The Indian government has launched several commendable social welfare schemes in the country in recent years. And the Ayushman Bharat Yojana, also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY), is one of the key welfare initiatives we have in the country today.

This is essentially a health insurance scheme backed by the government, and it aims to make insurance coverage more accessible and affordable to people from lower-income groups. Let’s take a deep dive into the workings of the Ayushman Bharath Yojana and get to know the eligibility criteria, the features, the benefits and the enrollment process for this scheme.

What is the Ayushman Bharat Yojana?

The Ayushman Bharat Yojana was launched with the aim of being one of the largest public health schemes in the world. Launched by the Indian government in 2018, it aims to provide health insurance coverage to roughly 50 crore Indians. 

This scheme offers coverage for various medical expenses such as the cost of diagnostics, pre-hospitalisation costs, the cost of medicines, the cost of actual medical treatment, and so much more. From the economic context, the Ayushman Bharat Yojana is typically directed towards the bottom 40% of India’s population.

The main features of the Ayushman Bharat Yojana

If you want to know the scope of the Ayushman Bharat Scheme better, check out the salient features of this initiative below. That should help you get a better idea of what this scheme entails. 

Maximum coverage: 

This scheme offers a maximum of ₹5 lakhs in coverage per family per annum for both secondary and tertiary healthcare in private as well as public hospitals.

Beneficiaries eligible:

Beneficiaries from over 10 crore families from economically weaker sections, which adds up to around 50 crore individuals, are covered under this scheme.

Pre and post-hospitalisation coverage:

The Ayushman Bharat Yojana covers up to 3 days of pre-hospitalisation expenses like medicines and diagnostics and up to 15 days of post-hospitalisation expenses.

Coverage for pre-existing conditions:

Pre-existing conditions are covered under the Ayushman Bharat Yojana right from day one. This is extremely beneficial for anyone with an existing illness.

No restrictions:

The scheme does not have any restrictions regarding the size of the family, the gender of the beneficiaries or the age of the beneficiaries.

Who is eligible for the Ayushman Bharat Yojana?

The Ayushman Bharat Scheme has two sets of eligibility criteria, depending on whether the beneficiary is from a rural or an urban household. Check out these criteria below.

Rural beneficiaries:

Rural households that are covered under the scheme are ranked based on their status, from D1 to D7, as listed below. 

• D1- Households with only one room with kucha walls and kucha roof
• D2- Families with no adult members between the ages of 16 to 59
• D3- Households with no adult male member between ages 16 to 59
• D4- Families with disabled members and no able-bodied adult member
• D5- Households belonging to Scheduled Castes and Scheduled Tribes
• D7- Landless households that derive a major part of their income from manual casual labour

Urban beneficiaries:

In the case of urban households, eligible beneficiaries are identified based on certain occupational categories. The following 11 occupational categories of workers are eligible for the scheme:

• Ragpickers
• Beggars
• Domestic workers
• Street vendors, cobblers, hawker and other service providers working on the streets
• Construction workers, plumbers, masons, labours, painters, welders, security guards, coolies and other such workers
• Sweepers, sanitation workers, etc.
• Home-based workers, artisans, handicrafts workers and tailors
• Transport workers, drivers, conductors, helpers to drivers and conductors, cart pullers, rickshaw pullers etc.
• Shop workers, assistants, peons in small establishments, helpers, delivery assistants, attendants and waiters
• Electricians, mechanics, assemblers and repair workers
• Washer-men and chowkidars

Categories of people who cannot avail of this scheme:

Apart from the eligibility criteria mentioned above, the government of India has also put in some clauses about the categories of people who cannot apply for this scheme. This is to ensure that the scheme benefits the people from the economically weaker sections directly. Check out the criteria regarding the exclusions.

