Ayushman Vay Vandana is the extension of Ayushman Bharat PM-JAY to every Indian citizen aged 70 or above, regardless of income, launched on 29 October 2024. Each eligible senior receives a separate Ayushman Vay Vandana card and ₹5 lakh of annual cover for secondary and tertiary hospitalisation at any empanelled hospital. By 28 February 2026, 36,229 hospitals were empanelled under PM-JAY — 19,483 public and 16,746 private — and more than ten lakh senior admissions worth over ₹2,150 crore had been authorised by the end of 2025. West Bengal joined in May 2026, taking the scheme to all 36 states and union territories.
For a private hospital this is the largest new patient segment in a decade: price-regulated, document-heavy, and growing every month as enrolment spreads. This guide explains how the scheme works from the hospital's side, what it takes to be paid on time, and what your software must handle.
Who is eligible, and what they get
- Age 70 or above, with Aadhaar as the age proof. No income, occupation or family criteria.
- ₹5 lakh per year of cover. Seniors in a family already covered by PM-JAY get an additional ₹5 lakh top-up shared among the family's 70+ members; seniors in families not previously covered get ₹5 lakh shared among the eligible members.
- Those already under CGHS, ECHS or similar choose one scheme. Seniors with private health insurance or ESIC remain eligible.
- Cover is cashless and portable across every empanelled hospital in India, with 1,961 procedures across 27 specialities under the Health Benefit Package.
What the case mix looks like
Hospitals report that 70+ admissions concentrate in a predictable set of packages: cataract and other ophthalmic surgery, dialysis, joint replacement and fracture management, cardiac procedures including angioplasty, oncology day-care and chemotherapy, stroke and neurology admissions, urology, and general medicine admissions for respiratory and infectious illness. Many of these are precisely the elective and chronic procedures that mid-size private hospitals in tier-2 cities are equipped for — which is why private empanelment has grown faster than public in the last year.
Empanelment: what a private hospital needs
- Minimum criteria: typically 10 or more inpatient beds, qualified medical and nursing staff, defined support services, and state-specific requirements that vary. Single-specialty and day-care centres are empanelled for the packages they can deliver.
- Registration on the Hospital Empanelment Module (HEM) of the State Health Agency, with facility documents, staff registrations, tariff acceptance and a physical inspection.
- ABDM readiness is increasingly checked at empanelment and renewal. PM-JAY hospitals are the first group where ABDM compliance is being tied to claim processing; see Is ABDM mandatory?
- An Ayushman Mitra — the trained desk staff who verify beneficiaries, raise pre-authorisations and submit claims on the Transaction Management System (TMS).
Our PM-JAY empanelment and claims guide covers the process step by step.
How a Vay Vandana admission is billed
PM-JAY does not pay an itemised bill. It pays a package rate for a defined procedure or admission, and that rate is meant to cover the room, procedure, consumables, medicines, diagnostics and follow-up specified in the package. In software terms the package is the claim, and individual services delivered under it are non-billable to the patient. The hospital's job is to:
- Verify the beneficiary and card at admission, biometrically where required.
- Raise the pre-authorisation for the correct package before or at admission (emergency admissions within 24 hours), with the supporting investigations attached.
- Deliver the services and document them — admission notes, investigation reports, OT notes, and photographs where the package demands them.
- Submit the claim on discharge with the discharge summary and the mandated documents.
- Track the claim to payment, including deductions and TDS, and reconcile it against the IPD account.
Patients under the scheme must not be charged for anything within the package. Hospitals that bill seniors for "extras" are de-empanelled, and the scheme's grievance line is well used.
Why claims get rejected or cut
- Pre-authorisation raised after treatment began, outside the permitted window.
- Package selected does not match the diagnosis or procedure in the discharge summary.
- Mandatory documents missing or illegible — the discharge summary is the usual culprit.
- Duplicate admission for the same beneficiary within a blocked period.
- Biometric verification not done, or done on the wrong day.
- Investigation reports not attached to support the package.
Almost every item on that list is a documentation discipline the HMS can enforce: mandatory fields, attached reports, a discharge summary drafted from the same data as the claim.
Cash flow: the part nobody warns you about
PM-JAY payments arrive after adjudication, often 30 to 90 days after discharge depending on the state, with deductions the hospital must accept or dispute. A hospital doing 100 senior admissions a month at an average package of ₹25,000 has ₹25 lakh a month moving through a scheme ledger. If that ledger lives in a register, the owner does not know what is receivable, what was deducted, or what was paid net of TDS. Your software should hold a sponsored payment mode for scheme patients, track each claim's status, deductions and settlement, and let you see receivables by scheme at any moment.
Communicating with 70+ patients and their families
Senior patients are usually accompanied by a son or daughter who manages the paperwork and the phone. WhatsApp messages in Hindi and English for admission confirmation, pre-authorisation status and discharge keep the family informed without a trip to the counter. Follow-up reminders reduce the missed post-operative reviews that are common in this age group. See our WhatsApp automation guide.
Frequently Asked Questions
What is the Ayushman Vay Vandana card?
It is the PM-JAY health card issued to every Indian citizen aged 70 or above, regardless of income, giving ₹5 lakh of annual cashless hospitalisation cover at empanelled hospitals. It was launched on 29 October 2024 and is issued through the PM-JAY portal, the Ayushman app or an empanelled hospital's Ayushman Mitra desk.
Can a private hospital treat Ayushman Vay Vandana patients?
Yes, if it is empanelled under PM-JAY with the State Health Agency. As of February 2026, 16,746 private hospitals were empanelled. The hospital is paid the scheme's package rate and must not charge the patient for services within the package.
How much does PM-JAY pay hospitals?
Hospitals are paid fixed package rates under the Health Benefit Package, which vary by procedure and by state, with incentives for NABH accreditation and for hospitals in aspirational districts. Payment follows claim adjudication and may carry deductions.
Is ABDM compliance required for PM-JAY hospitals?
ABDM readiness is increasingly required at empanelment and renewal, and hospitals that cannot demonstrate it may see claim processing delays. Creating ABHA IDs for scheme patients and linking their records also earns incentives under the Digital Health Incentive Scheme.
Bill PM-JAY packages without leakage
Healthixio handles PM-JAY as a package: the package is the claim, services under it are flagged non-billable to the patient, a sponsored payment mode keeps scheme money separate from cash, and settlement with deductions and TDS is tracked per claim. ABHA creation and record linking are built in. See TPA and scheme billing or book a demo.