How coverage works here: India.

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How coverage works here: India

Handout · moraph.org/commons/sessions/reach/how-coverage-works-here

This sheet explains how health care gets paid for, in general and where you live. It is general information, not medical advice or advice on choosing a plan.

Four ways care gets paid for

A public system, paid for through taxes.
Public programs for particular groups.
Insurance, through work or bought yourself.
Paying yourself at the point of care.

The words

Premium: what you pay to be covered.
Deductible or excess: what you pay before cover starts.
Co-payment or coinsurance: your share of each visit or prescription.
Out-of-pocket cost: anything you pay yourself.

Before you get care, ask

Is this covered, and is anything not?
Do I need a referral or a particular provider?
What will I pay, and does anything need approval first?

Stay safe

If it might be an emergency, call the emergency number first.
Real programs don’t cold-call to sell cover or ask for your details.
Check anything you’re unsure about on the official sites below.

In India

Ayushman Bharat PM-JAY. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a publicly funded scheme that gives eligible families health cover of up to ₹5 lakh per family per year for secondary and tertiary care in hospital. All members of an eligible family are covered, whatever their age, and treatment is cashless at empanelled government and private hospitals.
Who qualifies. Eligible families were first identified from the Socio-Economic Caste Census 2011, and many states and union territories have widened the list using other data. Since 29 October 2024, everyone aged 70 or over qualifies whatever their income, with a separate Ayushman Vay Vandana card; people 70 or over in families already covered get an extra top-up for themselves.
How people aged 70 or over enrol. Enrolment for people aged 70 or over is by application: through the official portal beneficiary.nha.gov.in, at a nearby empanelled hospital or at a Common Service Centre. The 24-hour call centre on 14555 answers questions.
Other public schemes. Some people are covered by other public schemes, such as the Central Government Health Scheme (CGHS) or the Ex-Servicemen Contributory Health Scheme (ECHS). People aged 70 or over in those schemes can keep their scheme or choose AB PM-JAY, and those with private insurance or Employees’ State Insurance can still use AB PM-JAY.
Public health facilities. Public health and hospitals are a state subject, with national support through the National Health Mission. Under its Free Drugs Service Initiative, states get support to provide free essential medicines in public health facilities, and many services, such as immunisation and care for tuberculosis and HIV, are free.
Primary care near home. Ayushman Arogya Mandirs (primary and sub-health centres) are meant to bring care closer to home, including care for long-term conditions, mental health, and free essential medicines and diagnostic tests. Teleconsultation is available at operational centres.

Official places to check:

Press Information Bureau (Government of India): www.pib.gov.in/PressReleasePage.aspx?PRID=2185049&reg=3&lang=1
Press Information Bureau (Ministry of Health and Family Welfare): www.pib.gov.in/PressReleasePage.aspx?PRID=2053883&reg=3&lang=1
Press Information Bureau (Ministry of Health and Family Welfare): www.pib.gov.in/PressReleasePage.aspx?PRID=2116209&reg=3&lang=1
Press Information Bureau (Ministry of Social Justice and Empowerment): www.pib.gov.in/PressReleasePage.aspx?PRID=2110780&reg=3&lang=1
Press Information Bureau (Ministry of Health and Family Welfare): www.pib.gov.in/PressReleasePage.aspx?PRID=1737183&reg=3&lang=1

More free official help in India: moraph.org/commons/help/health-access/in

General information, not advice about your own situation. Checked 20 October 2026. If an official source says something different, it is right. Free to copy and adapt. moraph.org/commons/sessions/reach/how-coverage-works-here