Ayushman Bharat Yojana Delhi- AB PM-JAY Health Insurance Scheme

Key Highlights Ayushman Bharat Yojana Delhi

Why Ayushman Bharat Yojana Matters for Delhi

Delhi has one of the largest urban poor communities among the JJ clusters, resettlement colonies, and unauthorized colonies in India. For the poor, a serious disease means catastrophic out-of-pocket expenditure. The out-of-pocket expenditures in India have fallen from 62% in 2014 to 38% today because of AB PM-JAY.

Delhi joined the 35th State/UT of Ayushman Bharat Yojana, where the government of Delhi decided on a top-up of ₹5 lakh over the central ₹5 lakh cover, totaling ₹10 lakh per family, which happens to be the highest combination cover available under any PM-JAY implementation by the State Government. Around 6.54 lakh families, i.e., 36 lakh individuals, including 6 lakh elderly individuals, will benefit under this health insurance scheme.

As a pan-India portable PMJAY scheme, it is especially relevant for Delhi's large migrant population, including migrants from Uttar Pradesh who may already be registered under PMJAY Uttar Pradesh and can seamlessly access cashless treatment at any of Delhi's 238 empanelled hospitals (NHA, 03-07-2026) without re-registration. For TB patients in Delhi, Nikshay Poshan Yojana provides ₹1,000 per month in nutritional support alongside PMJAY hospitalisation, both claimable simultaneously. Pregnant women can additionally claim Janani Suraksha Yojana (JSY) benefits for institutional delivery alongside their PM-JAY coverage.

AB PM-JAY Eligibility- Who Can Apply in Delhi

In Delhi, around 6.54 lakh families consisting of 30 lakh individuals and 6 lakh elderly are eligible. Urban families which are eligible in terms of occupation categories:

• Ragpickers, domestic workers, street vendors.
• Construction workers, plumbers, electricians.
• Sanitation workers, sweepers, home-based workers.
• Vulnerable categories other than the above specified.

Eligible persons will not include:

• Families where at least one individual is employed in Government or is a taxpayer.
• Individuals owning motorised vehicles or agricultural land above certain thresholds.

Moreover, elderly population over 70 years of age will also be provided an additional ₹5 lakh insurance cover through Ayushman Vaya Vandana Card separately from PM-JAY family cover.

How to Apply for Ayushman Bharat Yojana in Delhi

ONLINE – PMJAY Card Apply Online:

• Go to pmjay.gov.in or download the Ayushman app.
• Click “Am I Eligible” and input your mobile number.
• Input your Aadhaar or ration card number to confirm eligibility.
• Complete e-KYC via your Aadhaar OTP.
• Receive your PMJAY e-card once the application gets accepted.

Offline Application:

• Approach the nearest Common Services Centre (CSC) or panel hospitals' Ayushman Mitra counter.
• Bring your Aadhaar card and ration card.
• Go through biometric authentication.
• Get your Ayushman Bharat card once the application gets accepted.

It is highly recommended that all beneficiaries apply for the ABHA card (Ayushman Bharat Health Account) from abdm.gov.in. This ABHA ID card provides the beneficiary with a unique digital health ID as per the Ayushman Bharat Digital Mission (ABDM), making all your hospitalizations, prescriptions, and diagnostics digitalised and consolidated under one platform.

Documents Required

• Aadhaar card- primary identity document.
• Ration card- for family eligibility verification.
• Mobile number- for OTP and updates.
• Recent passport-size photograph.
• Any government-issued address proof.

What Does Ayushman Bharat Yojana Cover

According to the NHA data, the top used specialties are General Medicine, Ophthalmology, General Surgery, Obstetrics & Gynecology, and Medical Oncology. The highest frequency claimed procedures are Chronic Haemodialysis, Cataract surgery, Caesarean Delivery, Treatment of Animal bites, and Acute febrile illness – representing the true healthcare requirements of poor Indians.

For any cost above the cumulative limit, Rashtriya Arogya Nidhi (RAN) offers one-time support of up to ₹15 lakh in Government super speciality hospitals. For families with individuals suffering from Autism, Cerebral Palsy, or Multiple Disabilities, an additional option of Niramaya Health Insurance Scheme could be explored with PM-JAY.

How the Claim Process Works

The AB PM-JAY is based entirely on the cashless model:

• Just visit any of the 238 empanelled hospitals in Delhi with your Ayushman Bharat card and Aadhaar.
• At the desk of Ayushman Mitra, check your eligibility via the PMJAY portal.
• Pre-authorisation of your planned treatment is done.
• Treatment is based entirely on a cashless process, as all payments take place between the hospital and NHA.
• In cases of emergency, the treatment starts first and is followed by pre-authorisation later.
• After discharge, digital data entry is made in relation to your ABHA card.

AB PM-JAY and State Health Schemes

Citizens from Delhi who hail from other states and require extra insurance cover can look into various state insurance schemes:

"Atal Amrit Abhiyan" (Assam) scheme covers both BPL and APL families from 6 costly diseases without any cost or minimum cost. The "Gopabandhu Jan Arogya Yojana (GJAY)" (Odisha) provides coverage of up to ₹6 lakhs to urban families. This is especially helpful for Delhi, which has a considerable population of migrant people from Odisha. The "Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS)" (Tamil Nadu) provides low-cost insurance cover of up to ₹5 lakhs. "Mukh Mantri Sarbat Sehat Bima Yojana" (Punjab) and "Chirayu Ayushman Haryana" are beneficial for migrants from nearby states. "Swasthya Sathi Scheme" (West Bengal) and "Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)" (Maharashtra) provide the same insurance cover as well.

Helpline and Support

The inclusion of Delhi as the 35th State/Union Territory under the AB PM-JAY, with ₹5 lakh more added to reach a total coverage of ₹10 lakh per family, is an important development in terms of healthcare in the capital. With around 6.54 lakh families and 36 lakh beneficiaries covered, the PMJAY makes sure that finances never come in the way of getting specialised treatment. Attach your ABHA ID card to your PM-JAY account for a lifetime digital medical record, and refer to Rashtriya Arogya Nidhi for any expenses above the cap on the plan.