eligible.
Questions readers ask
My father is 74 and our family is not on the PM-JAY list. Is he covered?
Yes. Since the 2024 expansion every person aged 70 or above is covered whatever the family's income, and is issued a separate card under the scheme.
Our family already has Ayushman cards. What changes for my grandmother, who is 72?
She gets an additional top-up of up to Rs. 5 lakh a year for herself, which she does not share with the family members below 70.
My mother is in CGHS. Can she also take PM-JAY?
People aged 70 or above under CGHS, ECHS or the CAPF scheme can either keep their existing scheme or opt for PM-JAY.
Can we apply to be added to the list?
The scheme covers families from the SECC 2011 and RSBY data rather than by application, so the first step is to search the list by name or ration card. Your State may cover more families under its own scheme, which has its own rules.
Sources: Press Information Bureau, "Cabinet approves expansion of Ayushman Bharat PM-JAY" (11 September 2024, as published by the National Health Authority) for the cover, the rule for people aged 70 and above and the CGHS, ECHS, CAPF, private insurance and ESI cases; Comptroller and Auditor General of India, Performance Audit of AB-PMJAY (2023), Chapter III and Annexure 1.1, for the SECC 2011 criteria, RSBY families and family size. Read on 24 October 2026.