Is 5 Lakh Health Insurance Coverage Applicable Per Person Or Per Family?

A 5 lakh health insurance coverage under Ayushman Bharat PM-JAY is applicable per family per year, not per person. This cashless cover applies to all eligible family members, regardless of family size or age, covering secondary and tertiary healthcare hospitalisation. The PM-JAY provides healthcare coverage to crores of poor families.

In 2024, this scheme was extended to cover all senior citizens aged 70 and above. This scheme provides the Ayushman Bharat health card for senior citizens and all eligible families. People can submit these cards at any empanelled hospital and get treated without paying any upfront fees. In some particular cases, if the family of senior citizens above 70 years is already covered under the PMJAY scheme, then senior citizens can get an additional 5 lakh coverage for themselves in addition to the 5 lakh coverage for their family. To provide accessible healthcare to the economically backward people, the Ayushman Bharat Yojana scheme offers comprehensive coverage of up to Rs 5 lakh per family yearly for secondary and tertiary hospitalisation care.

Apart from this, the main advantage of having health insurance is that you can get medical treatment without burning a hole in your pocket. Moreover, many Indians end up borrowing money informally to pay medical bills.

Coverage Covered under the Scheme

The healthcare services covered under the Ayushman Bharat Yojana include:

• Medical consultation, treatment and consultation fees


• Pre-hospitalisation charges for up to three days


• Post-hospitalisation and follow-up charges for upto 15 days


• Medicines


• Treatments associated with complications


• Diagnostic procedures


• Intensive care and non-intensive care charges


• Expenses related to medical implants


• Costs room rent and related charges


• Food charges

What is not covered under the Scheme

Just like other health insurance policies, the PM-JAY scheme also has its own exclusions. Some components are not covered under the scheme. This involves cosmetic surgeries, drug rehabilitation, fertility treatment, organ transplant, individual diagnostics, out-patient department (OPD) expenses and drug rehabilitation.

Key Features

Features of this scheme include:

• Family floater plan category


• Private or public listed hospitals across India provide cashless treatment


• PED (Pre-existing disease) coverage available from the initial day of the plan


• Pre-hospitalisation up to three days and post-hospitalisation up to 15 days


• Non-medical charges, including transport and food expenses


• Daycare expenditures for no-hospitalisation treatments


• 5 lakh health and wellness centres exclusively for the scheme all over India