Health Insurance

AB-PMJAY Ladakh: Eligibility, Hospitals & Card Guide

Ann Tresa Jais

Written by Ann Tresa Jais

Insurance Writer

Gaurav Bhat

Reviewed by Gaurav Bhat

IRDAI-Certified Expert at Ditto

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Certified
AB-PMJAY Ladakh: Eligibility, Hospitals & Card Guide

Overview

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in Ladakh provides eligible beneficiaries with cashless coverage for covered secondary and tertiary hospitalization. The Union Territory’s State Health Agency supports implementation in Ladakh through beneficiary identification and Ayushman card generation.

Key Features & Implementation

  • Financial Cover: Eligible families receive coverage of up to ₹5 lakh per year for covered hospitalization expenses.
  • Network: Beneficiaries can access cashless treatment at empaneled public and private hospitals across India.
  • Registration and Digital Integration: Local enrollment activities support beneficiary identification and Ayushman card generation. Digital systems facilitate beneficiary verification, e-KYC, and Ayushman card services. 

Getting the right treatment in Ladakh can involve more than finding a suitable hospital, as hospitalization costs can also strain a family's finances. Under the scheme, eligible families can receive up to ₹5 lakh per year on a floater basis for covered hospitalization expenses, with the benefit available at empaneled hospitals across India.

In the next few minutes, you will learn who qualifies for AB-PMJAY Ladakh, what it covers, how to get an Ayushman card, where you can use it, and whether the scheme alone is enough to protect your family's healthcare finances.

What Is AB-PMJAY in Ladakh?

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a government-funded health insurance scheme that provides financial protection against the cost of eligible hospitalization for covered beneficiaries. In Ladakh, the scheme is implemented as AB-PMJAY Ladakh through the Union Territory (UT)'s State Health Agency.

According to the AB-PMJAY dashboard, around 2,00,000 Ayushman cards have been created in Ladakh, reflecting the scheme's reach across the Union Territory.

Don't Confuse the Two Schemes

AB-PMJAY and Ladakh's Universal Healthcare Scheme are two separate government healthcare schemes. The UT Administration introduced the Universal Healthcare Scheme alongside AB-PMJAY to provide healthcare coverage to all Ladakh citizens. 

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Eligibility Criteria for AB-PMJAY in Ladakh

01

SECC 2011 Beneficiaries

The original PM-JAY beneficiary base was identified using the Socio-Economic and Caste Census (SECC) 2011. The Ladakh administration has stated that families not covered under the earlier PM-JAY database were subsequently brought under the UT's Universal Health Coverage Scheme.

02

ASHA and Anganwadi Workers

ASHA workers, Anganwadi Workers, Anganwadi Helpers, and their families were included under AB-PMJAY through a national expansion announced by the Government of India. This expansion also applies to eligible beneficiaries in Ladakh.

03

Citizens Aged 70 Years and Above

Since the 2024 expansion, all Indian citizens aged 70 years and above are eligible for AB-PMJAY, regardless of socioeconomic status. The Ministry of Health and Family Welfare states that eligible senior citizens can receive up to ₹5 lakh in free treatment benefits per year under the scheme.

Benefits and Treatments Covered Under AB-PMJAY in Ladakh

BenefitWhat AB-PMJAY Covers
Coverage AmountUp to ₹5 lakh per family per year. 
Hospitalization CoverageListed secondary and tertiary care hospitalization.
Treatment Packages National Health Benefit Package covers 1,961 procedures across 27 medical specialties, including General Medicine, General Surgery, Orthopedics, Cardiology, and Oncology. 
Pre-Existing Diseases Eligible pre-existing diseases are covered from day one, with no waiting period.
Pre- and Post-Hospitalization Covers eligible expenses incurred up to 3 days before and 15 days after hospitalization. 
Room EntitlementGeneral ward accommodation is covered.
Family Size No restriction on the number of family members covered under an eligible family.
Age and Gender No age or gender restriction for beneficiaries who meet the scheme's eligibility criteria. 
Day-Care Treatment Covers eligible day-care procedures that do not require a full 24-hour hospital stay. 
Nationwide Portability Beneficiaries can access cashless treatment at empaneled hospitals across India. 

How to Check AB-PMJAY Beneficiary Status?

You can check whether your name is included in the AB-PMJAY beneficiary database through the official AB-PMJAY beneficiary portal.

