Ayushman Bharat PM-JAY SEHAT (J&K Universal Health Insurance Scheme)

What is the SEHAT scheme in Jammu and Kashmir?

AB PM-JAY SEHAT is the universal health insurance scheme of the union territory of Jammu and Kashmir, run by the Health and Medical Education Department through the State Health Agency, J&K. The department's own description on hme.jk.gov.in is direct: "The Universal Health care scheme introduced by the Government of India in addition to the Ayushman Bharat PMJAY is a fully funded Health care Insurance scheme for all the citizen of J&K which is focused on reducing the out of pocket expenses for the general public and especially for the Poor and Economically Weaker Section of the society."

Two things in that sentence define the scheme. It is fully funded, the family pays no premium. And it is for all citizens of J&K, not only the families identified by the national Ayushman Bharat criteria.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) was extended to the union territories of Jammu and Kashmir and Ladakh in December 2020. PM-JAY provides a cover of Rs 5 lakh per family per year for secondary and tertiary hospital care. SEHAT is the J&K layer on top: it takes the same cashless entitlement and gives it to every remaining resident family in the union territory at government cost. That is why government orders issued by the Health and Medical Education Department refer to the pair together as "AB PM-JAY/AB PM-JAY SEHAT".

Who is eligible for SEHAT, and who is not eligible?

You are covered if:

• Your family is a resident family of the union territory of Jammu and Kashmir. The department describes the scheme as covering all citizens of J&K.
• You are already a PM-JAY beneficiary under the national criteria, in which case your existing Ayushman entitlement applies and you do not need a separate SEHAT card.
• Your household income is high or low — there is no income test for the SEHAT extension. This is the single biggest difference from PM-JAY, which is targeted at deprivation and occupational categories.

You cannot apply if:

• Your family is not resident in Jammu and Kashmir. SEHAT is a union territory scheme funded by the J&K administration; a resident of another state is not eligible for a J&K SEHAT card, though a J&K cardholder can generally use PM-JAY portability at empanelled hospitals elsewhere.
• You are seeking cover for a treatment or a hospital outside the empanelled network and outside the approved package list. SEHAT pays for treatment at empanelled hospitals against defined packages, not as an open reimbursement of any medical bill.

What does SEHAT pay for?

SEHAT delivers the Ayushman Bharat PM-JAY benefit package: cashless secondary and tertiary hospital treatment at hospitals empanelled under the scheme, covered up to Rs 5 lakh per family per year on a family-floater basis. The cover is not split per member, one member can use the whole amount, or several members can share it across the year.

Treatment is delivered at both government and empanelled private hospitals. Government medical colleges in the union territory treat patients under the scheme: a Health and Medical Education Department government order in 2026 set up an inquiry committee for an audit and data analysis of cardiology cases performed at GMC Anantnag under AB PM-JAY and AB PM-JAY SEHAT, which confirms that high-value tertiary procedures are being claimed through the scheme at government medical colleges.

Because payment is cashless, a beneficiary is not expected to pay the hospital and claim afterwards. You present your card at the hospital's Ayushman Mitra help desk, the hospital raises the claim, and the State Health Agency settles it.

How to apply for a SEHAT card in Jammu and Kashmir

SEHAT enrolment is free and continuous. There is no annual application window, because the scheme is universal rather than competitive.

1. Check whether your family is already covered under Ayushman Bharat PM-JAY. Families in the national beneficiary list already hold an entitlement and only need a card generated, not a fresh enrolment.
2. Collect your documents; Aadhaar card, ration card and a proof of residence in Jammu and Kashmir for the family members you want on the card.
3. Visit a Common Service Centre (CSC) in your area, or the Ayushman Mitra help desk at an empanelled hospital, and ask for SEHAT card generation. These are the two standard Ayushman Bharat enrolment counters.
4. Complete the verification at the counter. The operator matches your Aadhaar and ration card details against the beneficiary database and completes an OTP or biometric verification.
5. Collect your SEHAT / Ayushman card. Keep it with you, and carry it with an Aadhaar card whenever a family member is admitted.
6. At the time of admission, go to the Ayushman Mitra help desk at the empanelled hospital before paying anything, and present the card so that the admission is registered as a cashless case from the start.

If the counter tells you your family is not traceable in the database, take the matter to the District Health Officer or the Chief Medical Officer of your district, who is the working level of the State Health Agency's district machinery.

Why a SEHAT claim gets rejected or delayed

• Card not presented at admission. A case registered as a paying admission and converted later is far harder to settle; present the card at the Ayushman Mitra desk before treatment starts.
• Name or Aadhaar mismatch between the card, the ration card and the hospital record.
• Hospital not empanelled. SEHAT is cashless only at hospitals empanelled under Ayushman Bharat in the union territory or, under portability, elsewhere.
• Treatment outside the package list. Ayushman Bharat pays against defined treatment packages; procedures outside that list are not covered.
• Family member not added to the card. Each member has to be enrolled; a member left out of the family record cannot claim.

Where to get help with SEHAT

• State Health Agency, Jammu and Kashmir, under the Health and Medical Education Department, is the implementing authority for AB PM-JAY and AB PM-JAY SEHAT, headed by a Chief Executive Officer.
• Health and Medical Education Department portal: hme.jk.gov.in, which publishes the department's government orders and circulars, including those concerning AB PM-JAY SEHAT.
• Ambulance and emergency response: 102 and 108, listed by the department as available 24x7.
• Tele-consultation, doctor on call: 104, listed by the department as available 24x7.
• Ayushman Mitra help desk at any empanelled hospital, for card, package and admission queries.

Enrolment under SEHAT is free. No agent, operator or hospital staff member may charge you a fee for generating a SEHAT or Ayushman card, and no cashless admission at an empanelled hospital should require you to pay a deposit.

What the official sources do not publish

Readers should know where the published record stops. The Health and Medical Education Department portal confirms that the scheme exists, that it is fully funded, that it covers all citizens of J&K, and that the State Health Agency runs it. It does not publish, on that page, a SEHAT-specific toll-free number, the current empanelled hospital list, the number of families enrolled, or a scheme-specific enrolment portal. The Rs 5 lakh per family per year figure quoted above is the Ayushman Bharat PM-JAY cover that SEHAT extends, not a separately notified J&K figure. Confirm the current cover, the empanelled hospital nearest you and the active enrolment counter with your District Health Officer or at an empanelled hospital's Ayushman Mitra desk before you rely on any figure for a planned admission.