Who is Eligible for Ayushman Bharat, How to Apply, and What Benefits You Get

Ayushman Bharat, launched by the Government of India following recommendations from the National Health Policy 2017, aims to achieve Universal Health Coverage (UHC). The initiative aligns with the Sustainable Development Goals (SDGs) and emphasizes the commitment to “leave no one behind.”

The program transitions from a fragmented, sectoral approach to a comprehensive, need-based healthcare system. It focuses on prevention, promotion, and ambulatory care at primary, secondary, and tertiary levels, adopting a continuum of care model through two main components:

1. Health and Wellness Centres (HWCs)

2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Health and Wellness Centres (HWCs): Bringing Primary Healthcare Closer

In February 2018, the government announced the establishment of 1,50,000 Health and Wellness Centres (HWCs) by upgrading existing Sub Centres and Primary Health Centres. These centres provide Comprehensive Primary Health Care (CPHC), delivering essential healthcare services closer to communities.

HWCs cater to maternal and child health, non-communicable diseases, and provide free essential drugs and diagnostic services. They are designed to meet the primary healthcare needs of local populations, promoting accessibility, universality, and equity.

A key focus of HWCs is health promotion and disease prevention, empowering individuals and communities to adopt healthy lifestyles and reduce the risk of chronic illnesses.

Pradhan Mantri Jan Arogya Yojana (PM-JAY): Largest Health Assurance Scheme

Launched on 23rd September 2018 in Ranchi, Jharkhand by Prime Minister Narendra Modi, PM-JAY is the world’s largest health assurance program. It provides a health cover of ₹5 lakh per family per year for secondary and tertiary hospitalization, benefiting over 12 crore families (approximately 55 crore people) in the bottom 40% of India’s population.

Eligibility is determined using Socio-Economic Caste Census (SECC 2011) criteria for rural and urban areas. PM-JAY replaced the National Health Protection Scheme (NHPS) and subsumed the Rashtriya Swasthya Bima Yojana (RSBY) launched in 2008. It is fully funded by the government, with costs shared between the Central and State Governments.

How to Apply for PM-JAY

Potential beneficiaries can apply for a PM-JAY e-card by visiting a hospital or Common Service Centre (CSC). The application process is as follows:

1. Beneficiary Search: The Arogya Mitra searches using the applicant’s name, location, ration card number, mobile number, or RSBY URN.

2. Search in BIS Application: The beneficiary is verified in SECC, RSBY, State Health Scheme, or additional databases.

3. Individual Identification: Valid ID documents like Aadhaar or Ration Card are verified and scanned.

4. Family Identification: Family records are uploaded and verified.

5. Approval or Rejection: The Health Insurance Company or State Health Agency (SHA) approves or rejects the application.

6. E-Card Issuance: Approved beneficiaries receive their PM-JAY e-card.

Required Documents:

• Age & Identity Proof (Aadhaar/PAN)

• Proof of Address

• Contact Details (Mobile/Email)

• Caste Certificate

• Income Certificate

• Family Status Proof (Joint/Nuclear)

Key Features of PM-JAY

• Fully government-funded with cashless healthcare access

• ₹5 lakh per family per year for secondary and tertiary care

• Benefits over 12 crore families (55 crore people)

• Cashless treatment at empanelled public and private hospitals

• Reduces catastrophic medical expenditure, which pushes ~6 crore Indians into poverty annually

• Covers 3 days pre-hospitalization and 15 days post-hospitalization expenses, including diagnostics and medicines

• No restriction on family size, age, or gender

• Pre-existing conditions covered from day one

• Portable benefits nationwide

• Covers ~1,929 medical procedures including drugs, diagnostics, surgery, OT, ICU, physician fees, accommodation, and food services

• Public hospitals reimbursed at par with private hospitals

Benefit Coverage Under PM-JAY

PM-JAY provides a family floater cover of ₹5 lakh per year, usable by one or all family members. It includes:

• Medical examination, treatment, and consultation

• Pre-hospitalization and post-hospitalization care

• Medicines and medical consumables

• Intensive and non-intensive care services

• Diagnostics and laboratory investigations

• Medical implantation services (if needed)

• Accommodation and food services

• Complications during treatment

Unlike previous schemes with annual ceilings of ₹30,000–₹3 lakh, PM-JAY has no family size limit, and pre-existing conditions are covered from day one.

Beneficiary Eligibility

Rural Beneficiaries

PM-JAY covers rural households meeting at least one of six deprivation criteria or automatic inclusion criteria such as:

• One-room houses with kucha walls/roof

• No adult member aged 16–59

• Disabled member with no able-bodied adult

• SC/ST households

• Landless households relying on manual labor

• Automatic inclusion: Destitute, manual scavenger households, primitive tribal groups, legally released bonded labor

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Urban Beneficiaries

Eligible urban workers include 11 occupational categories:

• Ragpickers, beggars, domestic workers

• Street vendors, cobblers, hawkers

• Construction workers, plumbers, masons, painters, welders, security guards

• Sweepers, sanitation workers, gardeners

• Home-based workers, artisans, handicraft workers, tailors

• Transport workers, drivers, conductors, rickshaw pullers

• Shop assistants, attendants, waiters

• Electricians, mechanics, repair workers

• Washermen, chowkidars

Exceptions

Excluded individuals include those who:

• Own motor vehicles or mechanized farming equipment

• Hold Kisan cards with credit limits above ₹50,000

• Are government employees or work in government-run enterprises

• Earn above ₹10,000 per month

• Own refrigerators, landlines, or well-built houses

• Own 5 acres or more of agricultural land

Ayushman Bharat is a revolutionary initiative aimed at strengthening India’s healthcare system. Through Health and Wellness Centres and PM-JAY, it delivers accessible, affordable, and comprehensive healthcare, protecting vulnerable families from catastrophic medical expenses, and advancing India’s goal of Universal Health Coverage, leaving no one behind.

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