Ayushman Bharat Yojana 2025: How to Access Health Benefits and Coverage Details

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Ayushman Bharat Yojana 2025: How to Access Health Benefits and Coverage Details

The Ayushman Bharat Yojana, officially known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), is a flagship healthcare initiative by the Government of India aimed at providing accessible and affordable healthcare to millions of citizens. Launched in September 2018, it continues to evolve, with significant updates in 2025, including expanded coverage for senior citizens and gig workers. This guide outlines how to access its health benefits and provides detailed coverage information as of March 23, 2025.

What is Ayushman Bharat Yojana?

Ayushman Bharat comprises two main components:

  1. Health and Wellness Centres (HWCs): Transforming existing primary health centers to deliver comprehensive care, including preventive and promotive services.
  2. Pradhan Mantri Jan Arogya Yojana (PM-JAY): A health insurance scheme offering up to ₹5 lakh per family per year for secondary and tertiary care hospitalization.

PM-JAY targets economically disadvantaged families, covering over 12 crore vulnerable households (approximately 55 crore beneficiaries), representing the bottom 40% of India’s population. In 2025, it has been expanded to include all senior citizens aged 70 and above, regardless of income, and gig workers registered on the e-Shram portal.

Coverage Details in 2025

PM-JAY provides a robust health insurance package with the following features:

  1. Financial Coverage:
  • ₹5 lakh per family per year on a family floater basis, meaning the amount can be shared among all eligible family members.
  • For senior citizens aged 70+ covered under existing PM-JAY families, an additional top-up cover of ₹5 lakh per year is provided exclusively for them, separate from the family’s coverage.
  1. Treatments Covered:
  • Approximately 1,949 medical and surgical procedures across 25 specialties, including:
    • Cardiology (e.g., coronary artery bypass grafting)
    • Oncology (e.g., cancer surgeries, chemotherapy)
    • Orthopedics (e.g., joint replacements)
    • Neurosurgery
    • Critical illnesses like COVID-19 treatment
  • Pre-existing conditions are covered from day one with no waiting period.
  • Pre-hospitalization expenses (up to 3 days) and post-hospitalization expenses (up to 15 days), including diagnostics, medicines, and follow-up care.
  • Daycare procedures (treatments not requiring overnight stays).
  1. Exclusions:
  • Outpatient department (OPD) consultations and procedures.
  • Fertility treatments (e.g., IVF).
  • Cosmetic surgeries (unless medically necessary due to accidents or illness).
  1. Cashless and Portable:
  • Services are cashless at empaneled hospitals, eliminating upfront payments.
  • Benefits are portable across India, allowing treatment at any empaneled public or private hospital nationwide.
  1. New Inclusions in 2025:
  • Senior Citizens (70+): All individuals aged 70 and above, irrespective of socio-economic status, are eligible for ₹5 lakh coverage via the Ayushman Vay Vandana Card.
  • Gig Workers: Approximately 1 crore gig workers registered on the e-Shram portal can access benefits, though it’s unclear if their families are included (details pending clarification from the government).

Who is Eligible?

Eligibility for PM-JAY in 2025 is based on the following criteria:

  1. Original Beneficiaries:
  • Families identified through the Socio-Economic Caste Census (SECC) 2011, including:
    • Rural households with deprivation indicators (e.g., no adult male aged 16-59, SC/ST families, landless laborers).
    • Urban households in specific occupations (e.g., ragpickers, domestic workers, construction workers).
  • Families with active Rashtriya Swasthya Bima Yojana (RSBY) cards as of February 28, 2018.
  1. Expanded Categories in 2025:
  • Senior Citizens: All individuals aged 70+ (no income criteria).
  • Gig Workers: Registered on the e-Shram portal with a Universal Account Number (UAN).
  1. No Restrictions:
  • No cap on family size, age, or gender for eligible households.

How to Access Health Benefits

Here’s a step-by-step guide to accessing PM-JAY benefits in 2025:

Step 1: Check Eligibility
  • Online:
  • Visit pmjay.gov.in or use the Ayushman Bharat app (available on Google Play Store).
  • Enter your mobile number, generate an OTP, and select your state.
  • Search using your Aadhaar number, ration card, or SECC-2011 details to confirm eligibility.
  • Offline:
  • Visit a nearby Common Service Centre (CSC), Health and Wellness Centre (HWC), or empaneled hospital with identification documents (e.g., Aadhaar, ration card).
  • Contact the toll-free helpline 14555 or 1800-111-565 for assistance.
Step 2: Obtain an Ayushman Card
  • For General Beneficiaries:
  • If eligible, apply for the Ayushman Bharat Golden Card online via pmjay.gov.in or the app:
    1. Log in with your mobile number and OTP.
    2. Complete e-KYC using Aadhaar (not mandatory; other IDs like voter ID or ration card work too).
    3. Download the e-card or get a physical PVC card (₹30 fee at CSC).
  • Offline, visit a CSC or empaneled hospital with your documents.
  • For Senior Citizens (70+):
  • Apply for the Ayushman Vay Vandana Card:
    1. Use the Ayushman app or setu.pmjay.gov.in.
    2. Enter Aadhaar details, complete e-KYC, and download the card.
    3. Alternatively, visit an HWC or CSC with Aadhaar.
  • For Gig Workers:
  • Register on the e-Shram portal (eshran.gov.in) to get a UAN, then link it to PM-JAY via the app or CSC.
Step 3: Avail Treatment
  • Locate an empaneled hospital using the Ayushman app or pmjay.gov.in (over 24,000 hospitals are empaneled as of 2025).
  • Present your Ayushman Card (Golden Card or Vay Vandana Card) at the hospital’s Ayushman Mitra kiosk.
  • The Ayushman Mitra verifies eligibility by scanning the card’s QR code and processes your admission.
  • Receive cashless treatment for covered procedures—no payment required up to ₹5 lakh per year.
Step 4: Post-Treatment
  • Hospitals submit claims online with discharge summaries and clinical reports.
  • For queries or grievances, contact the helpline or file a complaint via the CGRMS portal (cgrms.pmjay.gov.in).

Additional Features

  • Ayushman Bharat Digital Mission (ABDM): By 2025, over half of India has ABHA (Ayushman Bharat Health Account) IDs, enabling digital health records linked to PM-JAY for seamless care.
  • Support System: Ayushman Mitras at empaneled hospitals assist with documentation and claims, ensuring a smooth experience.

Why It Matters in 2025

The expansion to include senior citizens and gig workers reflects the government’s commitment to universal health coverage. With rising healthcare costs, PM-JAY alleviates financial burdens, offering:

  • Protection against out-of-pocket expenses that push millions into poverty annually.
  • Access to quality care at both public and private hospitals.
  • Enhanced focus on vulnerable groups like the elderly and informal sector workers.

Conclusion

The Ayushman Bharat Yojana in 2025 remains a transformative scheme, providing ₹5 lakh in health coverage to eligible families, senior citizens, and gig workers. To access benefits, verify your eligibility, obtain an Ayushman Card, and seek treatment at empaneled hospitals—all at no cost. Stay updated via pmjay.gov.in or the Ayushman app, as further enhancements may be announced throughout the year. This initiative continues to bridge healthcare gaps, ensuring no one is left behind.

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