Healthcare Services
Complete guide to Ayushman Bharat (PMJAY), ABHA Health ID, health insurance, vaccination, ESI, CGHS, medical reimbursement, and government healthcare schemes across India.
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Common Use Cases
Document Types & Fees
Ayushman Bharat Card (PMJAY)
Official SiteWorld's largest health insurance scheme. Free treatment up to ₹5 lakh per family per year at 25,000+ empaneled hospitals. Covers 1,673 procedures including surgery, medical, daycare. No premium, paperless, cashless hospitalization. Portable across all states.
ABHA (Ayushman Bharat Health Account)
Official SiteDigital Health ID (14-digit unique number) linking all health records. Access medical history, prescriptions, lab reports, discharge summaries digitally. Works at all ABDM-integrated hospitals/clinics. Essential for digital healthcare ecosystem.
ESI (Employees State Insurance)
Official SiteHealth insurance for employees earning up to ₹21,000/month. Covers employee + family (spouse, 2 children, parents). Free treatment at ESI hospitals/dispensaries. Includes maternity, disability, unemployment benefits. Employer contributes 3.25%, employee 0.75% of wages.
CGHS (Central Government Health Scheme)
Official SiteHealth insurance for central government employees, pensioners, and dependents. Treatment at CGHS wellness centers and empaneled hospitals. Covers OPD, IPD, diagnostics, medicines. Monthly contribution based on pay scale: ₹125-₹1,500.
Co-WIN Vaccination Certificate
Official SiteDigital certificate for COVID-19 and other national immunization programs. Download from Co-WIN portal using mobile/Aadhaar. Required for international travel, employment, school admission. WHO-approved format.
Pradhan Mantri Suraksha Bima Yojana (PMSBY)
Official SiteAccidental death and disability insurance. ₹2 lakh for accidental death, ₹1 lakh for permanent total disability. Premium only ₹12/year (auto-debit from bank account). Age 18-70 years, any Indian with bank account eligible.
Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY)
Official SiteLife insurance scheme. ₹2 lakh on death (any cause). Premium ₹436/year (auto-debit). Age 18-50 years to join, cover till 55. Claim directly to nominee's bank account.
Janani Suraksha Yojana (JSY)
Official SiteCash assistance for pregnant women for institutional delivery. ₹1,400 in rural areas, ₹1,000 in urban areas for below poverty line. Covers antenatal, delivery, postnatal care. Reduces maternal and infant mortality.
Rashtriya Bal Swasthya Karyakram (RBSK)
Official SiteChild health screening and early intervention. Free screening for 4 Ds: Defects at birth, Deficiencies, Diseases, Development delays. Covers 0-18 years children. Mobile health teams visit schools/anganwadis.
Step-by-Step Application Guide
Check Ayushman Bharat Eligibility
Visit pmjay.gov.in → Click "Am I Eligible" → Enter mobile number → Enter Aadhaar/Ration Card → Check eligibility status. If name appears in SECC 2011 database or income <₹5L, you're eligible.
Generate Ayushman Card
Method 1: Visit nearest Common Service Center (CSC) / Ayushman Mitra Kiosk with Aadhaar + PAN + Address proof → Verify documents → Get Ayushman card printed (free). Method 2: During hospital admission, ask hospital to generate card (takes 5 mins).
Create ABHA Health ID
Visit abha.abdm.gov.in → Click "Create ABHA Number" → Enter Aadhaar → Verify OTP → Choose 14-digit ABHA number → Set ABHA Address (yourname@abdm) → Download ABHA card. This digitizes all future health records.
Link ABHA with Ayushman (Optional but Recommended)
Login to ABHA portal → Go to Profile → Select "Link Health Programs" → Choose Ayushman PMJAY → Verify with Ayushman beneficiary ID → Linked! Now your Ayushman eligibility shows in ABHA app.
Find Empaneled Hospital
Visit hospitals.pmjay.gov.in → Enter your city/district → See list of all Ayushman empaneled hospitals with contact numbers. Or ask at hospital reception if they accept Ayushman. Over 25,000 hospitals empaneled.
