In 2018, the Government of India launched Ayushman Bharat Yojana, a major healthcare initiative designed to provide financial protection to millions of vulnerable households.
As the world’s largest government-funded health programme, Ayushman Bharat aims to support the Sustainable Development Goals (SDGs) and advance Universal Health Coverage (UHC) by covering over 55 crore beneficiaries. Eligibility is based on specific criteria for rural and urban households. The information below explains what the scheme covers and who qualifies.
What is the Ayushman Bharat Yojana?
Formulated following recommendations in the National Health Policy of 2017, Ayushman Bharat has two complementary components:
- Creation of Health and Wellness Centres (HWCs)
- Pradhan Mantri Jan Arogya Yojana (PM-JAY)
PM-JAY provides cashless hospitalisation cover of up to ₹5 lakh per eligible family per year for listed secondary and tertiary care conditions. Coverage may be used by one or more family members as needed.
Expenses covered under PM-JAY include:
- Medical examination, treatment and consultation
- Pre-hospitalisation care
- Medicines and medical consumables
- Non-intensive and intensive care services
- Diagnostic and laboratory investigations
- Medical implantation services where necessary
- Hospital accommodation benefits
- Food services during hospitalisation
- Treatment of complications arising during care
- Post-hospitalisation follow-up care up to 15 days
Eligibility Criteria for Rural Families
The Government of India identifies seven deprivation criteria for rural areas. PM-JAY covers six of these deprivation categories and additional automatic inclusion groups. Key rural criteria include:
- D1: Households with only one room having kutcha walls and kutcha roof
- D2: Households with no adult member aged 16–59 years
- D3: Households with no adult male member aged 16–59 years
- D4: Households with a disabled member and no able-bodied adult
- D5: SC/ST households
- D7: Landless households that derive a major part of income from manual casual labour
- Other automatically included groups: destitute persons or those living on alms, primitive tribal groups, manual scavenger households and legally released bonded labour
Eligibility Requirements for Urban Families
For urban areas, the Ministry of Health and Family Welfare lists occupational categories that qualify for inclusion. These include:
- Ragpickers
- Beggars
- Domestic workers
- Construction workers, masons, security guards, welders, plumbers and other head-load workers
- Street vendors, cobblers, hawkers and similar street-based service providers
- Sweepers, sanitation workers and gardeners
- Transport workers: drivers, conductors, helpers, cart pullers and rickshaw pullers
- Electricians, mechanics, assemblers and repair workers
- Home-based workers, artisans, handicraft workers and tailors
- Shop workers, assistants, peons in small establishments, delivery helpers, attendants and waiters
- Washermen and chowkidars
Understanding these eligibility categories makes it easier to determine whether your family can access benefits under Ayushman Bharat. If you are not eligible for this government-funded scheme, there are alternative healthcare financing options available from private providers to meet medical expenses.
FAQs on Ayushman Bharat Yojana
Am I eligible for the Ayushman Bharat card?
To qualify for the scheme, you must meet one of the following:
- Belong to any one of the seven rural deprivation categories (except D6) identified by the government
- Reside in an urban area and belong to any one of the 11 listed occupational categories
How do I know if I am eligible for PM-JAY?
To check eligibility, follow these general steps on the PM-JAY portal:
- Visit the official PM-JAY website and select the “Am I Eligible?” option
- Choose the beneficiary option and enter your mobile number
- Select an authentication method and log in
- Verify the One-Time Password (OTP) sent to your registered mobile number
- Provide requested details such as name, state, family member information and income
- Submit the form to view your eligibility status
How can I enrol for Ayushman Bharat?
To register for a card under the scheme, you can create an ABHA number through the Ayushman Bharat Digital Mission portal:
- Visit the Ayushman Bharat Digital Mission website and select “Create ABHA Number”
- Choose to create an ABHA using Aadhaar or another recognised ID such as a driving licence
- Complete the verification of your ID and enter details like name, income and PAN (if required)
- Submit the application and wait for approval from the relevant authorities
Which treatments are not covered under Ayushman Bharat?
Ayushman Bharat does not cover certain expenses. Common exclusions include:
- Out-Patient Department (OPD) visits
- Cosmetic and elective aesthetic surgeries
- Certain organ transplants (subject to scheme lists and state policies)
- Drug rehabilitation programs
- Fertility treatments
Is Ayushman Bharat free for everyone?
Ayushman Bharat benefits are provided free of cost to all eligible beneficiaries identified under the scheme’s criteria.