Important: This page provides general information about PM-JAY / Ayushman Bharat and is not a diagnosis or legal advice. Scheme details, eligibility criteria, and covered packages can change — always verify current coverage with the PM-JAY helpline (14555) or the hospital’s Ayushman Mitra desk before starting treatment.
What is PM-JAY?
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the Government of India’s flagship health insurance scheme. It provides health coverage of up to Rs 5 lakh per family per year for secondary and tertiary care hospitalization, with no premium — the scheme is entirely government-funded for eligible families.
PM-JAY covers serious illnesses including cancer, offering cashless treatment at empanelled government and select private hospitals across India. It is one of the world’s largest publicly funded health insurance programmes by beneficiary count. The scheme targets economically vulnerable families identified through the Socio-Economic Caste Census (SECC) 2011 data. Since September 2024, all senior citizens aged 70 and above are also covered regardless of income.
Why this matters for cancer patients: Cancer treatment in India typically costs Rs 3–10 lakh for early-stage cancers and Rs 10–20 lakh or more for advanced-stage cancers at private hospitals. For eligible families, PM-JAY can cover a significant portion of treatment costs at government hospitals — often the entire cost of surgery, chemotherapy, and radiation for early-stage cancers.
Who is eligible?
Eligibility for PM-JAY is based on socio-economic criteria determined by state governments, primarily targeting poor and vulnerable families.
You may be eligible if:
- Your family is listed in the SECC 2011 database (identified based on deprivation and occupation criteria)
- You hold a BPL card (Below Poverty Line) or Antyodaya (AAY) card
- You are a senior citizen aged 70 or above (added to PM-JAY in September 2024, regardless of income level)
- Your state has expanded PM-JAY eligibility to additional categories — Bihar has additional categories beyond the central scheme
How to check if you are eligible
Option 1 — By phone: Call 14555 (toll-free PM-JAY helpline). Keep your Aadhaar number or ration card number ready.
Option 2 — Online: Visit mera.pmjay.gov.in and enter your mobile number, Aadhaar number, or ration card number.
Option 3 — At the hospital: Visit the Ayushman Mitra desk at any government cancer hospital (Mahavir Cancer Sansthan, AIIMS Patna, IGIMS Patna, or any district hospital). Staff will check eligibility and can generate your e-card on the spot.
Option 4 — At a Common Service Centre (CSC): CSCs are available in most blocks and panchayats and can verify eligibility and generate PM-JAY cards.
Check eligibility at the time of diagnosis — before treatment starts. Getting a card and obtaining pre-authorization takes time. Do not wait until the day of surgery or chemotherapy.
What cancer treatments does PM-JAY cover?
PM-JAY covers cancer treatment including:
- Surgery — cancer surgeries of various types (breast, colorectal, gynecological, oral, lung, urological, and others)
- Chemotherapy — multiple chemotherapy regimens are included as covered packages
- Radiation therapy — external beam radiation and brachytherapy
- Diagnostic procedures — biopsy (for diagnosis), CT scan and MRI (for cancer staging), PET-CT (for staging and response assessment)
- Hospitalization — all inpatient costs for covered procedures, including ICU stay if required
- Pre-hospitalization expenses — up to 3 days before admission
- Post-hospitalization expenses — up to 15 days after discharge
The Rs 5 lakh limit applies per family per year — it is not a per-person limit, and all members of the enrolled household are covered under the same benefit.
What is NOT covered or has limits
PM-JAY is a hospitalization scheme and has important exclusions that every cancer patient should know about:
- OPD (outpatient) consultations — doctor’s fees for outpatient visits are not covered; only inpatient and day-care procedures are covered
- Medicines purchased outside the hospital — if a medicine is not available in the hospital pharmacy, you may need to purchase it separately
- Targeted therapy and immunotherapy— these are the most expensive cancer treatments.