Hospital Admission Process
Carry Aadhaar + Ayushman card → Show at hospital's Ayushman desk → Hospital verifies eligibility → Treatment starts (completely cashless) → No advance payment needed → Hospital gets payment directly from government.
Download Treatment Records to ABHA
After discharge, ask hospital to upload discharge summary to your ABHA account → Login to ABHA app → View all treatment history, prescriptions, lab reports digitally → Share with any doctor using ABHA address.
For ESI Users (Salaried Employees)
Check if ESI deducted from salary → Get ESI number from employer → Download from ESIC portal → Visit ESI dispensary/hospital with ESI card + Aadhaar → OPD immediately, IPD after 90 days contribution.
Important Notes
Common Mistakes to Avoid
Frequently Asked Questions
Who is eligible for Ayushman Bharat PMJAY?
Two criteria: 1) Families listed in SECC 2011 socio-economic census (rural: occupation-based, urban: deprivation factors like single-room house, sanitation, etc.). 2) Annual family income <₹5 lakh. Covers poorest 40% (50 crore people). Check eligibility on pmjay.gov.in by entering Aadhaar/mobile. If eligible, you'll see family members' names.
Is Ayushman Bharat card really free? Many agents are charging ₹50-500.
YES, 100% FREE by law! Government explicitly banned charging fees. Maximum ₹30 service charge allowed by CSC in some states (most states even that's waived). If anyone charges more, immediately complain at 14555 helpline or tweet @AyushmanNHA with proof. Action taken against such agents. Don't fall for scams - even card printing is free!
What is ABHA Health ID? Is it same as Ayushman card?
NO, completely different! ABHA (Ayushman Bharat Health Account) = 14-digit unique health ID linking all your medical records digitally across India. Like Aadhaar for healthcare. Stores prescriptions, lab reports, hospital visits. EVERYONE can create ABHA (free). Ayushman card = Health insurance for economically weaker sections (₹5L cover). You can have ABHA without Ayushman, and vice versa. Best: create ABHA + link Ayushman if eligible!
Which hospitals accept Ayushman Bharat card? Can I go to any hospital?
Only "empaneled" hospitals accept Ayushman - currently 25,000+ (growing daily) including AIIMS, big government hospitals, and many private hospitals. Search on hospitals.pmjay.gov.in by entering your district. Choose hospital with good reviews. Hospital must have "Ayushman Bharat - PMJAY Empaneled" sign at reception. Emergency cases: any empaneled hospital must treat, no questions asked.
What treatments are covered under Ayushman Bharat? What is NOT covered?
COVERED (1,673 procedures): All hospitalization >24 hours - surgeries (cardiac, cancer, orthopedic), medical treatment, ICU, daycare procedures (dialysis, chemotherapy), pre-hospitalization 3 days + post 15 days, room charges, medicines during stay, diagnostics. NOT COVERED: OPD doctor consultations, medicines from pharmacy (without hospitalization), cosmetic surgery, IVF, infertility, organ purchase (transplant surgery covered but not organ cost). Check full list: pmjay.gov.in/covered-treatments
My income is exactly ₹5 lakh. Am I eligible for Ayushman?
Borderline case - eligibility based on SECC 2011 database primarily, not current income. If your family was listed in SECC 2011 (census done in 2011), you're auto-eligible regardless of current income (many middle-class families qualify!). If NOT in SECC 2011, then income certificate <₹5L needed. Many states expanded eligibility beyond SECC - some cover all NFSA (food security) ration card holders. Check actual eligibility on pmjay portal, not assumptions!
How to create ABHA Health ID? Is Aadhaar mandatory?
