Who is Eligible for Ayushman Bharat Health Insurance?

What is an Ayushman Bharat Health Insurance? 

AB PM-JAY refers to the largest health insurance scheme in the world, launched by the Government of India.  It targets offering free healthcare coverage to economically weaker sections of society.  It aims to provide a health coverage of ₹ 5,00,000 per family per year for secondary and tertiary care hospitalisation to over 10.74 crores poor and vulnerable families that constitute the bottom 40% of the population of India. 

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.      

What are the documents needed for Ayushman Bharat Yojana Registration?

The documents required for Ayushman Bharat Yojana registration include : 

• Aadhaar card
• Identity proof documents such as a voter ID, driving licence, or passport. 
• Residential proof documents such as the utility bills, voter ID and a passport. 
• Family details, like the name and Aadhaar number of every member. 
• Caste certificates from beneficiaries belonging to particular categories. 
• Income certificate.
• Beneficiary's Bank account details.

Benefits of the Ayushman Bharat Health Insurance Card

There are many benefits of the Ayushman Bharat Health Insurance Card. Here are the Ayushman Bharat Health Insurance Card benefits : 
 

• Quick access to Medical Care - The Ayushman card provides access to medical care during some medical emergencies without worrying about arranging funds.
• Health Insurance Proof - The Ayushman card photo serves as evidence that you are eligible for free medical treatment or health care below the Ayushman Bharat Health Insurance scheme.
• Cashless Treatment - One can get cashless treatment at any of the network hospitals without having to pay upfront, once the Ayushman Card download process is complete. 
• Quality Healthcare for All - The Ayushman card helps the cardholder get quality healthcare or medical services, irrespective of their socio-economic status.

Also Read:

→ How To Apply For Ayushman Bharat Health Insurance

→ Who is Eligible for the Ayushman Card