Ayushman Bharat West Bengal : Rs 5 Lakh Health Cover, Eligibility & Hospital List

• In June 2026, West Bengal signed a formal agreement with the National Health Authority (NHA) to implement PM-JAY under the standard 60:40 fund-sharing model between the Centre and the State.
• To make sure no one loses health coverage, the state government introduced the Mukhyamantri Swasthya Bima Yojana (MMSBY) for families holding a Swasthya Sathi card who do not meet central PM-JAY criteria.
• On August 16, 2026 ("Ayushman Diwas"), the scheme was officially launched statewide across government medical colleges, district hospitals, sub-divisional hospitals, and empanelled private hospitals, with dedicated Ayushman Mitra help desks.
• Within the first month of rollout by mid-September 2026, official figures showed over 50,000 patients from West Bengal received cashless treatment under PM-JAY.
• On September 23, 2026, marking eight years of PM-JAY nationwide, the Central Government highlighted Bengal’s integration, connecting 1.5 crore eligible families to the national network.

• Entitlement is automatic if your family is listed in SECC 2011 or priority ration records. There is no enrollment fee or annual premium to pay.
• Treatments, surgeries, hospital beds, and recovery medicines are completely cashless at all empanelled hospitals.
• The ₹5,00,000 annual limit operates on a family floater basis, usable by one or more members throughout the year.
• There is no cap on family size or age limit for household members.
• Pre-existing medical conditions, including heart disease, diabetes, and cancer, are covered from day one with zero waiting period.

Rural Families (SECC 2011 Deprivation Criteria)

• Families living in temporary, single-room kuccha houses
• Households with no adult members between 16 and 59 years of age
• Female-headed households without an adult male aged 16 to 59
• Households with a disabled family member and no able-bodied adult
• Scheduled Caste (SC) and Scheduled Tribe (ST) households
• Landless families dependent on manual casual labour for their livelihood
• Destitute families, manual scavengers, primitive tribal groups, and legally released bonded labourers

Urban Families (Occupation-Based)

• Domestic workers, street vendors, cobblers, and hawkers
• Construction workers, plumbers, masons, painters, and security guards
• Transport workers including rickshaw pullers, auto drivers, and delivery personnel
• Shop assistants, counter staff, and peons in small businesses
• Tailors, craftspersons, artisans, and mechanics
• Sanitation workers, sweepers, and waste handlers

All Senior Citizens Aged 70 and Above

• Every citizen aged 70 or older, verified through the birth date on their Aadhaar card, qualifies automatically.
• There is no income ceiling, pension restriction, or wealth test for this senior category.
• Seniors receive an Ayushman Vay Vandana Card with ₹5,00,000 annual cover, which sits over and above their family floater card.

• Government employees and pensioners enrolled in WBHS, CGHS, or ECHS
• Households owning a motorized four-wheeler, three-wheeler, or mechanized farming vehicle
• Farmers holding a Kisan Credit Card with a credit limit exceeding ₹50,000
• Families where any member pays income tax, professional tax, or works in a government corporation
• Rural families owning more than 5 acres of irrigated agricultural land for two crop cycles
• Families living in modern, multi-room concrete houses recorded in municipal property records

• In-patient hospital stays requiring 24 hours or longer, including ICU care, bed charges, doctor visits, and surgeries
• Pre-hospitalisation medical expenses for up to 3 days before admission, covering diagnostic scans and doctor check-ups
• Post-hospitalisation care for 15 days after discharge, including follow-up visits and prescribed recovery medicines
• Full coverage for surgical supplies including approved heart stents, knee and hip implants, and cardiac valves
• Day-care treatments that do not require an overnight hospital stay, such as eye cataract surgeries, dialysis, and chemotherapy
• Services not covered: routine outpatient (OPD) clinic consultations, purely cosmetic surgeries, and fertility treatments

Primary Identification

• Aadhaar Card of each family member for biometric and identity verification
• Active mobile number to receive authentication OTPs and status messages
• Digital Ration Card (Khadya Sathi Card) to confirm family members linked to your household

Additional Documents When Needed

• Voter ID as an alternative photo proof if biometric scanning has issues
• Birth certificate or marriage certificate when adding a newborn child or spouse to an existing card
• Disability certificate issued by a government hospital where qualifying under disability criteria
• Age proof if the Aadhaar card lists only a birth year for a 70+ senior

