Ayushman Card for Private Hospitals allows eligible beneficiaries of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to receive covered treatment at private hospitals that are empanelled under the scheme. The benefit is designed to provide cashless access to eligible hospitalisation services without requiring the beneficiary to pay the full approved treatment cost upfront.
PM-JAY provides health coverage of up to ₹5 lakh per family per year for eligible secondary and tertiary hospitalisation. The benefit is portable across India, which means an eligible beneficiary can use the Ayushman Card at an empanelled hospital outside the home state as well. The National Health Authority’s framework specifically includes both public and private empanelled hospitals.
However, simply having an Ayushman Card does not mean that every private hospital will provide free treatment. The hospital must be empanelled under PM-JAY, and the particular treatment must be available under the hospital’s approved package or speciality.
This distinction is important when planning treatment at a private hospital.
Can Ayushman Card Be Used in Private Hospitals?
Yes. Eligible Ayushman Card beneficiaries can use PM-JAY benefits at private hospitals that are empanelled under the scheme.
PM-JAY was designed to allow beneficiaries to access covered hospitalisation through both public and private empanelled healthcare providers. The scheme operates through defined health benefit packages, and hospitals must be authorised for the relevant services.
Therefore, before visiting a private hospital, a beneficiary should check two things:
- Whether the hospital is currently empanelled under PM-JAY.
- Whether the required treatment or speciality is available under its empanelment.
A private hospital may be empanelled for some procedures but not necessarily for every treatment available under PM-JAY.
What Does Ayushman Card Treatment Mean in a Private Hospital?
Ayushman Card treatment at a private hospital means that an eligible beneficiary can receive an approved PM-JAY treatment package on a cashless basis, subject to the scheme’s rules.
The beneficiary does not normally pay the full approved package cost directly to the hospital.
The hospital processes the case through the PM-JAY system and claims the applicable amount according to the approved package and scheme procedures.
The National Health Authority describes PM-JAY as providing cashless and paperless access to covered healthcare services at empanelled hospitals.
The actual benefit depends on:
- Beneficiary eligibility
- Hospital empanelment
- Treatment package
- Hospital speciality
- Pre-authorisation requirements
- Applicable scheme rules
- Exclusions
- Available coverage
Therefore, the Ayushman Card should not be treated as an unlimited free-treatment card.
How Does Ayushman Card Work in a Private Hospital?
The process usually begins when the beneficiary approaches the hospital’s designated Ayushman or PM-JAY help desk.
The hospital verifies the beneficiary’s identity and eligibility before registering the treatment.
A general process can include:
- The patient reaches an empanelled private hospital.
- The patient or family member approaches the Ayushman help desk.
- The hospital verifies the Ayushman Card and beneficiary record.
- Identity and e-KYC requirements are checked where applicable.
- The doctor examines the patient.
- The hospital identifies the relevant treatment package.
- Pre-authorisation is submitted if required.
- The treatment is approved according to PM-JAY rules.
- The hospital provides the covered treatment.
- The hospital processes the claim under the scheme.
- The patient receives discharge documents and applicable post-hospitalisation services.
The exact procedure can vary according to the treatment, state implementation and hospital.
What Is an Empanelled Private Hospital?
An empanelled private hospital is a private healthcare facility that has been approved to provide specified PM-JAY services under the scheme.
Hospital empanelment is important because PM-JAY benefits are not automatically available at every private hospital.
The National Health Authority maintains a system for hospital empanelment and provides an empanelled-hospital network through the PM-JAY framework.
An empanelled hospital is expected to follow the applicable PM-JAY procedures for beneficiary registration, treatment packages, claims and other scheme requirements.
Why Hospital Empanelment Matters
A private hospital may be:
- Fully empanelled for several specialities
- Empanelled only for specified procedures
- Newly added to the network
- Temporarily unavailable for a particular service
- No longer authorised for a particular package
Therefore, beneficiaries should check current information instead of relying only on an old hospital list or information received from another patient.
How to Find a Private Hospital Accepting Ayushman Card
Beneficiaries should use the official PM-JAY hospital-search facility to identify empanelled hospitals.