Super easy, takes 5 minutes: Visit abha.abdm.gov.in → "Create ABHA Number" → Enter Aadhaar (yes, mandatory) → Verify OTP → System generates 14-digit ABHA number → Create ABHA Address (like yourname@abdm, works like email for health records) → Set 4-digit PIN → Download ABHA card PDF. Alternative: Download "ABHA" app from Play Store/App Store and create via mobile. Aadhaar mandatory but ABHA number different from Aadhaar.
I need treatment urgently. How to get Ayushman card immediately?
DON'T WAIT FOR PHYSICAL CARD! Process: 1) Go to empaneled hospital with Aadhaar. 2) At Ayushman Mitra desk, provide Aadhaar. 3) They verify eligibility online (takes 2 minutes). 4) If eligible, generate card digitally + biometric verification. 5) Start treatment immediately (within 30 mins). Physical card optional - Aadhaar itself works. In emergency (accident, heart attack): hospital MUST treat first, verification later. No one can be denied emergency care.
Does Ayushman cover COVID treatment, vaccination, medicines?
COVID treatment: YES, if hospitalized (COVID pneumonia, breathing difficulty requiring admission). Covered up to ₹5L including ICU, ventilator, medicines during stay. COVID vaccination: FREE at all government hospitals for everyone (Ayushman not needed). Just walk in with Aadhaar, get vaccinated, download certificate from Co-WIN. COVID medicines from pharmacy: NOT covered unless you're admitted. However, during hospitalization, all medicines given free.
I'm a salaried employee. Should I get Ayushman or ESI? What's difference?
Depends on salary: If earning <₹21,000/month: ESI (mandatory, deducted from salary 0.75%). Covers you + family at ESI hospitals. If earning >₹21K but family income <₹5L: Check Ayushman eligibility. If earning >₹21K and not eligible for Ayushman: Buy private health insurance. Key difference: ESI for organized sector workers (mandatory contribution), Ayushman for economically weaker sections (free, no contribution). ESI covers OPD + hospitalization. Ayushman only hospitalization. Cannot use both simultaneously for same treatment.
My company provides health insurance. Can I still use Ayushman?
YES, if eligible! Ayushman eligibility independent of company insurance. Use company insurance first (usually better hospital network). Use Ayushman as backup if: 1) Company insurance exhausted. 2) Pre-existing disease not covered by company (Ayushman covers all pre-existing). 3) Treatment at government hospital where Ayushman easier. 4) Job loss (company insurance stops, Ayushman continues). Keep both active!
Does Ayushman card work in other states? I moved from UP to Maharashtra.
YES, 100% portable! Biggest advantage of Ayushman - works PAN India at any empaneled hospital in any state. No need to transfer card or re-register. Same benefits in all states. Example: Card issued in Bihar, get treatment in Karnataka - fully covered. However, search hospital in new state on pmjay website as empaneled hospitals differ by location. Portability makes it perfect for migrants, students, workers.
Hospital is asking ₹50,000 advance despite having Ayushman card. Is this correct?
ABSOLUTELY NOT! Illegal under PMJAY rules. Treatment under Ayushman is 100% cashless - zero patient payment for covered procedures. Hospital gets payment directly from government. If hospital demands money: 1) Ask to speak to Ayushman Mitra/Nodal Officer at hospital. 2) Call 14555 immediately and complain. 3) Tweet @AyushmanNHA with hospital name + photo. 4) Go to another empaneled hospital. Hospital can be de-empaneled for this violation. Don't pay!
What is the ₹5 lakh limit exactly? Per person or per family? Annual or lifetime?
Per FAMILY per YEAR. If family has 6 members, all share ₹5L pool (not ₹5L per person). Example: Father uses ₹2L for surgery, mother can use remaining ₹3L. Resets every year on April 1 - fresh ₹5L available. Some states provide EXTRA amount on top: Delhi (₹5L), Punjab (₹5L), Andhra (₹5L) - CHECK your state for bonus coverage. Lifetime: No lifetime cap - you get ₹5L fresh every year lifelong as long as eligible.
Can I use Ayushman for planned surgery or only emergency?