1. Step 1: Open the official portal at beneficiary.nha.gov.in or open the Ayushman App on your phone.
2. Step 2: Select "Beneficiary", enter your 10-digit mobile number, click "Verify", and enter the OTP and captcha.
3. Step 3: Choose State as "West Bengal", Scheme as "PMJAY", and select your home district.
4. Step 4: Search by Aadhaar Number (fastest), Family ID / Ration Card Number, or village/town location.
5. Step 5: A green "Verified" badge means your card is ready. An orange "Identified" badge means you need to complete a quick e-KYC.

Option A: Online (Self-Assisted)

1. Log in to beneficiary.nha.gov.in using your mobile number and OTP.
2. Find your family member’s name and click the e-KYC option.
3. Select Aadhaar OTP and enter the code sent to your Aadhaar-linked mobile.
4. Review your personal details and capture a live selfie with your phone or computer camera.
5. Enter your pin code and mobile number, then submit.
6. Once your status changes to "Approved", click the Download Card icon to save your PDF.

Option B: Offline (Assisted at a Centre)

1. Visit your nearest Bangla Sahayata Kendra (Tathya Mitra Kendra / CSC) or the Ayushman Help Desk at any government hospital.
2. Bring your original Aadhaar card and digital ration card.
3. The operator verifies your record and completes fingerprint or iris scanning.
4. Once approved, the operator prints your laminated Ayushman Card free of cost.

• 1. Report to the hospital’s Ayushman Bharat Help Desk and speak to the Ayushman Mitra.
• 2. Present the patient’s Ayushman card (printout or digital) along with their original Aadhaar card.
• 3. The attending doctor examines the patient, confirms the diagnosis, and blocks the matching package in the system.
• 4. Emergency patients are admitted immediately, while scheduled surgeries undergo rapid pre-authorisation approval.
• 5. The hospital administers room stay, nursing, tests, medicines, and surgery without requesting any cash deposit.
• 6. At discharge, the patient signs the treatment slip confirming zero charges, and receives free medicines for 15 days.

• Visit the hospital search portal at hospitals.pmjay.gov.in or click "Find Hospital" on beneficiary.nha.gov.in.
• Select West Bengal, choose your home district (e.g. North 24 Parganas, Kolkata, Hooghly), and choose Public or Private.
• Filter by the required medical specialty (such as Cardiology, Orthopaedics, Nephrology, or General Surgery).
• The website shows hospital names, addresses, direct contact numbers, and active medical specialties.

• The card and treatment are completely free. Never pay any fee to check names, complete e-KYC, download cards, or receive treatment.
• Cashless treatment is available only at empanelled hospitals. Non-empanelled private clinics cannot offer free care or post-treatment reimbursement.
• The scheme covers in-patient admissions requiring 24 hours of stay and approved day-care surgeries, not routine clinic visits.
• Ensure names and birth dates match across your Aadhaar card and Ration Card to prevent admission delays.
• Keep your personal credentials and Aadhaar OTPs confidential. Never share them with unsolicited callers or unverified apps.

• Do not travel to out-of-state hospitals in Vellore, Chennai, or Bengaluru relying solely on Swasthya Sathi. An Ayushman card is required for nationwide treatment.
• Never pay an upfront cash deposit at an empanelled hospital for covered procedures. If asked to pay, report it to the Ayushman Mitra right away.
• Do not pay for local income certificates expecting to get enrolled. PM-JAY inclusion is strictly based on central survey records or the 70+ age criterion.
• Always carry the patient’s original Aadhaar card along with the Ayushman card when reporting to the hospital.
• Only use official government portals ending in ".gov.in" to avoid fraudulent fee-charging websites.

• Speak directly to the Ayushman Mitra at the hospital help desk for immediate on-site assistance.
• Call the 24/7 National Toll-Free Helpline at 14555 or 1800-111-565 (available in Bengali, Hindi, and English).
• Contact the West Bengal Health Helpline at 1800-345-5384 or 033-2357-6000.
• Submit an online grievance at cgrms.pmjay.gov.in by selecting "Register Grievance", choosing AB-PMJAY and West Bengal, and uploading relevant documents.