• People who own mechanised farming equipment
• People who own a two-wheeler, three-wheeler or four-wheeler
• People with a Kisan Credit Card
• Government employees
• People who own a motorised fishing boat
• People earning more than Rs.10,000 per month
• People working in 
• Those who are working in government-run non-agricultural organisations
• People with more than 5 acres of agricultural land
• People who own landline phones or refrigerators
• People living in decently built houses

What’s covered under the Ayushman Bharat Scheme?

So, now that you know who can and cannot apply for this scheme, it’s time to take a closer look at what this health insurance scheme covers. This initiative is quite comprehensive and offers coverage for various critical illnesses such as prostate cancer, COVID-19, coronary bypass surgery, neurosurgery and more.

Here is a list of the common inclusions under the Ayushman Bharat Yojana. 

• Medical examination, consultation and treatment
• Pre-hospitalisation costs
• Non-intensive and intensive care services
• Medicine and medical consumables
• Diagnostic and laboratory services
• Accommodation costs
• Medical implant services
• Food services
• Cost of treating complications arising during treatment
• Post-hospitalisation expenses 
• COVID-19 (Coronavirus) treatment

What’s not covered under the Ayushman Bharat Scheme?

Like all health insurance covers, the Ayushman Bharat Yojana also has some specific exclusions. These are not covered by the insurance plan. Check out some of these exclusions below. 

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

How to check eligibility for the Ayushman Bharat Yojana scheme?

Anyone who wants to check their eligibility for the Ayushman Bharat Scheme can do so online easily. Here’s a step-by-step guide to how this works.

1. Visit the official PMJAY website here
2. Click on the tab that reads ‘Am I Eligible?’
3. Enter your mobile number and the captcha code.
4. Click on the ‘Generate OTP’ option. 
5. Submit the details required, like your state, your name, ration card number, and household number
6. If your family is covered under PMJAY, your name will appear on the screen.

Alternatively, to check eligibility, interested people can also call the following helpline numbers —

• 14555 
• 1800111565 

How can an eligible person apply for this scheme?

There is no specific process for enrollment in the Ayushman Bharat Yojana, because it is an initiative where beneficiaries are identified based on their entitlement to the scheme. The government identifies eligible families based on the criteria mentioned above. 

Families identified in this manner will receive the Ayushman Bharat card. This card contains a dedicated identification number that is allotted to eligible families. It can be used by any of the family members to avail of the healthcare services covered under the scheme, as and when needed.

Summing it up

Ever since its launch, the Ayushman Bharat Yojana has greatly benefited eligible beneficiaries over the years. Looking back at the data available, we see that over 18 crore cards have been issued, more than 3 crore hospital admissions have been made, and around ₹36,500 crores have been disbursed as claims under this scheme.

So, the bottom line is, if you know anyone in your life who can benefit from this scheme, do spread the word. The higher the insurance coverage is in the country, the better. 

Frequently Asked Questions

1. What is an Ayushman Bharat card?

This is a card issued to eligible families under the Ayushman Bharat Yojana. It helps the beneficiaries access to the various benefits and healthcare facilities covered by this insurance scheme. 

2. What is the process to get an Ayushman Bharat card?

The Ayushman Bharat card will be sent by the government to eligible families that have been enrolled in this scheme. Alternatively, eligible families can also log into their account on the official PMJAY website and download the card.

3. Who can not apply for Ayushman card?

Here are the people who can't apply for the Ayushman card -

1. People who own mechanised farming equipment
2. People who own a two-wheeler, three-wheeler or four-wheeler
3. People with a Kisan Credit Card
4. Government employees
5. People who own a motorised fishing boat
6. People earning more than Rs.10,000 per month
7. People working in 
8. Those who are working in government-run non-agricultural organisations
9. People with more than 5 acres of agricultural land
10. People who own landline phones or refrigerators
11. People living in decently built houses

4. What are the benefits of Ayushman card?

1. Maximum coverage

2. Beneficiaries eligible

3. Pre and post-hospitalisation coverage

4. Coverage for pre-existing conditions

5. No restrictions