- Treatment costs exceeding Rs 5 lakh per year — additional costs beyond the annual limit must be paid by the patient or sourced through other assistance schemes
- Cosmetic procedures — not covered
- Organ transplant — covered under a separate government scheme, not standard PM-JAY
- Fertility treatments — not covered
What this means in practice: For most early-stage cancer surgeries, chemotherapy, and radiation at government hospitals, PM-JAY should cover the full treatment. For advanced cancers requiring targeted therapy, immunotherapy, or costs that exceed Rs 5 lakh, PM-JAY covers part of the cost and you will need to use additional assistance schemes (see the section below).
How to use PM-JAY at a hospital — step by step
Step 1: Check eligibility and get your PM-JAY card
- Call 14555 or visit mera.pmjay.gov.in to check if your family is listed
- If eligible, visit an empanelled hospital’s Ayushman Mitra desk or a Common Service Centre (CSC) with your Aadhaar card
- The Ayushman Mitra will verify your identity and generate a PM-JAY e-card (free of charge)
- Family members listed under the same household are all covered under the same e-card
Step 2: Choose an empanelled hospital
- Not all hospitals accept PM-JAY. You must go to a PM-JAY empanelled hospital for cashless treatment.
- All major government cancer hospitals in Bihar are fully empanelled: Mahavir Cancer Sansthan (Patna), AIIMS Patna, IGIMS Patna, and Homi Bhabha Cancer Hospital (Muzaffarpur)
- Some private hospitals in Bihar are also empanelled for select cancer packages
- To find empanelled hospitals: call 14555, visit pmjay.gov.in, or ask at the hospital’s Ayushman Mitra desk
Step 3: Present your card at admission
- When you arrive at the hospital for admission or day-care procedure, go to the Ayushman counter (Ayushman Mitra desk) first — before going to any other desk
- Show your PM-JAY e-card or Aadhaar card
- The Ayushman Mitra will verify your identity biometrically (fingerprint or OTP)
Step 4: Pre-authorization
- The hospital staff will submit a pre-authorization request to the PM-JAY portal on your behalf before the procedure begins
- Do not pay any money or sign any documents for covered procedures until pre-authorization is granted — the hospital is responsible for getting this
- Pre-authorization typically takes a few hours to a day for elective procedures; emergency procedures are handled separately
Step 5: Cashless treatment
- Once pre-authorized, treatment proceeds cashlessly — you should not be asked to pay for covered procedures
- Ensure all hospital bills, prescriptions, and discharge documents are documented under your PM-JAY case number — keep copies of everything
- If costs exceed the annual Rs 5 lakh limit, additional costs must be paid by you or covered by other assistance schemes
Step 6: If something goes wrong
- If an empanelled hospital refuses to accept your PM-JAY card for a covered procedure, call 14555 immediately
- You can also file a grievance online at the PM-JAY website
- The PM-JAY helpline (14555) handles eligibility disputes, authorization delays, and hospital complaints
How to find empanelled hospitals
Several ways to find PM-JAY empanelled hospitals near you:
- Online: Visit pmjay.gov.in — the hospital search tool allows you to search by state, district, and treatment type
- Helpline: Call 14555 and ask for empanelled hospitals in your district that provide cancer care
- At the hospital: The Ayushman Mitra desk at any government hospital has the list of empanelled hospitals and can give you a printed list or direct you
- District hospital: Your nearest district hospital or primary health centre can direct you to empanelled cancer centres for referral
For Bihar patients: The main fully empanelled cancer hospitals are Mahavir Cancer Sansthan (Patna), AIIMS Patna, IGIMS (Patna), and Homi Bhabha Cancer Hospital (Muzaffarpur). District hospitals may also provide basic cancer diagnostics and can process PM-JAY referrals.
