Ayushman Bharat Calculator — PM-JAY Eligibility & Coverage
Check if your family qualifies for Ayushman Bharat PM-JAY free health cover of ₹5,00,000/year, see coverage details for 1,949 treatment packages at 29,000+ empanelled hospitals, and compare PM-JAY with private health insurance. Updated for FY 2025-26 including the Budget 2024 expansion covering all seniors aged 70+ regardless of income.
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How to Use This Calculator
Am I Eligible? tab
Select your area type (rural or urban), the closest matching SECC 2011 category, your ration card type, and the age of the oldest family member. The calculator checks eligibility under SECC deprivation criteria, occupational categories, and the Budget 2024 expansion for seniors 70+. It also shows how to verify eligibility officially and get your Ayushman Card.
Coverage Details tab
Select a treatment or procedure from the 16 most common PM-JAY packages (or enter a custom amount). See the PM-JAY package rate, estimated pre- and post-hospitalisation costs, how much is covered cashlessly, and your out-of-pocket expense. If you have already claimed some amount this year, enter it to see remaining cover.
PMJAY vs Private Insurance tab
Enter your age, family size, and your private insurance premium and cover amount. The calculator compares PM-JAY (free, ₹5L, government hospitals) with private insurance (paid, wider network, higher cover) across 12 parameters. Includes 5-year and 10-year premium projections and a personalised recommendation.
Share your result
Every input is encoded in the URL. Click Share to send your eligibility check or coverage estimate to a family member, or save it for reference when visiting the hospital.
PM-JAY at a Glance — FY 2025-26
Who Is Eligible for Ayushman Bharat PM-JAY?
Rural Families (SECC 2011 Deprivation Criteria)
Rural households are eligible if they meet at least one of these deprivation parameters from SECC 2011:
- D1: Only one room with kucha walls and kucha roof
- D2: No adult member aged 16–59 in the household
- D3: Female-headed household with no adult male member aged 16–59
- D4: Household with disabled member and no able-bodied adult
- D5: SC/ST household
- D6: No literate adult above 25 years of age
- D7: Landless household with major income from manual casual labour
- Automatically included: Primitive tribal groups, legally released bonded labourers, manual scavengers, destitute persons living on alms, unprotected/vulnerable families
Urban Families (SECC 2011 Occupational Categories)
Urban households where the primary earner belongs to one of 11 listed occupations:
- Rag picker, beggar, domestic worker
- Street vendor, cobbler, hawker
- Construction worker, plumber, mason, painter, welder, security guard
- Sweeper, sanitation worker, gardener
- Home-based artisan, handicraft worker, tailor
- Transport worker (driver, conductor, rickshaw puller, cart puller)
- Shop worker, peon, delivery assistant, waiter (earning up to ₹15,000/month)
- Electrician, mechanic, assembler, repair worker
- Washer-man, chowkidar
Budget 2024 Expansion: All Seniors 70+
Union Budget 2024-25 expanded PM-JAY to all Indian citizens aged 70 and above, regardless of income, existing insurance, or SECC status. Effective from 29 October 2024, eligible seniors receive an Ayushman Vay Vandana Card with ₹5 lakh annual cover. If the family is already covered under PM-JAY, the 70+ member gets an additional ₹5 lakh (total ₹10 lakh family cover). An estimated 4.5 crore seniors are expected to benefit.
What PM-JAY Covers
Covered (Secondary + Tertiary Hospitalisation)
- 1,949 treatment packages across 27 specialties including cardiology, orthopaedics, oncology, neurosurgery, urology, ophthalmology, and obstetrics
- Room, board, and nursing: General ward, ICU/ICCU, food
- Diagnostics: Lab tests, X-rays, MRI, CT scans, ECG, ultrasound
- Medicines: During hospitalisation + 15-day post-discharge
- Surgical procedures: Surgeon fees, anaesthesia, OT charges
- Implants: Stents, knee/hip joints, pacemakers, cochlear implants (within package rate)
- Pre-existing conditions: Covered from day 1 — zero waiting period
- Pre-hospitalisation: 3 days before admission (diagnostics, medicines)
- Post-hospitalisation: 15 days after discharge (follow-up, medicines, diagnostics)
- Transport allowance: ₹500 per hospitalisation (one-way)
NOT Covered
- OPD consultations — outpatient visits and prescribed medicines
- Cosmetic/aesthetic surgery — elective procedures for appearance
- Fertility treatment — IVF, surrogacy, assisted reproduction
- Organ procurement — only recipient-side transplant is covered
- Drug rehabilitation
- Spectacles and hearing aids (without surgical procedure)
Example
Lakshmi — 72-year-old grandmother needs knee replacement surgery
Lakshmi is 72 years old, lives in Varanasi with her son’s family. Her son earns ₹8 lakh/year (above SECC threshold). She needs a knee replacement surgery costing approximately ₹80,000.
Step 1: Eligibility check
Step 2: Coverage assessment
Step 3: Out-of-pocket calculation
Lakshmi gets a fully cashless knee replacement at an empanelled hospital. She simply shows her Ayushman Vay Vandana Card and Aadhaar at the Ayushman Mitra desk. No forms, no claim reimbursement, no out-of-pocket expense.
How PM-JAY Works
Check at mera.pmjay.gov.in using Aadhaar or mobile number
OR visit an empanelled hospital / CSC with Aadhaar
Step 2: Get Ayushman Card
Complete e-KYC (Aadhaar + biometric) at hospital or CSC
Card generated instantly (digital) or in 2–3 days (physical)
Cost: ₹30 at CSC, free at empanelled hospitals
Step 3: Cashless treatment
Visit any PM-JAY empanelled hospital across India
Show Ayushman Card + Aadhaar at Ayushman Mitra desk
Hospital verifies, admits, and treats — zero payment from you
Coverage formula:
Covered Amount = MIN(Treatment Cost, ₹5,00,000 − Previous Claims This Year)
Out-of-Pocket = MAX(0, Treatment Cost − Covered Amount)
Annual reset:
₹5 lakh cover resets every policy year (typically April)
Unused cover does NOT carry forward
FAQ
Step 2: If eligible, visit any empanelled hospital’s Ayushman Mitra desk or a Common Service Centre (CSC).
Step 3: Complete e-KYC with Aadhaar and biometric verification.
Step 4: Your Ayushman Card is generated instantly (digital) or in 2–3 days (physical). Cost: ₹30 at CSC, free at many hospitals.
You can also call the toll-free helpline 14555 or 1800-111-565 for assistance. The card is valid at any empanelled hospital across India.