Who Is Eligible For Government Health Insurance Schemes In India?

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The government health insurance scheme, or Ayushman Bharat health insurance, is meant for the deprived and economically underprivileged sections of society. Basic eligibility criteria depend on socio-economic condition, family size, and geographical area.


Socio-Economic Caste Census Criteria



  • Economically Backward Families:Socio-Economic and Caste Census (SECC) categorises Indian households in rural and urban sectors, with preference given to categories without land, employment, or a stable source of income.

  • Scheduled Castes (SC), Scheduled Tribes (ST), and Other Backward Classes (OBCs):The probability of qualifying is higher for people who come under the scheduled castes, scheduled tribes, and other backward classes.

  • Unorganised Workers:The scheme also provides coverage to people doing unorganised or low-paying, informal jobs.


Annual Family Income Limit



  • PMJAY also includes families with a yearly income of up to ₹5 lakh, ensuring that health insurance will now be available to all low-income sections of society. Families earning above ₹5 lakh are not eligible for the scheme's benefits except for having eligibility under SECC on some other grounds.


Geographic Factors



  • Enrollment priority for this scheme is given to states and regions with the maximum percentage of economically underprivileged individuals. However, the scheme design for across pan-India, and so is the recipient population are both rural and urban.


Eligibility for Specific Groups Under the Government Health Insurance Scheme


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



  • Rural Households: Households with no adult members between the ages 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 labourers in unorganised sectors.

  • Vulnerable Groups: This includes elderly individuals, 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; the PM-JAY is available to all citizens aged 70 years or above, irrespective of income and socio-economic categories. Hence, each member of this age group can now benefit from the health coverage benefit under PM-JAY.


However, the Government of India has made it easy to check whether you or your family qualify for Ayushman Bharat. You can 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. In addition, the PM-JAY mobile application is available for Android and iOS. From there, you can check your eligibility status and other scheme details.


Now, despite benefiting a wide range of people, Ayushman Bharat health insurance does not apply to people falling outside the above-mentioned categories.