The official PM-JAY hospital information allows beneficiaries to check the network of empanelled hospitals. The National Health Authority also states that the list of PM-JAY empanelled hospitals is available through the PM-JAY portal.
When searching for a hospital, it is useful to check:
- State
- District
- Hospital name
- Hospital type
- Available speciality
- Available treatment package
- Current empanelment status
For planned treatment, it is better to contact the hospital’s Ayushman desk before travelling.
Can Every Private Hospital Provide Ayushman Treatment?
No.
This is one of the most important points about Ayushman Card treatment.
A private hospital must be empanelled under PM-JAY to provide scheme benefits, and the required procedure must fall within the services for which the hospital is authorised.
The National Health Authority’s operational material makes clear that specialised tertiary services are available through healthcare providers empanelled for those particular services.
For example, a hospital may be part of the PM-JAY network but may not provide every speciality or every procedure.
Therefore, patients should not assume that every private hospital in their city accepts the Ayushman Card for every treatment.
Which Treatments Can Be Taken in Private Hospitals?
PM-JAY primarily covers eligible secondary and tertiary hospitalisation.
The actual treatments available depend on the approved health benefit packages and the hospital’s empanelled specialities.
Depending on the applicable package, treatment can include areas such as:
- Cardiac procedures
- Cancer treatment
- General surgery
- Orthopaedic treatment
- Kidney-related procedures
- Neurological procedures
- Certain emergency treatments
- Selected day-care procedures
- Other approved medical procedures
- Other approved surgical procedures
The availability of a particular treatment must be confirmed with the hospital.
Cancer Treatment in Private Hospitals
Cancer treatment can be covered under PM-JAY when the applicable package and conditions are satisfied.
NHA guidance states that cancer treatment requires an appropriate treatment plan and pre-authorisation for applicable cancer packages.
Therefore, a cancer patient should select a private hospital that is empanelled for the relevant oncology services.
Surgery in Private Hospitals
Eligible surgeries can also be covered when the procedure falls within the applicable PM-JAY package.
The hospital may need to obtain pre-authorisation before proceeding with certain procedures.
Patients should ask the Ayushman desk whether the proposed surgery is included and whether any approval is required.
Is Treatment Completely Free in a Private Hospital?
Covered treatment under PM-JAY is intended to be cashless at the point of service.
However, “cashless” does not mean that every service provided by a private hospital is automatically free.
The benefit applies to covered PM-JAY packages.
For example, PM-JAY guidance lists outpatient care, drug rehabilitation, cosmetic treatment, organ transplantation and fertility treatment among excluded services.
There can also be package-specific exclusions.
Therefore, before admission, patients should ask the hospital:
- Which package is being used?
- What services are included?
- Is pre-authorisation required?
- Are there any services outside the package?
- Is any requested payment related to a non-covered service?
This helps distinguish an approved PM-JAY treatment from a service that falls outside the scheme.
Does the Patient Have to Pay the Private Hospital?
For an approved and covered PM-JAY package, the beneficiary generally receives the treatment on a cashless basis.
The PM-JAY framework is specifically designed to protect eligible beneficiaries from paying the full cost of covered hospitalisation themselves.
However, if a hospital requests payment, the beneficiary should first ask why.
There can be several possibilities:
- The service is outside the approved package.
- The patient has requested an upgrade or additional service.
- The treatment is not covered under PM-JAY.
- The hospital is not authorised for the particular procedure.
- The case has not yet received required approval.
- There is a beneficiary verification problem.
Patients should ask for a clear explanation before making any payment.
Can a Private Hospital Charge for a Room Upgrade?
Room-related benefits depend on the applicable PM-JAY package.
NHA’s published support information states that the scheme generally entitles the beneficiary to the room category specified under the package, and an upgrade can affect coverage of treatment expenses.
Therefore, beneficiaries should not independently choose an upgraded room and assume that the entire treatment bill will remain covered.
Before admission, ask the hospital about:
- Eligible room category
- Package conditions
- ICU provisions
- Additional room charges
- Charges associated with an upgrade
This is particularly important in private hospitals because room upgrades and additional services can increase the patient’s bill.
