The PMJAY scheme aims to provide healthcare to ten crore families. These mostly include the poor and people with lower middle income, through a health insurance scheme covering Rs. 5 lakh per family. The ten crore families comprise eight crore families in rural areas and 2.33 crore families in urban areas. Broken into smaller units, this means that the scheme will aim to cater to 50 crore individual beneficiaries.
To qualify for Ayushman Bharat Yojana, applicants must belong to one of the specified categories: SC/ST, Lower Income Group, or EWS. You can ascertain your Ayushman card eligibility by utilising the ‘Am I Eligible’ feature on the official website.
However, the scheme has certain pre-conditions by which it picks who can avail of the health cover benefit. While in the rural areas, the list is mostly categorised on lack of housing, meagre income, and other deprivations.
Eligibility criteria for senior citizens above 70 years
On September 12, 2024, the Union Cabinet approved the expansion of PMJAY for all senior citizens above 70 years of age. The specifications of the eligibility have been given below:
- All senior citizens, above 70 years of age, irrespective of their social-economic status will be given a health coverage of up to Rs. 5 lakh under this scheme.
- This expansion will enable the ease of financial expenses that may be required by senior citizens for healthcare.
- The Centre and State governments will share the cost of this extended coverage.
- Senior citizens aged 70 and above, who belong to families already covered under AB PM-JAY, will receive an additional top-up coverage of up to Rs 5 lakh per year exclusively for themselves. This coverage will not need to be shared with other family members below the age of 70.
- Senior citizens with private health insurance can benefit from the scheme alongside their existing coverage.
- Seniors enrolled in other public health schemes, such as CGHS, ECHS, or Ayushman CAPF, must choose between their existing coverage and the new Ayushman Bharat health insurance.
All eligible senior citizens will be issued a separate health card to facilitate easier access to the scheme’s benefits.
PMJAY Rural
The 71st round of the National Sample Survey Organisation reveals that a staggering 85.9% of rural households do not have access to any healthcare insurance or assurance. Additionally, 24% of rural families access healthcare facilities by borrowing money. Ayushman Bharat Yojana aims to help this sector by providing yearly assistance of up to Rs. 5 lakh per family. The scheme will aid economically disadvantaged families as per data in the Socio-Economic Caste Census 2011. Here too, households enrolled under the Rashtriya Swasthya Bima Yojana (RSBY) will come under the ambit of the PM Jan Arogya Yojana.
In the rural areas, the PMJAY health cover is available to:
- Those living in scheduled caste and scheduled tribe households
- Beggars and those surviving on alms
- Families with no individuals aged between 16 and 59 years
- Families having at least one physically challenged member and no able-bodied adult member
- Landless households who make a living by working as casual manual labourers
- Primitive tribal communities
- Legally released bonded labourers
- Families living in one-room makeshift houses with no proper walls or roof
- Manual scavenger families
PMJAY Urban
According to the National Sample Survey Organisation (71st round), 82% of urban households do not have health insurance. Further, 18% of Indians in urban areas have addressed healthcare expenses by borrowing money in one form or the other. Pradhan Mantri Jan Arogya Yojana helps these households avail of healthcare services by providing funding of up to Rs. 5 lakh per family per year. PMJAY will benefit urban workers’ families in the occupational category present in the Socio-Economic Caste Census 2011. Further, any family enrolled under the Rashtriya Swasthya Bima Yojana will benefit from the PM Jan Arogya Yojana.
In the urban areas, those who can avail of the government-sponsored scheme consist mainly of:
- Washerman/ watchmen
- Rag pickers
- Mechanics, electricians, repair workers
- Domestic help
- Sanitation workers, gardeners, sweepers
- Home-based artisans, or handicraft workers, tailors
- Cobblers, hawkers, and other services provided on streets or pavements
- Plumbers, masons, construction workers, porters, welders, painters, and security guards
- Transport workers like drivers, conductors, helpers, cart, or rickshaw pullers
- Assistants, peons in small establishments, delivery boys, shopkeepers, and waiters
People not entitled to health cover under Pradhan Mantri Jan Arogya Yojana:
- Those who own a two, three or four-wheeler or a motorised fishing boat
- Those who own mechanised farming equipment
- Those who have kisan cards with a credit limit of Rs. 50000
- Those employed by the government
- Those who work in government-managed non-agricultural enterprises
- Those earning a monthly income above Rs. 10000
- Those owning refrigerators and landlines
- Those with decent, solidly built houses
- Those owning 5 acres or more of agricultural land
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What is covered under Ayushman Bharat Yojana Scheme or PMJAY?
With the aim of providing accessible healthcare to the economically disadvantaged, the Ayushman Bharat Yojana Scheme, including the AB-PMJAY and Ayushman card, offers comprehensive coverage of up to Rs. 5 lakh per family annually for secondary and tertiary hospitalisation care.
Health insurance provided under AB-PMJAY encompasses various components, such as medical examination, consultation, and treatment, pre-hospitalisation services, both non-intensive and intensive care, medication and medical consumables, diagnostic and laboratory tests, accommodation, medical implants where necessary, food services, treatment-related complications, and post-hospitalisation expenses for a duration of up to 15 days.
What is not covered under Ayushman Bharat Yojana Scheme or PMJAY?
Just like other health insurance policies, Ayushman Bharat Yojana Scheme has its exclusions. The following components are not covered under the scheme:
- Out-Patient Department (OPD) expenses
- Drug rehabilitation
- Cosmetic surgeries
- Fertility treatments
- Individual diagnostics
- Organ transplant
How to check Ayushman Bharat Yojana eligibility online
To verify your eligibility for Ayushman Bharat online, adhere to the following steps:
Step 1: Go to the official website of Ayushman Bharat Yojana at https://www.pmjay.gov.in/
Step 2: Access the "Am I Eligible" section on the homepage.
Step 3: Input your mobile number and captcha code on the subsequent page, then click the "Generate OTP" button.
Step 4: Enter the OTP received on your mobile and click the "Verify OTP" button.
Step 5: On the subsequent page, furnish essential information such as name, state, age, family members, and income details.
Step 6: Once all details are entered, click the "Submit" button.