BOTH! Emergency: Immediate treatment, verification done later within 48 hours. Planned/elective surgery: Process is 1) Visit hospital with card + Aadhaar. 2) Doctor recommends surgery. 3) Hospital uploads "transaction" to PMJAY system. 4) Pre-authorization approval (takes 2-6 hours, sometimes instant). 5) Surgery scheduled. 6) Cashless treatment. Pre-authorization ensures government approves payment before surgery. For planned procedures, visit hospital 2-3 days before desired surgery date.
I had treatment. How to get discharge summary and bills for records?
Mandatory: Hospital MUST provide 1) Discharge summary (mentions diagnosis, treatment, medicines, follow-up). 2) List of procedures done. Request before leaving hospital. For ABHA users: Ask hospital to upload discharge summary to your ABHA account - becomes permanent digital record. Take 2 copies: 1 for you + 1 for ABHA/insurance claims. If hospital refuses, complain to 14555. Also useful for: follow-up treatment, second opinion, tax deduction under 80D, future insurance claims.
My name not showing in Ayushman eligibility checker. What to do?
Reasons + solutions: 1) Not in SECC 2011 database - Check if your state has expanded eligibility (ration card holders, state-specific schemes). Apply for state health scheme. 2) Name mismatch (spelling difference) - Try father's name, mother's name. Use Aadhaar spelling exactly. 3) Data entry error during SECC - Visit nearest Ayushman Mitra / CSC and request "beneficiary identification" with proof of residence, income certificate. 4) Above ₹5L income - Not eligible, consider buying private insurance or state schemes. 5) Some states have parallel schemes - check your state health department website.
What is CGHS? Am I eligible?
CGHS (Central Government Health Scheme) for: 1) Central Govt employees. 2) Central Govt pensioners. 3) MPs, Judges, Freedom Fighters. 4) Their dependent family members. Benefits: OPD + IPD at CGHS wellness centers + empaneled hospitals. Monthly contribution: ₹125-₹1,500 based on pay scale. Coverage: Self + spouse + dependent children + parents (if dependent). Lifetime after retirement. If you're central govt employee, enrollment automatic. If state govt employee, check CGHS equivalent in your state (many states have similar schemes).
Where to download COVID vaccination certificate? I lost my certificate.
Easy retrieval: 1) Visit cowin.gov.in. 2) Click "Download Certificate". 3) Enter mobile number OR Aadhaar (used during vaccination). 4) Verify OTP. 5) Select vaccine dose (1st/2nd/booster). 6) Download PDF certificate. Certificate shows: Name, age, vaccine name, batch number, dates, QR code (international format). Also available via Aarogya Setu app or UMANG app. Print or save PDF - required for international travel, joining some workplaces, college admission. No need to revisit vaccination center.
What is 108 ambulance? Is it really free? When to call?
108 = FREE emergency medical ambulance service (some states use 102 for mother-child ambulance). Available 24x7 in all states. When to call: Heart attack, accident, stroke, breathing difficulty, poisoning, pregnancy complications, ANY medical emergency. Service: Trained paramedic + basic life support equipment in ambulance. FREE transport to nearest hospital. Response time: 15-20 minutes in cities, 30-45 min rural. How to call: Dial 108 → Tell location + emergency → Ambulance dispatched with GPS tracking. NEVER hesitate to call thinking it costs money - saves thousands of lives!
Required Documents
- Aadhaar Card (mandatory for all health schemes)
- Ration Card or SECC 2011 data (for Ayushman eligibility)
- Income Proof (income certificate, salary slip for income-based schemes)
- Address Proof (electricity bill, rent agreement, voter ID)
- Bank Account Passbook (for DBT schemes like JSY)
- Mobile Number (OTP verification)
- Passport Size Photos (2-4 recent)
- Caste Certificate (if applicable for reserved categories)
- Employee ID / Pension Order (for CGHS)
- Previous medical records (for ABHA, reimbursements)
- Prescription from registered doctor (for medicines reimbursement)
- Original bills & discharge summary (for hospitalization claims)