What Documents Are Required at a Private Hospital?
The documents required can depend on the beneficiary and treatment.
Commonly useful documents include:
- Ayushman Card
- Aadhaar Card
- Mobile phone
- Beneficiary identification details
- Medical reports
- Doctor’s prescriptions
- Previous discharge summaries
- Diagnostic reports
- Referral documents where applicable
The hospital may use the available beneficiary details to verify eligibility through the PM-JAY system.
The National Health Authority’s system supports beneficiary identification and verification before treatment.
For senior citizens covered under the 70+ provision, Aadhaar-based e-KYC is particularly important for enrolment and card issuance.
Ayushman Card for Private Hospitals for Senior Citizens
People aged 70 years and above have a separate and important eligibility provision under PM-JAY.
All Indian citizens aged 70 or above are eligible irrespective of income under this senior-citizen expansion.
This benefit can also be used at private hospitals that are empanelled under PM-JAY.
A senior citizen should therefore:
- Complete the required enrolment.
- Complete Aadhaar-based e-KYC.
- Obtain the Ayushman Card.
- Find an empanelled private hospital.
- Confirm the required treatment package.
- Complete hospital verification.
- Receive the covered treatment according to PM-JAY rules.
Private Insurance and 70+ Senior Citizens
A senior citizen aged 70 years or above can remain eligible for PM-JAY even if they already have private health insurance.
The official NHA FAQ specifically confirms that private health insurance does not make an eligible 70+ person ineligible for PM-JAY.
However, certain other government health schemes have different rules, so beneficiaries should check the applicable provisions before choosing between existing government coverage and PM-JAY.
Can Ayushman Card Be Used at a Private Hospital in Another State?
Yes.
PM-JAY provides portability across India.
An eligible beneficiary can receive covered treatment at an empanelled hospital outside the home state. NHA’s support information states that treatment outside the home state can be provided at an empanelled hospital in a cashless manner.
This can be useful when:
- The required specialist is unavailable locally.
- The patient has moved temporarily.
- The family lives in another state.
- A specialised treatment is available at another empanelled hospital.
- The beneficiary is travelling.
The hospital must still be empanelled and authorised for the required treatment.
What If the Private Hospital Does Not Accept the Ayushman Card?
If a private hospital does not accept the Ayushman Card, first determine whether the hospital is actually empanelled.
There is a difference between:
- A hospital that has never been empanelled
- A hospital that is empanelled but not for the required procedure
- A hospital where beneficiary verification has failed
- A hospital that is temporarily unable to process a case
- A hospital that has a package-specific limitation
If the hospital is not empanelled, the PM-JAY cashless benefit generally cannot simply be assumed to apply there.
If the hospital is empanelled but refuses an eligible covered service, the beneficiary should ask the Ayushman desk for the reason and use the appropriate grievance mechanism if necessary.
What If an Empanelled Private Hospital Refuses Treatment?
An empanelled hospital is expected to follow PM-JAY procedures for eligible beneficiaries and covered services.
NHA support information states that an empanelled hospital should not deny services to a PM-JAY beneficiary in the context of portability.
If a beneficiary faces a refusal, the first step should be to ask the hospital’s authorised PM-JAY/Ayushman staff for clarification.
Possible reasons may include:
- Treatment not included in the package
- Hospital not authorised for the required speciality
- Beneficiary verification issue
- Pre-authorisation pending
- Technical issue
- Package-specific restriction
- Treatment falling under an exclusion
If the explanation does not resolve the issue, the beneficiary can use the applicable PM-JAY grievance or support mechanism.
NHA’s PM-JAY support system lists 14413 as the hospital toll-free helpline.
Can a Private Hospital Refuse Because the Patient Is From Another State?
PM-JAY portability is designed to allow beneficiaries to receive treatment outside their home state.
NHA states that a beneficiary can receive treatment outside the home state at an empanelled hospital on a cashless basis, with the home state responsible for the treatment expense through the scheme’s mechanism.
Therefore, merely being registered in another state does not by itself remove portability.
However, the patient must still satisfy the scheme’s beneficiary and treatment requirements.
