Is free treatment possible once the Ayushman card limit is exhausted? Know the rules..

Under the central government's ambitious scheme, Ayushman Bharat (PM-JAY), poor and needy families in the country are provided with free, cashless medical treatment of up to ₹5 lakh annually. However, many beneficiaries often ask: if the ₹5 lakh limit is exhausted within a financial year, does the free medical treatment cease? It should be noted that the ₹5 lakh coverage under the Ayushman scheme is for the entire family; it does not provide a separate ₹5 lakh cover for each individual family member.

Does treatment stop once the limit is exhausted?
According to the rules of the Ayushman Bharat scheme, a health cover of ₹5 lakh is allocated to a family each year. If the entire ₹5 lakh amount is spent on the treatment of one or more family members within a financial year, the facility for free treatment via the Ayushman card is discontinued for the remainder of that financial year. However, this limit is not permanently exhausted; it is automatically renewed at the start of the new financial year.

Can assistance still be obtained after the limit is exhausted?
If the ₹5 lakh limit is exhausted and a patient requires urgent further treatment or surgery, special permission may be sought from the District Health Department or the State Health Agency (SHA)—particularly in cases involving serious illnesses such as cancer, organ transplants, or cardiac care. Following a review of the case by the Chief Medical Officer (CMO), additional government assistance may be provided.

If the Ayushman limit has been exhausted, a patient may apply for financial aid through the 'Rashtriya Arogya Nidhi' or the Chief Minister's Relief Fund of the respective state.

Important points to keep in mind:
As long as the ₹5 lakh coverage amount remains available, beneficiaries can be admitted to a hospital for treatment as many times as necessary within the year. The benefits of the scheme are available only at government and private hospitals that are empanelled under the Ayushman Bharat scheme. Before beginning any treatment, be sure to check the remaining balance on your card at the Ayushman helpdesk located at the hospital.

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