    • Visit the Official Beneficiary Portal: Open the AB-PMJAY beneficiary portal.
    • Log In: Enter your mobile number and complete the OTP verification.
    • Select Ladakh: Choose Ladakh as your Union Territory.
    • Enter Your Details: Provide the requested beneficiary details to search the database.
    • Check Your Status: The portal will display your beneficiary record and relevant eligibility details.

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How to Apply for an AB-PMJAY Card in Ladakh and Documents Required

Eligible beneficiaries can complete their AB-PMJAY registration through the following options: 

    • Online: Use the official AB-PMJAY beneficiary portal or the Ayushman App to complete beneficiary verification and card-related services. 
    • At an Empaneled Hospital: Visit an AB-PMJAY empaneled hospital and approach the designated PM-JAY staff for assistance with beneficiary verification and card generation.
    • Through a Common Service Centre (CSC): Beneficiaries can also visit a CSC for assistance with enrollment and Ayushman card services.
    • Through Local Enrollment Drives: The Ladakh Administration has been providing PM-JAY enrollment and card-related services through outreach camps in different parts of the UT.

Steps to Apply Online for an AB-PMJAY Card

    • Visit the official AB-PMJAY beneficiary portal.
    • Log in using your mobile number and complete the required verification.
    • Search for your beneficiary record.
    • Complete the required e-KYC and submit the necessary details.
    • Once verification and approval are complete, access or download your Ayushman card.

The Ayushman App also supports self-verification for eligible beneficiaries and offers multiple authentication methods for card creation.

Documents Required for an AB-PMJAY Card

Required documents can vary by beneficiary category and verification method. Keep the following available where applicable:

    • Aadhaar Card: Used for identity verification and e-KYC.
    • Ration Card or Other Family Identification Details: These may be used to establish or verify the beneficiary's family record. 
    • Mobile Number: May be required for OTP-based verification.
    • Other Supporting Documents: If required for your beneficiary category or verification.

AB-PMJAY Empaneled Hospitals in Leh and Kargil

In Ladakh, AB-PMJAY treatment is primarily delivered through empaneled public health facilities, including district hospitals in Leh and Kargil and several community and primary health centers. Examples include SNM Hospital Leh, DH Kargil, CHC Khaltse, CHC Nubra, and CHC Sankoo.

Ladakh has a limited private hospital network, so access to empaneled private hospitals is more relevant when beneficiaries seek treatment outside the Union Territory. AB-PMJAY's nationwide portability allows eligible beneficiaries to receive covered cashless treatment at empaneled hospitals across India.

You can check the latest list of AB-PMJAY empaneled hospitals through the National Health Authority's Hospital Empanelment Module. Select Ladakh as the state or union territory, then choose the relevant district to view the available facilities and their empaneled services.

AB-PMJAY vs. Private Health Insurance in Ladakh: Do You Still Need Cover?

AB-PMJAY in Ladakh can cover a significant part of your hospitalization costs if you are eligible. However, it is not a complete substitute for private health insurance if you want a higher sum insured or more flexibility in choosing where you receive treatment.

    • Higher Financial Protection: AB-PMJAY provides up to ₹5 lakh per family per year, but does not include cumulative bonus or restoration of cover. A private policy can provide a higher sum insured with these features, based on the policy terms.
    • More Choice for Treatment Outside Ladakh: Ladakh has limited tertiary healthcare facilities, so patients requiring specialized treatment are referred to Srinagar, Jammu, Chandigarh, or Delhi. AB-PMJAY is portable for treatment at empaneled hospitals outside Ladakh. Private insurance can provide a wider hospital network and cover eligible road or air ambulance expenses, based on the policy terms.
    • Extra Protection Beyond Government Schemes: Ladakh residents can have government health coverage through AB-PMJAY or the Universal Healthcare Scheme. Private health insurance can provide extra protection through a higher sum insured and additional benefits beyond the government coverage. 
    • Medical Inflation: Medical inflation can gradually reduce what ₹5 lakh can cover. As hospital and treatment costs increase, this amount covers a smaller share of expensive procedures or prolonged hospitalization.

Our Recommendation: If you are eligible for AB-PMJAY in Ladakh, use it for the treatments it covers. If you can afford it, a private health insurance policy can work alongside the scheme and provide an additional financial cushion.