How to Check a Private Hospital Before Admission
Before travelling for planned treatment, follow this checklist:
- Confirm the hospital’s PM-JAY empanelment.
- Confirm the hospital’s current status.
- Ask whether the required speciality is available.
- Ask whether the exact procedure is covered.
- Ask whether pre-authorisation is necessary.
- Carry the Ayushman Card.
- Carry Aadhaar and required identity documents.
- Carry previous medical reports.
- Ask which room category is included.
- Ask whether any additional services will be charged separately.
This is especially important for expensive procedures where a misunderstanding about package coverage can lead to unexpected expenses.
What Is Pre-Authorisation in Private Hospitals?
Pre-authorisation is the process through which the hospital obtains approval for applicable treatment under the PM-JAY system before or during the treatment process, depending on the package.
It helps establish that the proposed procedure meets the scheme’s requirements.
Not every treatment follows exactly the same approval process.
For some specialised treatments, additional clinical information or treatment plans may be required.
Cancer treatment is one example where NHA guidance specifically requires pre-authorisation for applicable packages.
Patients should therefore ask the private hospital whether their procedure requires pre-authorisation.
What Happens After Treatment?
After the covered treatment is completed, the hospital follows the applicable discharge and claim procedures.
The patient should collect:
- Discharge summary
- Prescriptions
- Medical reports
- Diagnostic reports
- Follow-up instructions
- Other treatment documents
Where post-hospitalisation benefits are included in the applicable package, they should be used according to the prescribed rules.
The exact post-treatment benefit depends on the package.
What If the Private Hospital Has No Internet Connection?
PM-JAY has procedures for situations where a hospital has poor or interrupted internet connectivity.
NHA’s technical guidance states that hospitals can use prescribed procedures to verify beneficiaries and process eligible cases even when connectivity is unavailable, including use of the central helpline and beneficiary identification details.
Therefore, a temporary connectivity problem does not necessarily mean that an eligible patient has lost access to the scheme.
The hospital’s authorised PM-JAY staff should follow the applicable offline or poor-connectivity procedure.
Can Emergency Treatment Be Taken at a Private Hospital?
Emergency situations can require immediate medical care.
NHA guidance provides a specific procedure for certain emergency cases where a person claims to be a PM-JAY beneficiary but cannot immediately provide acceptable identification. The hospital can follow the prescribed emergency identification process.
Patients should not delay emergency medical attention while trying to resolve documentation issues.
The hospital’s authorised PM-JAY personnel can handle the beneficiary identification procedure according to the applicable rules.
What Treatments Are Not Automatically Covered?
The Ayushman Card should not be treated as an unlimited healthcare membership.
NHA’s published PM-JAY guidance identifies several services that are excluded, including:
- Routine outpatient care
- Drug rehabilitation
- Cosmetic treatment
- Organ transplantation
- Fertility treatment
Other exclusions can apply depending on the treatment package and scheme rules.
For this reason, a private hospital’s general acceptance of Ayushman Card does not mean that every consultation, medicine, test or procedure will be covered.
Does Ayushman Card Cover Pre-Existing Diseases at Private Hospitals?
PM-JAY was designed to cover pre-existing conditions from the beginning of coverage under the scheme.
The scheme’s operational material states that pre-existing conditions are covered from day one.
However, the actual treatment still has to fall within an applicable PM-JAY package and be processed by an authorised hospital.
A patient with a long-standing condition should therefore tell the doctor about previous treatment and provide medical records when seeking admission.
Can Ayushman Card Be Used for Cancer Treatment in a Private Hospital?
Yes, if the private hospital is empanelled for the relevant cancer services and the proposed treatment is covered under the applicable PM-JAY package.
NHA’s cancer-treatment guidance specifically describes clinical treatment approval and pre-authorisation for applicable cancer packages.
The patient should confirm:
- Oncology department availability
- Hospital empanelment
- Applicable cancer package
- Pre-authorisation requirements
- Treatment stages covered
- Any package-specific conditions
Can Ayushman Card Be Used for Heart Surgery in a Private Hospital?
Eligible cardiac procedures can be covered when they fall within an applicable PM-JAY package and the hospital is authorised to provide that service.
