Ayushman Bharat Delhi: Rs 10 Lakh Health Cover 2026

📖What Ayushman Bharat Delhi Is

Eligibility for the Ayushman Bharat Delhi scheme is determined by the Socio-Economic Caste Census (SECC) 2011 data, which forms the basis of the PM-JAY beneficiary list at the national level. Families whose names appear in the SECC database and are listed as PM-JAY beneficiaries in Delhi are automatically eligible for the Rs 10 lakh combined cover; no separate income certificate or means test is required beyond the SECC-based eligibility determination.

The Ayushman card (also called Ayushman Bharat card or PMJAY e-card) is the key document that beneficiaries must carry to avail cashless treatment at empaneled hospitals. This card can be generated online at hospitals.pmjay.gov.in by verifying the beneficiary's Aadhaar number against the SECC database, and is also available through Common Service Centres (Jan Seva Kendras), Ayushman Bharat Aarogya Mitras at empaneled hospitals, and the PM-JAY mobile app.

📖What Ayushman Bharat Delhi Is More

At the time of hospitalisation at an empaneled hospital, the beneficiary presents the Ayushman card and undergoes identity verification via Aadhaar-based authentication. The hospital's Aarogya Mitra then initiates the pre-authorisation request on the NHA portal, and once approved, the treatment proceeds as cashless hospitalisation with the hospital billing the scheme directly rather than the patient.

The list of treatment packages covered under Ayushman Bharat Delhi spans 1,500+ medical and surgical procedures across specialties including cardiology, oncology, orthopaedics, neurology, nephrology, and maternal and child health. Day-care procedures, surgeries requiring hospitalisation, ICU care, diagnostics during admission, and post-discharge medicines for up to 15 days are included within a single package; pre-existing diseases are covered from day 1 with no waiting period.

💰The Two Components of the Cover

National portability is a significant feature of the PM-JAY scheme: a Delhi beneficiary can use their Ayushman card at any empaneled hospital anywhere in India, not just in Delhi. This is particularly useful for patients who travel to other cities for specialised treatment at tertiary care centres such as AIIMS Bhopal, Apollo hospitals, or other empaneled facilities in cities with specific centres of excellence for conditions like cancer or cardiac surgery.

Delhi's empaneled hospital network under Ayushman Bharat includes government hospitals such as AIIMS Delhi, Safdarjung Hospital, RML Hospital, GTB Hospital, and numerous Delhi government hospitals, as well as private empaneled hospitals across the city. The full list of empaneled hospitals is available on the PM-JAY hospital locator tool at hospitals.pmjay.gov.in and is regularly updated.

The scheme explicitly covers a wide range of chronic and high-cost conditions that are particularly burdensome for low-income families in Delhi: dialysis for kidney failure patients, cancer chemotherapy and radiation, coronary artery bypass grafting (CABG), knee and hip replacement surgeries, and treatment in ICU/NICU. These are precisely the interventions that have historically pushed families into catastrophic out-of-pocket expenditure and debt.

Maternity and newborn care are also part of the Ayushman Bharat package. Normal delivery, caesarean section, and newborn care packages are covered for mothers who deliver at empaneled private hospitals, complementing the publicly funded Janani Suraksha Yojana (JSY) that provides cash incentives for institutional delivery and together forming a comprehensive maternal support framework for Delhi's urban poor.

📋Ayushman Bharat Delhi at a Glance

✅Who Is Eligible in Delhi

The Delhi Aarogya Kosh, which funds the Rs 5 lakh top-up component, also supports beneficiaries in accessing treatment at AIIMS Delhi and other premier government hospitals where PM-JAY packages may need to be supplemented. The administration of this top-up component is coordinated between the Delhi Health Department and the National Health Authority.

Families who believe they are PM-JAY eligible but do not see their names in the beneficiary list can approach the nearest Common Service Centre (CSC), Jan Aushadhi Kendra, or the PM-JAY helpline at 14555 to check their status. The PM-JAY portal also allows self-checking at pmjay.gov.in using mobile number and Aadhaar; corrections to SECC data errors or exclusion errors require approaching the district welfare office for formal redressal.

✅Who Is Eligible in Delhi More

The Ayushman Bharat Delhi scheme directly reduces the burden of medical debt among Delhi's low-income urban households, who face higher healthcare costs than their rural counterparts due to the elevated cost of private healthcare in the capital city. With Rs 10 lakh of cashless coverage, even a major cardiac procedure or a prolonged ICU stay does not require the family to arrange emergency funds or take high-interest loans.

Fraud prevention under the PM-JAY system involves the NHA's analytics and monitoring tools that flag unusual hospitalisation patterns, duplicate claims, and facilities with suspiciously high claim rates. Beneficiaries are encouraged to report any demand for cash payment at an empaneled hospital (which is prohibited under the cashless mandate) to the 14555 helpline, and hospitals found guilty of fraud are removed from the empaneled list.

👵The Senior Citizen Cover

Delhi's integration with PM-JAY also means that Delhi residents can check their Ayushman card generation status and hospitalisation history on the national PM-JAY app (available on iOS and Android). The app shows pending pre-authorisations, approved claims, and the amount of coverage used in the current policy year, giving beneficiaries full transparency about their utilisation of the Rs 10 lakh cover.

The scheme represents a significant convergence between Delhi's existing publicly funded healthcare infrastructure and the national PM-JAY architecture. Delhi government hospitals, which already provide heavily subsidised or free care to Delhi residents, now also participate in the PM-JAY cashless hospitalisation framework, allowing them to claim reimbursement for services rendered to PM-JAY beneficiaries while maintaining free access for all patients regardless of PM-JAY eligibility.

