Ayushman Bharat Uttar Pradesh

What was the reason for this Scheme?

Uttar Pradesh is the most densely populated Indian state with over 24 crores population. It's also a state that has long been among the states with the highest out-of-pocket healthcare spending. The schemes are run simultaneously via the portal of Ayushmanup.in. UP is the leading state in the country in terms of Ayushman Card distribution with 5.38 crore Ayushman Cards distributed as of September 2024, out of 9 crore beneficiaries targeted in the state.

The Socio-Economic Caste Census (SECC) 2011 revealed crores of deprived families in UP that were in need of a structured health support system. But, even after PM-JAY was launched in September 2018 in the country, some families were not registered in the SECC 2011 database, hence not captured. The uninsured families were covered by the UP government's MMJAA. These two schemes constitute one of the largest health coverage schemes in India at the state level.

Eligibility

Covers in the state of Uttar Pradesh come from two concurrent schemes:

AB-PMJAY (Central Scheme):

• Those families that appear in the SECC 2011 database in one of the identified deprivation categories.
• The families that were identified by the occupation such as construction workers, domestic workers, rag pickers, street vendors, beggars, sanitation workers, home based workers and other informal living workers.
• Under the Ayushman Bharat scheme (which began from 1st September 2024), all senior citizens of age 70 years and above, irrespective of their income status are eligible. Provided that it comes under a separate Ayushman Vay Vandana Card with an individual annual cover of ₹5 lakh.

Mukhyamantri Jan Arogya Abhiyan (MMJAA- State Scheme):

• Where families face the same deprivation as outlined in SECC 2011 and their names are not included in the PM-JAY list because there are data gaps.
• Currently 8.43 lakh families are only under the MMJAA.
• 100% funded by the Uttar Pradesh state government.
• All MMJAA beneficiaries get the annual coverage of ₹5 lakh, same as that of PM-JAY beneficiaries.

Registration Process

Registration under both schemes can be done online, at Jan Seva Kendras, or directly at empanelled hospitals.

Online (Self-Registration):

• Visit ayushmanup.in and click on "Apply Online".
• Check your eligibility by entering your Aadhaar number, mobile number, or ration card details.
• If eligible, fill in your details and upload the required documents.
• Submit and download your Ayushman Card once approved.

At Jan Seva Kendra (Common Service Centre- CSC):

• Visit the nearest CSC with your Aadhaar card and mobile number.
• The CSC operator verifies your eligibility on the PM-JAY portal.
• The Ayushman Card is issued on the spot or delivered digitally within a few days.

At an Empanelled Hospital:

• Visit any empanelled hospital and approach the Arogya Mitra help desk.
• The Arogya Mitra verifies your eligibility on the spot and can generate your Ayushman Card immediately.
• This is particularly useful during emergencies, as there is no need to visit a separate office.

Health Camps:

• UP regularly organises mass enrollment drives across districts where Ayushman Cards are issued to eligible families at their doorstep.

Benefits and Coverage

This is what makes AB-PMJAY in UP genuinely comprehensive. The coverage goes far beyond basic hospitalisation.

• ₹5 lakh per family per year cashless cover, on a floater basis, covering all family members.
• Over 1,929 treatment packages across 27 specialities, including cardiology, oncology, neurosurgery, orthopaedics, nephrology, paediatrics, burns, ophthalmology, and emergency care.
• Pre-existing diseases covered from day one, no waiting period, no exclusions.
• Pre-hospitalisation expenses incurred up to 3 days before admission are included.
• Post-hospitalisation care, such as the follow-up treatment costs for up to 15 days after discharge are covered.
• Medicines, diagnostics, and consumables are all included within the package rate.
• The fee for the surgeon, the anaesthetist and the specialist are included in the package.
• Under Ayushman Vay Vandana Card, all senior citizens (above 70 years age) are eligible for a separate annual cover of ₹5 lakh, while those already covered under PMJAY will get an additional ₹5 lakh top up for them.
• Treatment at any empanelled hospital in India not just in UP, if you are in Mumbai or Delhi, you are covered!
• No premium, that is, the whole cost is to be borne by both the Central Government (60%) and Uttar Pradesh Government (40%).

Pregnant women availed of the benefits of AB-PMJAY for institutional delivery incentives can also avail of the benefits of Janani Suraksha Yojana (JSY) and direct maternity cash support from Pradhan Mantri Matru Vandana Yojana (PMMVY) in UP for maternity hospitalisation. The provision of antenatal care is in line with Surakshit Matritva Aashwasan Yojana (SUMAN) which provides free specialist care and respectful care during delivery at Public Health Institutions.

