Who is Eligible for Ayushman Bharat Health Insurance?

Eligibility Criteria for Ayushman Bharat Health Insurance

The Ayushman Bharat Yojana (ABY), also known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), is a government initiative designed to provide health insurance coverage to economically disadvantaged families in India. Socio-economic and demographic factors primarily determine eligibility for this scheme. 

Below are the key eligibility criteria for the scheme.

Eligibility for the Ayushman Bharat Scheme

Ayushman Bharat health insurance is meant for the deprived and economically weaker section of society. Basic eligibility criteria are based on socio-economic status, family size, and geographical area.

a. Socio-Economic Caste Census Criteria

Eligibility depends on Socio-Economic Caste Census (SECC) data for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. Its benefits are provided to any individual or family within the vulnerable classes. These include:

●Economically Backward Families: SECC categorizes households in rural and urban sectors, with preference given to categories of no land, no employment, or stable source of income.
●Scheduled Castes (SC), Scheduled Tribes (ST), and Other Backward Classes (OBCs): The probability of qualifying for ABY is higher for people who fall in the scheduled castes, scheduled tribes, and other backward classes.
●Unorganized Workers: The scheme also covers people doing unorganized or low-paying, informal jobs.

b.Annual Family Income Limit

PMJAY also includes families with an annual income of up to ₹5 lakh, ensuring that health insurance will now be available to all low-income groups. Families earning above ₹5 lakh will not be included in the scheme except in case of eligibility under SECC on some other grounds.

c.Geographic Factors

The scheme enrollment priority is given to states and regions with the maximum percentage of economically disadvantaged persons. However, the scheme design is pan-Indian and so is the recipient population: both rural as well as urban.

Eligibility for Specific Groups Under Ayushman Bharat

The list of groups the Ayushman Bharat health insurance policy covers is mentioned below:

●Rural Families:  Households with no adult members between the age of 16-59 years, landless households, and those not engaged in any regular source of income are eligible.
●Urban Poor: Street vendors, domestic maids, rickshaw pullers, or other laborers in unorganized sectors.
●Vulnerable Groups: This includes elderly persons, widows, orphans, differently abled individuals, and others in the SECC category.

Eligibility for Senior Citizens under Ayushman Bharat Yojana

As of 11th September 2024, the Union Cabinet has expanded the eligibility criteria under the PM-JAY for all citizens aged 70 years or above, irrespective of income and socio-economic categories. Thus, each member of this age group can now benefit from the health coverage PM-JAY offers.

How to Check Your Eligibility for Ayushman Bharat Health Insurance?

The Government has made it easy to check whether you or your family qualifies for Ayushman Bharat. There are multiple ways to check:

●Online Portal: Visit the official PM-JAY website (https://pmjay.gov.in) and use the ‘AM I Eligible’ tool by entering your mobile number, name, and state.
●Mobile Application: The PM-JAY mobile application is available for Android and iOS. From there, you can check your eligibility status and other scheme details.
●Ayushman Bharat Cards: On confirmation of eligibility, the Ayushman Bharat card is issued, providing beneficiaries with healthcare benefits.

Now, despite benefitting a wide range of people, Ayushman Bharat health insurance is not applicable to people falling outside the above-mentioned categories. For them, opting for a health insurance policy from reliable providers like Star Health can be an ideal way to gain comprehensive medical coverage.     

Also Read:

→ How To Apply For Ayushman Bharat Health Insurance

→ Who is Eligible for the Ayushman Card