👵The Senior Citizen Cover More

For families with multiple serious illnesses in the same year, the Rs 10 lakh combined cover under Ayushman Bharat Delhi provides a much larger safety net than the Rs 5 lakh PM-JAY baseline. If a family member undergoes a major surgery costing Rs 4 lakh and another member later in the year requires cancer treatment costing Rs 6 lakh, the combined Rs 10 lakh ceiling is sufficient to cover both treatments within the same policy year without any out-of-pocket expenditure.

Parents should ensure that all family members are included in the Ayushman card as listed in the SECC beneficiary data; the scheme covers the family unit as defined in the SECC database without requiring separate registration for each member. Verifying that all family members are correctly listed in the PM-JAY beneficiary database before a health emergency arises is strongly advisable, as corrections may take time to process.

📝How to Get Your Ayushman Card

The Ayushman Bharat Delhi scheme is particularly significant for Delhi's large migrant worker population. Many workers who migrated from states like Bihar, Uttar Pradesh, Jharkhand, and West Bengal are SECC-listed PM-JAY beneficiaries, and their enrolment status in the Delhi PM-JAY implementation determines whether they can use their Ayushman card at Delhi hospitals; workers in this situation should check their eligibility at pmjay.gov.in to confirm coverage.

For patients requiring treatment not available in Delhi, the national portability feature of PM-JAY allows them to travel to specialised centres in other cities such as PGIMER Chandigarh, AIIMS Bhopal, or cancer centres in Mumbai, and receive the same cashless treatment there. The treating hospital must be an empaneled PM-JAY hospital in the destination city, and the Ayushman card is valid across this entire national network.

📝How to Get Your Ayushman Card More

The quality assurance aspect of the PM-JAY empanelment process requires hospitals to meet specific infrastructure, staffing, and service criteria before listing, with periodic audits that can suspend or remove any hospital found to have fallen below standards or engaged in fraudulent billing. This quality filter is meant to protect beneficiaries from substandard care and ensures that the empaneled hospital list reflects facilities capable of delivering the covered treatments safely.

Delhi's Mohalla Clinics and polyclinics, which are the primary healthcare pillars of the Delhi government's health model, operate separately from the Ayushman Bharat framework; they provide outpatient consultations, medicines, and basic diagnostics free of charge to all Delhi residents regardless of PM-JAY eligibility. Ayushman Bharat Delhi covers secondary and tertiary inpatient hospitalisation, while the Mohalla Clinics handle primary outpatient care, together covering the full spectrum of healthcare needs.

Mere pati ko heart surgery ki zaroorat thi. Private hospital mein 3.5 lakh ka bill aaya, lekin Ayushman card ke wajah se ek rupaya bhi nahi dena pada. Card banwane mein 10 minute lage, aur ilaaj bilkul free mila. Delhi mein yeh scheme bahut zaroori hai.

🩺Cashless Treatment at Hospitals

The critical illness benefit under Ayushman Bharat Delhi is arguably its most important feature for low-income families in Delhi. Conditions like cancer, kidney failure requiring regular dialysis, heart disease requiring bypass surgery, and neurological conditions requiring extended hospitalisation are catastrophically expensive in private hospitals; the Rs 10 lakh cashless cover at empaneled facilities means a family does not need to sell assets or take loans to access treatment.

Pregnant women from PM-JAY eligible families in Delhi should inform their gynaecologist or the hospital at the time of registration for antenatal care that they are Ayushman Bharat beneficiaries. This allows the hospital to prepare the Ayushman Bharat pre-authorisation in advance of the delivery, ensuring a smooth cashless experience at the time of hospitalisation rather than having to process paperwork during an emergency.

📑Ayushman Bharat Delhi: Quick Reference

🩺Cashless Treatment at Hospitals More

The NHA operates an active monitoring dashboard that tracks PM-JAY utilisation across states, and Delhi's data is publicly reported through this system. This transparency allows researchers, policymakers, and civil society organisations to assess the uptake of the scheme in Delhi, identify which types of treatments are most commonly claimed, and flag any gaps in access or hospitalisation patterns that suggest barriers to utilisation.

For elderly beneficiaries in Delhi who may not be comfortable with digital processes, the Aarogya Mitra at any empaneled hospital is required to assist with all Ayushman card generation and pre-authorisation steps completely free of charge; no facilitation fee is permissible at any stage, and any such demand should be reported immediately to the PM-JAY helpline at 14555.

⚠️If Your Name Is Not in the List More

The long-term goal of Ayushman Bharat Delhi, consistent with the national PM-JAY vision, is to shift India's urban poor away from dependence on informal moneylenders and emergency loans for healthcare toward a structured insurance-backed model where the state absorbs the financial risk of hospitalisation. Every successful cashless treatment claim in Delhi under this scheme is a data point demonstrating the viability and necessity of this model for a city with the healthcare cost profile and income inequality of Delhi.

Children of PM-JAY eligible families in Delhi are also covered under the Ayushman Bharat Delhi scheme, making it a comprehensive family health cover that does not distinguish by age. Paediatric hospitalisation, including neonatal care, surgery in children, and treatment for childhood illnesses requiring admission, all fall under the cashless coverage framework, ensuring that the Rs 10 lakh annual cover is truly a family-level protection and not limited to adult members.

❓Frequently Asked Questions