Ayushman Bharat in Odisha (Unified AB PM-JAY and Gopabandhu Jan Arogya Yojana)

What is Ayushman Bharat in Odisha?

Ayushman Bharat in Odisha is not a standalone programme any more. Odisha runs the central Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) converged with its own state health assurance scheme, the Gopabandhu Jan Arogya Yojana (GJAY), under a single co-branded card issued by the Health & Family Welfare Department through the State Health Assurance Society.

The state scheme has a long lineage. Biju Swasthya Kalyan Yojana (BSKY) was launched on 15 February 2017 and, over 2017 to 2024, extended assurance cover to roughly 70 lakh families, more than 70 per cent of Odisha's population. After the 2024 change of government the scheme was renamed Gopabandhu Jan Arogya Yojana. In February 2025 the state took the further step of converging it with AB PM-JAY, and the Union Health Minister and the Chief Minister jointly launched distribution of the co-branded card at Cuttack.

Convergence is the fact that matters most to a patient. According to the launch announcement, the unified scheme covers about 1.03 crore families, roughly 3.5 crore people, and gives them access to more than 29,000 empanelled hospitals across India, a very large jump from roughly 900 hospitals under the earlier state-only network.

What the converged scheme provides

• Cashless hospital treatment of Rs 5 lakh per family per year.
• An additional Rs 5 lakh for women members of the family, usable only by female members.
• Free treatment at all Odisha government health facilities, from sub-centres up to district headquarters hospitals.
• Nationwide portability, so an Odisha cardholder can be treated at an empanelled hospital in another state.

Who is eligible for the scheme in Odisha?

You are covered if:

• Your family already appears on the state health assurance beneficiary list that Odisha maintains for GJAY. This list was built to be wider than the central socio-economic criteria, and it historically covered both below-poverty-line and many above-poverty-line households.
• Your family is an AB PM-JAY beneficiary identified through the central deprivation and occupational criteria.
• You are a senior citizen aged 70 or above. The national expansion covers every citizen in that age group irrespective of household income, and Odisha issues cards under it.
• You are an Odisha resident living outside the state. Residency outside Odisha does not by itself cancel entitlement under the state scheme.

You are not eligible, or cannot claim, if:

• Your household is not on either the state beneficiary list or the AB PM-JAY list, and no member is aged 70 or above.
• You seek treatment at a hospital that is not empanelled. Empanelment is a hard boundary; a non-empanelled private hospital cannot bill the scheme even for a listed procedure.
• The procedure is outside the approved package list, cosmetic surgery and most purely elective work fall here.
• The care is outpatient only. The scheme is built around hospital admission, and a consultation with a take-home prescription is not a claim.

Because the state list, the central list and the 70-plus expansion are three different routes into the same benefit, a household should not assume it is out just because one route does not fit. The practical test is a beneficiary search, not self-assessment.

What documents are required?

How to apply for and get your Ayushman card in Odisha

1. Check that your family is on the list. Use the beneficiary search on gjay.odisha.gov.in, or the national beneficiary portal, with your mobile number and ration card details. If the search is confusing, ask an Ayushman Mitra helpdesk to run it for you.
2. Go to a card generation point with your Aadhaar card and ration card. Cards are generated at hospital Ayushman Mitra helpdesks, Common Service Centres, and camps organised by blocks and urban local bodies.
3. Complete e-KYC at the counter. The operator verifies your Aadhaar by OTP sent to your linked mobile number, or by a fingerprint or face scan if your mobile is not linked.
4. Get a card generated for every member, including children and elderly parents. A single card in the head of family's name does not automatically let another member claim; each covered person should have their own.
5. Collect the co-branded card or download it, and store a photograph of it on the family's phone. Hospital admission at 2 a.m. is not the moment to be hunting for a paper card.

How to use the card at a hospital

1. Reach the Ayushman Mitra or Arogya Mitra desk at the empanelled hospital, before admission if the case is planned, or as soon as the emergency is stabilised.
2. Show the card and Aadhaar. The desk verifies identity and opens a case on the transaction management system.
3. Let the hospital raise the pre-authorisation for the procedure. The state health assurance society approves the package, and the patient signs nothing that commits them to pay.
4. Take discharge without paying for the covered package. Ask for the discharge summary and the claim reference; both are needed if a dispute is raised later.

Emergency admissions do not require a prior referral. A patient brought in by ambulance is treated first and verified afterwards.

How much does the scheme pay, and for what?

The financial cover is Rs 5 lakh per family per financial year, drawn down as packages are used, with a further Rs 5 lakh reserved for women members. A family that exhausts the shared Rs 5 lakh on a male member's cardiac surgery has not exhausted the women's component; a female member can still claim against the top-up.

Cover applies to secondary and tertiary hospital care — surgeries, cardiac procedures, cancer treatment, dialysis, orthopaedic work, neonatal intensive care and similar admissions defined in the package list. Diagnostics, medicines and follow-up consultations that sit inside an admission package are part of the package price and are not billed separately to the patient.

Why claims get rejected, and what to do

• Hospital is not empanelled. Nothing can be done retrospectively; confirm empanelment before a planned admission.
• e-KYC incomplete or Aadhaar mismatch. A name spelled differently on Aadhaar and the ration card is the commonest technical failure. Get the Aadhaar record corrected first, then regenerate the card.
• Member not individually carded. The family is covered but the specific patient has no card in their name; the helpdesk can usually generate one during admission.
• Procedure outside the package list. Ask the hospital which package was attempted and whether an alternative listed package applies.
• Annual limit already used. Check whether the women's top-up is still available for a female patient.
• Old BSKY card presented. The superseded card will not open a case. Get the co-branded card generated.

Where to raise a grievance

Grievances start at the Ayushman Mitra helpdesk inside the hospital, which is staffed precisely to resolve cashless disputes. If that fails, escalate to the District Medical Officer or the district-level grievance cell, and then to the State Health Assurance Society through the contact details published on gjay.odisha.gov.in. Being asked to pay cash for a covered package at an empanelled hospital is itself the grievance, say that plainly when you complain, and keep the receipt you were given.

Card generation is free. No Common Service Centre operator, hospital agent or middleman may charge a fee to "get your name added" to the list, and no official will ask for your Aadhaar OTP over the phone.