9 Facts Every Delhi Family Should Know About PM‑JAY & Private Health Planning

As a CERTIFIED FINANCIAL PLANNER™ and a financial coach to thousands of Indian families, I often get asked, “Is PM-JAY (Ayushman Bharat) for all Delhi citizens?”

The answer is not quite.

The PM-JAY scheme is a revolutionary move towards universal health coverage, but it’s not automatically available to every resident—especially in Delhi. Over the past few weeks, I’ve seen both senior citizens and young families walk into confusion about who qualifies, what’s covered, and how to apply.

Let me take you through 9 key facts that will clear the air—so you or your loved ones don’t miss out on this incredible ₹5 lakh to ₹10 lakh cashless health cover.

1. PM‑JAY for Delhi: Not Automatically for Everyone

This is the most significant change in recent times. Since September 2024, the Government of India has made PM-JAY available to all Indian citizens aged 70 and above, regardless of their income, SECC status, caste, or location.

In Delhi, this rollout began in full swing in early 2025. The state government took it a step further and added an additional ₹5 lakh, effectively giving ₹10 lakh of total cashless health coverage to each eligible senior.

PM‑JAY isn’t a universal scheme. For residents under 70, coverage depends on inclusion in the Socio-Economic Caste Census (SECC-2011)—families categorised as deprived or belonging to specified occupations are eligible (nha.gov.in, India today.in). The SECC-2011 is a comprehensive list of households in rural and urban areas, and it categorizes families based on their economic status, occupation, and other factors. If your name isn’t on that list, you won’t qualify, regardless of your income or health insurance ignorance.

2. Universal Coverage for Age 70+

On September 11, 2024, the Union Cabinet approved automatic PM‑JAY enrolment for all citizens aged 70+, irrespective of income or SECC status (pmindia.gov.in). Seniors need an Aadhaar-based e-KYC to obtain their Ayushman Vay Vandana card—no income proofs, no documentation hassles.

Mrs. Mehra’s Journey to Peace of Mind

I remember speaking to Mrs. Sarla Mehra, 72, from South Delhi. For years, she skipped medical check-ups due to costs. Her son attempted to get her covered under the standard PM-JAY rules, but her name wasn’t on the SECC-2011 list. But now? She holds her Ayushman card with pride, knowing that she has ₹10 lakh coverage for major treatments—without paying a single rupee in premiums. This sense of relief and peace of mind is what PM-JAY brings to many seniors like Mrs. Mehra.

3. Delhi Seniors Enjoy ₹10 Lakh Cashless Cover

Here’s a real bonus for Delhi’s elderly population: not only do they receive the central government’s ₹5 lakhs under PM-JAY, but the Delhi Government adds another ₹5 lakhs as a top-up.

This means that any senior Delhi citizen aged 70 and above receives ₹10 lakh of free, cashless treatment at empanelled hospitals—no income proof. No premium. There is no age cap.

Delhi goes further by combining the ₹5 lakh central PM-JAY cover with a ₹5 lakh state top-up under the Vay Vandana Yojana, a state-specific scheme that provides additional health coverage to senior citizens. This combined coverage provides Delhi seniors with ₹10 lakh per family. It’s fully cashless and paperless at empanelled hospitals.

4. How to Check Eligibility (All Ages)

Now, here’s the catch: if you’re below 70, you can only access PM-JAY if your family is listed in the Socio-Economic Caste Census (SECC) of 2011.

The government uses this data to identify vulnerable and economically weaker households, and only those families are eligible for the ₹5 lakh PM-JAY cover.

How to Check If You’re Eligible (Below 70)

1. Visit the official PM-JAY portal: https://www.pmjay.gov.in
2. Click on “Am I Eligible?”
3. Enter your mobile number and OTP.
4. Select Delhi as your state.
5. Check if your name or family appears.

Pro Tip: You can also check this at any Common Service Centre (CSC) in your locality.

• Under 70: Visit pmjay.gov.in → “Am I eligible?” → Enter your mobile/OTP → Choose Delhi and check. CSC centres can also assist.
• Age 70+: Use the “PM-JAY for 70+” tab, verify your Aadhaar e-KYC, and download your Vay Vandana/Ayushman card

5. What PM‑JAY Covers (₹5–10 L Family Floater)

Where Can You Use This Cover?

Over 28,000 public and private hospitals across India are empanelled under PM-JAY. In the Delhi NCR area alone, there are hundreds of listed facilities—both government and reputable private hospitals. You can get surgeries, hospitalisations, and even cancer treatments cashless at these hospitals.

Under PM-JAY, here’s what’s covered:

• Hospitalisation expenses (pre/post)
• Surgeries, including cardiac, kidney, ortho, and oncology
• ICU and critical care services
• Medicines and diagnostics
• Daycare surgeries
• Emergency ambulance transport

You don’t need to pay anything upfront. It’s entirely cashless and paperless at network hospitals.

• 3 days pre-hospitalisation and 15 days post-care
• Surgical and medical treatments (cardiac, ortho, oncology)
• ICU, diagnostics, medicines, and ambulance services (nha.gov.in)
No prepaid amount is needed—empanelled hospitals handle billing.

6. You Don’t Need to Pay Premiums or Buy a Policy

One of the most beautiful things about PM-JAY is this:

You don’t pay anything.
No paperwork. No premiums. No intermediaries.