If PM-JAY doesn’t cover your treatment
PM-JAY may not cover everything — particularly targeted therapy, immunotherapy, very expensive medicines, or treatment costs that exceed Rs 5 lakh per year. Here are the other options available:
Central government schemes
- Rashtriya Arogya Nidhi (RAN): Financial assistance for BPL patients treated at government super-specialty hospitals. Can cover up to Rs 15 lakh. Apply through the hospital’s Medical Social Worker
- Health Minister’s Discretionary Grant (HMDG): Up to Rs 1,50,000 per case for treatment at government hospitals. Apply through hospital administration
- Prime Minister’s National Relief Fund (PMNRF): Apply at pmnrf.gov.in with medical documents and a cost estimate
- CGHS / ESI: If you or your spouse is a central or state government employee or pensioner, Central Government Health Scheme (CGHS) or Employees’ State Insurance (ESI) may cover cancer treatment at empanelled hospitals
Bihar state schemes
- Mukhyamantri Chikitsa Sahayata Yojana: State scheme providing up to Rs 1,00,000 for cancer treatment. Apply through the District Magistrate’s office
- State Illness Assistance Fund: For BPL families, apply through the hospital social worker
NGO and charitable assistance
- Indian Cancer Society Cancer Cure Fund: Financial aid for low-income patients nationwide. Call 1800-22-1951 (toll-free, 24/7)
- Mahavir Mandir Trust (at MCSRC): Free treatment for pediatric cancer patients; Rs 10,000 grant for poor adult patients at Mahavir Cancer Sansthan
- Tata Trusts Cancer Care Programme: Assistance through the Tata Memorial Centre network (including Homi Bhabha Cancer Hospital, Varanasi)
- Cancer Patients Aid Association (CPAA): Financial aid and free diagnostic camps. Contact: 022-24122413
Medicines at lower cost
- Jan Aushadhi Kendras: Government generic medicine stores sell cancer drugs at 50–90% lower prices than branded equivalents. Ask the hospital pharmacy or check janaushadhi.gov.in
- Pharmaceutical patient assistance programmes: Novartis / Max Foundation CancerPath to Care (free imatinib for eligible patients), Roche Blue Tree Programme (Roche medicines), Cipla Palliative Care (subsidised palliative medicines). Ask your oncologist to apply on your behalf
Important: apply to multiple schemes at once
Do not wait for one scheme to be approved before applying to another. Hospital social workers at government hospitals (MCSRC, AIIMS, IGIMS) know all the current schemes and will help you apply to multiple sources simultaneously. This is one of the most important steps you can take at the time of diagnosis.
Questions to ask at the PM-JAY desk
When you visit the Ayushman Mitra desk at a hospital, ask these questions before treatment begins:
- Is my family registered under PM-JAY? (Bring your Aadhaar and ration card number for verification.)
- Is my specific treatment — [name the surgery / chemotherapy drug / radiation type] — covered under a PM-JAY package at this hospital? Ask for the specific package name or code.
- What is the maximum package rate for my treatment? If the actual treatment cost is higher, you will pay the difference.
- Are OPD consultations and outpatient diagnostic tests covered? (Answer: generally no — PM-JAY is for inpatient and day-care only.)
- What documents do I need to keep, and will the hospital handle the pre-authorization? (They should handle it, but confirm.)
- If PM-JAY does not fully cover my treatment, which other schemes can I apply for? Ask the Ayushman Mitra to connect you with the hospital’s Medical Social Welfare desk.
Helplines
| Helpline | Number | What it is for |
|---|---|---|
| PM-JAY Helpline | 14555 | Eligibility, empanelled hospitals, authorization issues, grievances (toll-free) |
| PM-JAY alternate | 1800-111-565 | Alternate toll-free number for PM-JAY queries |
| Indian Cancer Society | 1800-22-1951 | Cancer information, financial aid, emotional support (toll-free, 24/7) |
| Tata Memorial Hospital | 022-2417-7000 | Appointments, referrals, treatment information |
| Cancer Patients Aid Association | 022-24122413 | Financial aid, diagnostic camps |
| Ambulance | 108 | Free ambulance service across India |
| National Emergency | 112 | Police, fire, ambulance |
For Bihar patients: Ayushman Mitra desks are available at Mahavir Cancer Sansthan (Patna), AIIMS Patna, IGIMS Patna, and at district hospitals and CSCs across the state. If you cannot reach Patna, your nearest district hospital can verify eligibility, generate a PM-JAY card, and issue a referral to a tertiary cancer centre.