The beneficiary should not assume that every heart-related consultation or procedure is covered.
Before admission, the hospital’s Ayushman desk should confirm the applicable package and whether the proposed procedure requires pre-authorisation.
Important Difference Between Private Hospital and Private Clinic
An Ayushman Card is primarily used for covered PM-JAY hospitalisation and approved healthcare packages.
A private clinic that provides ordinary outpatient consultation is not automatically equivalent to an empanelled PM-JAY hospital.
NHA’s PM-JAY guidance specifically excludes routine outpatient care from the scheme.
Therefore, beneficiaries should distinguish between:
- Private clinic consultation
- Private diagnostic centre
- Private hospital
- PM-JAY empanelled hospital
- Hospital authorised for a particular package
This distinction can prevent confusion about whether a service will be cashless.
How Much Does Ayushman Card Cover in a Private Hospital?
The general PM-JAY health cover is up to ₹5 lakh per family per year for eligible beneficiaries.
The amount is not a fixed payment to the hospital for every admission. It is used according to the applicable health benefit package and available coverage.
The PM-JAY framework describes the benefit as ₹5 lakh per family per year for secondary and tertiary hospitalisation and makes the benefit portable across empanelled hospitals.
The actual cost covered for an individual procedure therefore depends on the approved package.
Important Safety Tips for Private Hospital Treatment
Beneficiaries should be particularly careful about unofficial agents.
Do not pay anyone simply to:
- Activate an Ayushman Card
- Add a beneficiary
- Release the ₹5 lakh benefit
- Generate a fake emergency approval
- Guarantee treatment
- Provide a private-hospital referral
Do not share:
- UPI PIN
- ATM PIN
- Internet banking password
- Unnecessary OTPs
- Banking passwords
A genuine Ayushman Card does not represent ₹5 lakh cash in a bank account.
If a hospital employee or outside agent asks for an unofficial payment for a covered service, ask for an explanation and use the authorised grievance channel when appropriate.
Ayushman Card for Private Hospitals: Quick Checklist
| Check | What to Confirm |
|---|---|
| Beneficiary | Eligible under PM-JAY |
| Card | Ayushman Card available and verified |
| Hospital | Empanelled under PM-JAY |
| Speciality | Required speciality available |
| Procedure | Covered package available |
| Approval | Pre-authorisation if required |
| Room | Package-eligible room category |
| Documents | Aadhaar, card and medical records |
| Payment | Confirm what is covered before admission |
| Portability | Outside-state treatment available under PM-JAY rules |
| Support | Hospital Ayushman desk / authorised support |
| Emergency | Follow prescribed emergency process |
Conclusion
Ayushman Card for Private Hospitals allows eligible PM-JAY beneficiaries to access covered treatment at private hospitals that are empanelled under the scheme. The benefit can provide cashless treatment for approved secondary and tertiary hospitalisation packages, subject to beneficiary eligibility, hospital empanelment and treatment-package rules.
The most important step before planned treatment is to verify that the private hospital is currently empanelled and authorised for the required speciality or procedure. An empanelled hospital does not necessarily provide every PM-JAY treatment package.
Eligible beneficiaries can also use PM-JAY portability when receiving covered treatment outside their home state. Senior citizens aged 70 years and above have an additional eligibility provision irrespective of income, and eligible 70+ beneficiaries can use the benefit at empanelled private hospitals as well.
The ₹5 lakh amount is a health coverage limit, not cash given to the patient. Beneficiaries should confirm the applicable package, understand what is included, keep their documents ready and avoid unofficial payments or agents.
FAQs
1. Can I use my Ayushman Card in a private hospital?
Yes. You can use it at a private hospital that is empanelled under PM-JAY and authorised for the required treatment package.
2. Do private hospitals provide Ayushman treatment completely cashless?
Covered PM-JAY packages are intended to be provided on a cashless basis, but services outside the approved package are not automatically free.
3. Can a 70+ senior citizen use Ayushman Card at a private hospital?
Yes. Eligible Indian citizens aged 70 years and above can receive PM-JAY benefits irrespective of income, including at empanelled private hospitals.