Who is Eligible for Ayushman Bharat (PM-JAY)?

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Ayushman Bharat is officially called Pradhan Mantri Jan Arogya Yojana (PM-JAY). It is a government-funded health insurance scheme that provides free medical coverage of up to ₹5 lakh per family per year for secondary and tertiary hospitalisation. It was launched on 23rd September 2018 by the Hon’ble Prime Minister of India.


The scheme aims to protect economically vulnerable families from high healthcare costs and improve access to quality medical treatment across the country.


What are the Benefits of Ayushman Bharat (PM-JAY)?


Ayushman Bharat is considered one of the world’s largest publicly funded health insurance programmes.


According to IBEF, it aims to cover over 10.74 crore poor and vulnerable families, which translates to nearly 50 crore beneficiaries across India. Here are some of the major benefits offered under the scheme:



  • Hospitalisation Coverage: Health cover of up to ₹5 lakh per family per year for secondary and tertiary hospitalisation.

  • Cashless Treatment: Cashless and paperless treatment at empanelled hospitals across India.

  • Pre and Post Hospitalisation Support: Coverage for 3 days pre-hospitalisation and 15 days post-hospitalisation expenses.

  • Wide Range of Coverage: Covers a wide range of medical procedures, including surgeries, diagnostics, medicines, and follow-up care.

  • Family Size: No restriction on family size, age, or gender, which ensures the entire household can be covered under the scheme.


What are the Eligibility Criteria of Ayushman Bharat?


The Socio-Economic Caste Census (SECC) 2011 data primarily determines eligibility for Ayushman Bharat. The eligibility criteria are slightly different for rural and urban households.


Rural Households


In rural areas, Ayushman Bharat mainly covers households that fall under deprivation categories. Here are some of the key eligibility categories:



  • Families living in one-room houses with kutcha walls and roofs.

  • Households with no adult member between the ages of 16 and 59 years.

  • Families with no adult male support between the ages of 16 and 59 years.

  • Households with disabled members and no able-bodied adults.

  • Families belonging to the Scheduled Castes or the Scheduled Tribes (SC/ST).

  • Landless households that depend mainly on manual labour for income.


Urban Households


In urban areas, eligibility is based largely on occupational categories that typically represent economically weaker sections of society. The scheme generally covers workers engaged in occupations such as:



  • Domestic workers

  • Washer-man and chowkidar

  • Street vendors and hawkers

  • Construction workers and labourers

  • Ragpickers and sanitation workers

  • Drivers, helpers, and transport workers

  • Security guards and other low-income service workers


By focusing on these occupations, the scheme aims to ensure healthcare access for urban families that may not have stable incomes or employer-provided health insurance.


Final Word


Ayushman Bharat (PM-JAY) plays a crucial role in expanding healthcare access for economically vulnerable families in India. By offering up to ₹5 lakh in annual coverage and enabling cashless treatment at empanelled hospitals, the scheme helps reduce the financial burden caused by medical emergencies.