The government bears the entire cost through the National Health Authority (NHA). Once you’re enrolled (especially if you’re 70 or older), you can download your Ayushman card and carry it to the hospital. That’s it. The simplicity of this process ensures that you can access your benefits without any hassle or confusion.

How to Get the Ayushman or Vay Vandana Card (For Seniors)

If you’re aged 70+, here’s what you do:

1. Go to https://www.pmjay.gov.in
2. Click “PM-JAY for 70+ Citizens.”
3. Enter Aadhaar number and verify with OTP
4. Complete your e-KYC
5. Download your Ayushman Card (or visit a CSC for print)

If you’re not comfortable doing this online, visit a nearby Common Service Centre or call the Ayushman Bharat helpline: 14555.

Also read: How to Confidently Overcome All Your Limiting Beliefs on Your Journey to Riches and True Wealth with Wisdom in 11 Steps

 Mrs. Sharma’s ₹10 Lakh Lifesaver

Mrs Sharma, 73, from Lajpat Nagar, needed cataract surgery. Under the Vay Vandana scheme, she underwent hospitalisation and treatment without any payment—her entire ₹10 lakh entitlement stayed untouched. She said:

“Finally, the peace of mind I’ve been paying for in premiums.”

No red tape. Just dignity.

7. Why Many Delhi Residents Still Feel Left Out

Middle-class families under 70 often believe PM-JAY is universal, but unless the SECC-2011 lists them, they’re not eligible for the ₹5 lakh cover (ayushmanbharat.haryana.gov.in, India today.in). That results in disappointment when they try to apply and discover they’re listed as non-SECC.

Contrary to belief, middle-class and upper-middle-class families in Delhi are not automatically enrolled—even if they have no health insurance.

The scheme is not income-based for the general population—it’s a list-based scheme. Unless your family is found in SECC-2011 data, you don’t qualify.

Mr Amit Sood, a self-employed consultant from Dwarka, approached me after reading about the PM-JAY scheme. He assumed he could sign up like any government scheme. After checking online, he discovered that his name wasn’t on the SECC list—and hence, he wasn’t eligible. However, I advised him to explore affordable retail health insurance plans, and now he’s covered privately for ₹10 lakh at an annual premium of ₹ 8,500.

8. The Case for Private Health Insurance

For those under 70 and not SECC‑listed, consider private health insurance—why?

Feature	Private Insurance	PM‑JAY	Vay Vandana
Eligibility	Open to all	SECC‑listed families	Citizens 70+
Sum Insured	₹3–6 crore+	₹5 lakh	Additional ₹5 lakh
Premium	Yes, based on risk	None	None
Covers OPD	Often	No	No
Network Hospitals	Wide but varies	Empanelled only	Same

Private policies offer significantly larger limits, OPD coverage, customisation, and global portability—something PM‑JAY lacks (policybazaar.com, pib.gov.in).

9. A Balanced Health-Cover Strategy

• 70+ Delhi residents: Use PM‑JAY + Vay Vandana as foundational cover (₹10 lakh).
• Additionally, consider top-up or private policies to cover non-empanelled hospitals, outpatient care (OPD), and lifestyle diseases.
• Under 70 & SECC-listed: PM‑JAY’s ₹5 lakh is a start—but still consider private insurance.
• Under 70 & not SECC-listed: Prioritise retail health insurance; PM‑JAY isn’t available to you.

Final Thoughts: Where Does Financial Planning Come In?

At The Richness Academy, I coach families not just to earn, save, and invest—but to protect their wealth. Health is wealth’s twin, and a financial plan without health coverage is like a car with no brakes.

If you’re 70 or older, PM-JAY is a gift of dignity and security.

If you’re below 70 and not eligible, then it’s time to strategically consider a private health insurance policy that suits your family’s needs. Because medical expenses are the #1 reason families in India fall into debt.

Final Takeaway

• PM-JAY isn’t universal—it’s selective, based on SECC, for those under 70 years old.
• All senior citizens in Delhi (70 years and above) receive a ₹10 lakh cashless health cover with no premiums (pib.gov.in, nivabupa.com).
• If you’re younger and SECC-listed—you qualify, but families will benefit from adding a private plan.
• If you’re younger and not SECC-listed—you’re ineligible; a solid private policy is essential.

Securing health isn’t just about coverage—it’s about protection, peace of mind, and planning. PM‑JAY and Vay Vandana are powerful tools, especially for seniors—but a balanced private-public health strategy ensures your family’s financial well-being right through life.

Want My Help?

• Need personalised guidance on choosing a policy?
• Want help comparing top insurers or understanding claim networks?
• Are you looking to integrate health coverage into your overall financial plan?

Just say the word—I’m here as your financial coach.

—

About the Author

Taresh Bhatia, CFP®
CERTIFIED FINANCIAL PLANNER™
Founder – The Richness Academy

As a financial freedom coach, I’ve guided over 10,000 families and professionals in aligning their wealth with their life goals. Health planning is part of financial planning—and I’m here to help you get both right.

Join My Free Webinar – “Couple Finance Formula™”

🗓 Sunday at 5:30 PM IST
🎁 Includes free toolkit + lifetime access to recording
👉 Register FREE at: www.CoupleFinanceFormula.in

📢 Join free live webinar —
Couple Finance Formula™ Register here