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Conclusion

AB-PMJAY in Ladakh provides eligible beneficiaries with cashless coverage for a range of hospitalization expenses, along with nationwide portability at empaneled hospitals. However, the scheme has defined eligibility criteria, treatment packages, and a ₹5 lakh annual family coverage limit.

If you are eligible, use AB-PMJAY in Ladakh for covered treatments, but consider whether the coverage meets your family's healthcare needs. If you need broader financial protection, comparing the best health insurance plans in India can help you choose an additional policy based on your coverage requirements and budget.

Frequently Asked Questions

Is AB-PMJAY available in both Leh and Kargil districts of Ladakh?

Yes. AB-PMJAY is implemented across Ladakh, including the Leh and Kargil districts. Eligible beneficiaries can access covered treatment at empaneled hospitals in the UT. To find the current hospital network, use the National Health Authority's Hospital Empanelment Module, select Ladakh as the Union Territory, and then choose the relevant district.

Can I use my AB-PMJAY card from Ladakh at a hospital in Srinagar, Jammu, or Delhi?

Yes. AB-PMJAY provides nationwide portability, so eligible beneficiaries from Ladakh can receive covered cashless treatment at empaneled hospitals across India. This includes empaneled hospitals in Srinagar, Jammu, Delhi, and other locations. Before seeking treatment, check the National Health Authority's current hospital list to confirm that the hospital is empaneled and offers the required treatment package.

Does AB-PMJAY cover the cost of traveling out of Ladakh for treatment?

No. AB-PMJAY covers eligible hospitalization and treatment expenses included under the applicable health benefit package. The scheme does not provide a separate benefit for travel expenses incurred when a beneficiary travels outside Ladakh for treatment. Therefore, transportation costs to Srinagar, Jammu, Delhi, or another location are not covered simply because the treatment is eligible under AB-PMJAY.

What is the full form of AB-PMJAY?

The AB-PMJAY full form is Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. It is a government health insurance scheme that provides eligible beneficiaries with financial protection for covered hospitalization expenses. The scheme offers up to ₹5 lakh per family per year and provides cashless treatment for eligible procedures at empaneled public and private hospitals. Coverage includes listed secondary and tertiary care treatments under applicable health benefit packages. 

Which hospitals in Ladakh are empaneled under AB-PMJAY?

AB-PMJAY has empaneled hospitals in Ladakh where eligible beneficiaries can receive covered cashless treatment. Examples include SNM Hospital Leh, District Hospital Kargil, Community Health Centre Khaltse, Community Health Centre Nubra, and Community Health Centre Sankoo. The list can change as hospitals are added or removed. You can check the current list through the National Health Authority's Hospital Empanelment Module.

How do I download my AB-PMJAY card after registering in Ladakh?

After your beneficiary details are verified and your Ayushman Card is generated, you can access the card through the official AB-PMJAY beneficiary portal or the Ayushman App. Log in using your registered mobile number and complete the required verification. Once the card is available, you can access and download the digital copy for use at empaneled hospitals.

Does AB-PMJAY in Ladakh cover Out-Patient Department (OPD) consultations and diagnostic tests?

AB-PMJAY primarily covers eligible secondary and tertiary hospitalization and the expenses included in the applicable treatment packages. It is not a general outpatient health insurance scheme that covers routine OPD consultations. Diagnostic tests are covered when they form part of an eligible hospitalization package. Therefore, AB-PMJAY does not automatically cover standalone OPD consultations or diagnostic tests.

What does AB-PMJAY not cover?

AB-PMJAY does not cover routine outpatient care, drug rehabilitation, cosmetic or aesthetic treatments, fertility treatment, vaccinations, and most dental treatments. Individual diagnostic tests without a covered treatment are also excluded. Coverage is based on the Health Benefit Packages, so a treatment must fall within an approved package to qualify.

Can I get an Ayushman card if I am over 70 and already have other health coverage?

Yes, but it depends on your existing coverage. If you have private health insurance or Employees’ State Insurance Corporation coverage, you can also use AB-PMJAY. If you are covered under the Central Government Health Scheme, Ex-Servicemen Contributory Health Scheme, or Ayushman Central Armed Police Force, you must choose between your existing scheme and AB-PMJAY. If your family already has AB-PMJAY, your ₹5 lakh senior citizen cover is an additional top-up.

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