As hospitalisation and nutritional assistance are two separate benefit streams under TB treatment under AB-PMJAY, the patients can avail of Nikshay Poshan Yojana and receive ₹1,000 per month for nutritional support. The BPL families whose treatment bills are higher than the ₹5 lakh limit in PMJAY can avail financial assistance once in a lifetime under Rashtriya Arogya Nidhi (RAN) limit of ₹15 lakh at Government super-specialty hospital.

What is NOT covered:

• OPD consultations that do not lead to hospitalisation
• Cosmetic procedures and fertility treatments
• Drug de-addiction and rehabilitation treatments
• Injuries due to attempted suicide or self-harm
• Treatment at non-empanelled hospitals

Documents Required

Documents needed at the time of enrollment or hospital visit:

• Aadhaar card for identity and biometric verification; mandatory.
• Ration card for family identification and eligibility confirmation.
• Mobile number linked to Aadhaar for OTP verification during enrollment.
• SECC data printout, if already on the PMJAY beneficiary list.
• Self-declaration form for MMJAA registration where applicable.

Card Download Process

Once your eligibility is confirmed, the Ayushman Card can be downloaded instantly:

• Visit ayushmanup.in or the national portal pmjay.gov.in.
• Click on "Download Ayushman Card".
• Enter your Aadhaar number or mobile number and verify via OTP.
• Download and save the e-card in PDF format.

For senior citizens, the Ayushman Vandana Card is issued through the same portal after age verification. The card can also be downloaded from the Ayushman Bharat App available on the Google Play Store.

Claim Process

AB-PMJAY works on a fully cashless model. No advance payment at the hospital, no reimbursement paperwork.

• Visit any empanelled hospital with your Ayushman Card and Aadhaar card.
• Approach the Arogya Mitra help desk at the hospital for eligibility verification.
• The hospital submits a pre-authorisation request online to SACHIS or the National Health Authority (NHA) before planned treatment begins.
• In emergencies, treatment begins immediately, pre-authorisation can follow.
• All treatment costs are settled directly between the hospital and SACHIS/NHA, the patient pays nothing.
• Post-discharge, the beneficiary's health record is updated on the portal in real time.
• Follow-up treatment for up to 15 days after discharge is also cashless and covered under the same package.

Families with members having Autism, Cerebral Palsy, or Multiple Disabilities can additionally explore the Niramaya Health Insurance Scheme for specialised disability-focused coverage beyond what AB-PMJAY provides. Children in institutional care under Mission Vatsalya who are UP residents can access Ayushman Bharat hospitalisation benefits at empanelled hospitals. Adolescent girls supported under the Scheme for Adolescent Girls (SAG) at Anganwadi Centres can transition to AB-PMJAY coverage as their families qualify. Residents of Tamil Nadu seeking similar coverage have CMCHIS, while those in Andhra Pradesh and Telangana can refer to Dr. YSR Aarogyasri and Rajiv Aarogyasri, respectively.

Helpline Details

For any issue at the hospital, during enrollment, or with the card:

• National Toll-Free Helpline: 14555, available 24 hours, pan-India.
• UP State Helpline: 180018004444.
• Official UP Portal: ayushmanup.in.
• National Portal: pmjay.gov.in.
• SACHIS Office: State Agency for Comprehensive Health and Integrated Services, Uttar Pradesh.
• Ayushman Bharat App: Available on Google Play Store, for card download, hospital search, and claim tracking.

Any empanelled hospital that denies cashless treatment, demands advance payment, or refuses to verify an Ayushman Card must be reported on the helpline immediately.

Why Ayushman Bharat UP Matters

Uttar Pradesh is home to the maximum number of beneficiaries under the government's targeted healthcare initiative, Pradhan Mantri Jan Aay Yojana (AB-PMJAY) with 9 crore targeted beneficiaries in the state. 5.38 crore cards have already been issued as per the data available as on September 2024, at least one member of 87% of eligible families has got an Ayushman Card and UP is the top ranked state in India as far as card distribution is concerned. These figures are not administrative ones, but it is true that now, crores of families are able to avail of health cover of ₹5 lakh that they could not afford a decade ago.

The Ayushman Card makes it possible to get treated rather than go without in the case of a rickshaw puller in Lucknow whose wife requires kidney surgery, or a farmer in Jhansi whose child is diagnosed with cancer. Gaps in the scheme, OPD exclusions are still high and awareness is not uniform in the most remote talukas. However, Ayushman Bharat UP is one of the most impactful health initiatives in India, as a promise to prevent poverty from standing in the way of specialist medical procedures.

In Uttar Pradesh, if your family name is in the SECC 2011 list then you can visit ayushmanup.in or your nearest Jan Seva Kendra or if you are a senior citizen of 70 years and above you can visit. The card is free. This is not a fake coverage. It could be more important than you think.