Who Qualifies for Healthcare Coverage Under Ayushman Bharat Yojana

  • Updated on: 19 Jul 2024
  • Published on: 13 Jun 2024
Who Qualifies for Healthcare Coverage Under Ayushman Bharat Yojana

In 2018, the Government of India launched Ayushman Bharat Yojana – a transformative healthcare initiative aimed at providing financial protection to millions of vulnerable households. 

Being the world’s largest government-funded scheme, it aims to achieve Sustainable Development Goals (SDGs) and the vision of Universal Health Coverage (UHC) by covering over 55 crore beneficiaries. However, to be eligible for the Ayushman Bharat scheme, certain criteria need to be met. To know more about this scheme and who can qualify for it, read on.

What is the Ayushman Bharat Yojana?

Based on the recommendations of the National Health Policy of 2017, the Union Government formulated this policy. The Ayushman Bharat Scheme comprises two inter-related components:

  • Creation of Health and Wellness Centres (HWCs)
  • PM-JAY

The full form of PM-JAY is Pradhan Mantri Jan Arogya Yojana, an overview of which is provided below: 

  • It provides a cashless cover of up to ₹5 lakhs per eligible family per annum for listed secondary and tertiary care conditions 
  • One or all members of a family can use the funds available under this scheme

Here are the expenses covered under this component of the scheme:

  • Medical examination, treatment and consultation
  • Pre-hospitalisation
  • Medicine and medical consumables
  • Non-intensive and intensive care services
  • Diagnostic and laboratory investigations
  • Medical implantation services (where necessary)
  • Accommodation benefits
  • Food services
  • Complications arising during treatment
  • Post-hospitalisation follow-up care up to 15 days

Eligibility Criteria for Rural Families

The Government of India has identified seven deprivation criteria for rural areas. Out of these, PM-JAY covers six deprivation and automatic inclusion criteria:

  • D1- Only one room with kutcha walls and kutcha roof
  • D2- No adult member between ages 16 and 59 years
  • D3- Households with no adult male member between ages 16 and 59 years
  • D4- Disabled member and no able-bodied adult member
  • D5- SC/ST households
  • D7- Landless households deriving a major part of their income from manual casual labour
  • Destitute or those living on alms, primitive tribal groups, manual scavenger households and legally released bonded labour

Eligibility Requirements for Urban Families

The Ministry of Health and Family Welfare has also listed the following eleven occupational categories to qualify for Ayushman Bharat Yojana:

  • Ragpicker
  • Beggar
  • Domestic worker
  • Construction workers, masons, security guards, welder, plumbers, coolie and other head-load workers
  • Street vendors, cobblers, hawkers and other service providers working on streets
  • Sweeper, sanitation worker and gardener
  • Transport workers, drivers, conductors, helpers to drivers and conductors, cart pullers and rickshaw pullers
  • Electricians, mechanics, assemblers and repair workers
  • Home-based worker, artisan, handicrafts worker and tailor
  • Shop workers, assistants, peons in small establishments, helper or delivery assistants, attendants and waiters
  • Washermen and chowkidars

By understanding the eligibility requirements outlined above, you will be better equipped to navigate through the complexities of Ayushman Yojana and secure your family’s health. However, if you don’t qualify for this government-funded scheme, you can also access funds for all your healthcare needs on Fibe.

Fibe allows you to secure up to ₹10 lakhs with its Healthcare Finance facility, enabling you to repay as per your chosen timeline at no-cost and low-cost EMIs. Download our Personal Loan App or log in to our website to access a medical loan with ease and at minimal interest rates.

FAQs on Ayushman Bharat Yojana 

Am I eligible for the Ayushman Bharat card?

To qualify for this healthcare scheme, you need to meet any one of the following criteria:

  • Among 7 deprivation categories identified for rural areas, you must belong to any one of these deprivation criteria except for D6
  • If you reside in an urban area, you must belong to any one of the 11 occupational categories listed by the Union Government

How do I know if I am eligible for PMJAY?

Follow these steps to determine if you qualify for Ayushman Bharat Yojana:

  • Visit the official website PMJAY and click on the ‘Am I Eligible’ section
  • Select the ‘Beneficiary’ option and enter your mobile number
  • Choose the authentication mode and hit the login button
  • Verify the One-Time Password (OTP) received on your registered mobile number
  • Provide further information, such as your name, state, details of the family members and income
  • Click on the ‘Submit’ button to know if you are eligible for Ayushman Bharat healthcare scheme

How can I enrol for Ayushman Bharat?

You can register for a card under this scheme by following these simple steps:

  • Visit the official website of ‘Ayushman Bharat Digital Mission’
  • Click on the ‘Create ABHA Number’ option
  • Select if you want to create an ABHA number using your ‘Aadhaar Card’ or ‘Driving Licence’ 
  • After verifying the details of your Aadhaar card or driving licence, enter other information like name, income and PAN card
  • Submit the application and wait for approval from the concerned authorities  

Which diseases are not covered under Ayushman Bharat?

This government-funded Ayushman Bharath health insurance scheme does not cover the following medical expenses:

  • Out-Patient Department (OPD) visits
  • Cosmetic surgeries
  • Organ transplants
  • Drug rehabilitation
  • Fertility treatments 

Is Ayushman Bharat free for everyone?

Yes, the Ayushman Bharat health insurance is free for all eligible beneficiaries.


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