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In a significant move towards universal healthcare, the Government of India launched the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), one of the world’s largest government-funded health insurance schemes. It aims to provide a health cover of ₹5 lakh per family per year for secondary and tertiary care hospitalization. However, a key question for millions is: “”Am I eligible?”” This simple guide for 2026 will break down the Ayushman Bharat Yojana eligibility criteria, helping you understand if you and your family can avail the benefits of this transformative healthcare scheme.
Quick Answer
Eligibility for Ayushman Bharat Yojana (PMJAY) is primarily based on the Socio-Economic Caste Census (SECC) 2011 data. In rural areas, it covers families based on specific deprivation criteria, while in urban areas, it is based on occupational categories. There is no enrollment process; eligibility is automatic for identified families. You can check your eligibility on the official PMJAY website.
What is Ayushman Bharat Yojana (PMJAY)?
Launched in 2018, PMJAY is a national health protection scheme designed to provide financial protection to the poor and vulnerable population against catastrophic health expenditures. It covers over 12 crore poor and vulnerable families (approximately 55 crore beneficiaries), providing them with access to quality healthcare services without any financial hardship. The scheme covers the cost of hospitalization, pre-hospitalization expenses, and post-hospitalization follow-up care. Beneficiaries can avail cashless treatment at any empanelled public or private hospital across India.
Benefits of Being an Eligible Beneficiary
If your family is eligible for PMJAY, you unlock a host of critical healthcare benefits:
- Significant Financial Protection: A health cover of ₹5 lakh per family per year is a substantial safety net that prevents families from falling into debt due to medical emergencies.
- Cashless Hospitalization: You can receive treatment at any empanelled hospital without paying any money out of pocket for covered procedures.
- Comprehensive Coverage: The scheme covers almost all aspects of secondary and tertiary care, including the cost of medicines, diagnostics, doctor’s fees, and room charges.
- No Cap on Family Size or Age: The benefit is for the entire family, and there are no restrictions on the number of family members, their age, or gender.
- Portability Across India: A beneficiary from one state can avail cashless treatment at an empanelled hospital in any other state or union territory in India.
Eligibility Criteria for Ayushman Bharat Yojana
The eligibility for PMJAY is not open to everyone. The government has used the data from the Socio-Economic Caste Census (SECC) of 2011 to identify the beneficiary families. The criteria are different for rural and urban areas.
Eligibility Criteria for Rural Areas
In rural areas, families are automatically included if they fall into at least one of the six specified deprivation categories (D1 to D5, and D7):
- Families living in only one room with kucha walls and a kucha roof.
- Families with no adult member between the ages of 16 and 59.
- Female-headed households with no adult male member between the ages of 16 and 59.
- Families with a disabled member and no able-bodied adult member.
- SC/ST households.
- Landless households deriving a major part of their income from manual casual labour.
Additionally, some households, like those without shelter or engaged in manual scavenging, are automatically included.
Eligibility Criteria for Urban Areas
In urban areas, eligibility is based on the occupation of the main breadwinner of the family. The scheme covers workers in 11 specified occupational categories:
- Rag picker
- Beggar
- Domestic worker
- Street vendor / Cobbler / Hawker / Other service provider working on streets
- Construction worker / Plumber / Mason / Labour / Painter / Welder / Security guard
- Sweeper / Sanitation worker / Mali
- Home-based worker / Artisan / Handicrafts worker / Tailor
- Transport worker / Driver / Conductor / Helper to drivers and conductors / Cart puller / Rickshaw puller
- Shop worker / Assistant / Peon in small establishment / Helper / Delivery assistant / Attendant / Waiter
- Electrician / Mechanic / Assembler / Repair worker
- Washer-man / Chowkidar
Who is automatically excluded?
Certain families are automatically excluded from the scheme, regardless of their deprivation or occupational status. This includes those who own a motorised vehicle, have a kisan credit card with a limit above ₹50,000, have any member as a government employee, or earn more than ₹10,000 per month.
How to Check Your Eligibility for 2026
The government has made it very easy to check if your family is on the list of beneficiaries.
Step 1: Visit the Official Portal
Go to the official PMJAY website: https://beneficiary.nha.gov.in/
Step 2: Log In as a Beneficiary
On the portal, select ‘Beneficiary’ and enter your mobile number. You will receive an OTP to log in.
Step 3: Search for Your Name
Once logged in, select your State, Scheme (PMJAY), District, and choose a search parameter. You can search by:
- Family ID (Ration Card Number)
- Aadhaar Number
- Name
- Location (Rural/Urban)
Enter the details as required.
Step 4: View the Result
If your family is included in the list, the names of all eligible family members will be displayed on the screen. You can then proceed to download your Ayushman Card.
What is an Ayushman Card?
The Ayushman Card (also known as the PMJAY e-card) is an official document that proves your eligibility for the scheme. While not mandatory to avail treatment, having the card makes the process at the hospital smooth and hassle-free. You can download this card from the official portal after completing your e-KYC. This card is a crucial document, much like those you can store in a DigiLocker.
Common Mistakes and Misconceptions
- Thinking You Can Register for the Scheme: There is no registration or enrollment process for PMJAY. Eligibility is purely based on the SECC 2011 data. Beware of fraudulent websites or individuals claiming they can enroll you in the scheme for a fee.
- Believing the Scheme is for Everyone: PMJAY is a targeted scheme for the poor and vulnerable sections of society. It is not a universal healthcare scheme for all citizens.
- Confusing it with State Schemes: Many states run their own health insurance schemes. Sometimes these are integrated with PMJAY. It’s important to know which scheme you are covered under.
Conclusion
The Ayushman Bharat Yojana is a monumental step towards ensuring that no one in India is denied healthcare due to a lack of funds. Understanding the eligibility criteria is the first step for potential beneficiaries to access these life-saving benefits. By using the official PMJAY portal, you can easily check your eligibility in 2026 and download your Ayushman Card. This scheme, along with others like the Pradhan Mantri Awas Yojana Gramin, forms a robust social security framework for the nation’s most vulnerable citizens.
Frequently Asked Questions
Is there any cost to the beneficiary for this scheme?
No, the PMJAY scheme is completely free for all eligible beneficiaries. There are no premiums to be paid, and the hospitalization is cashless. The entire cost is borne by the government.
What treatments are covered under PMJAY?
PMJAY covers a wide range of medical and surgical treatments, including but not limited to cardiology, oncology (cancer treatment), neurosurgery, and nephrology (kidney-related diseases). It does not cover outpatient (OPD) services or cosmetic procedures.
How do I find an empanelled hospital near me?
You can find a list of all hospitals empanelled under PMJAY by using the ‘Find Hospital’ feature on the official PMJAY website or by calling the national helpline number 14555. You can search for hospitals by state, district, and speciality.
Is childbirth covered under the Ayushman Bharat scheme?
Yes, normal deliveries, caesarean sections, and high-risk deliveries are covered under the scheme. It also includes newborn care as part of the package, ensuring maternal and child health.
What documents do I need at the hospital to avail the benefits?
To avail cashless treatment, you ideally need your Ayushman Card. However, if you don’t have it, any government-issued photo ID like an Aadhaar card or Voter ID can be used for verification at the hospital’s PMJAY kiosk. The ‘Arogya Mitra’ at the hospital will assist you.
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