Ayushman Card Eligibility: Can Taxpayers, PF & ESI Beneficiaries Get an Ayushman Card? Explained

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana aka PM-JAY is government's healthcare program that provides cashless hospital treatment worth up to Rs. 5 lakh per family every year at empanelled government and private hospitals.

The scheme is now operational across all 28 states and 8 Union Territories after West Bengal's rollout on June 8th

Ayushman Card Eligibility

To be eligible for PM-JAY, one must fall under the Socio-Economic Caste Census (SECC) 2011 data, along with state-specific beneficiary databases and defined occupational categories. The eligibility criteria is different for both rural and urban areas

However, in rural areas, eligibility is based on deprivation criteria such as households without an adult member aged 16 to 59, female-headed households without an adult male earner, families with disabled members and no able-bodied adult, and homes built with unbaked mud or non-durable single-room structures. Certain groups are automatically included regardless of these criteria, among them SC/ST households, manual scavengers, legally released bonded labourers, and some tribal groups.

In urban areas, eligibility is occupation-based rather than asset-based. It covers informal and low-paid workers such as ragpickers, domestic workers, street vendors, hawkers, construction workers, plumbers, masons, painters, sanitation workers, tailors, drivers, rickshaw pullers, and shop assistants, among roughly eleven defined occupational categories.

Now it also covers senior citizens after a Cabinet decision on September 11, 2024, every citizen aged 70 and above is eligible for a distinct Ayushman Vay Vandana Card carrying its own Rs. 5 lakh annual cover, regardless of income or existing exclusion criteria. This top-up applies on a per-senior-citizen basis and stacks on top of any family-level PM-JAY cover the household may already have.

Will Taxpayers And Those Covered Under PF Or ESI Qualify

For the general population assessed under standard SECC-based criteria, income tax payers are excluded from PM-JAY eligibility.

Other exclusions include

• households having a two-wheeler, three-wheeler, four-wheeler, or motorised fishing boat.
• families with a government employee
• those with a pucca house of three or more rooms
• owners of five acres or more of irrigated land
• and households running a government-registered non-agricultural enterprise.

That said, there are two important carve-outs where PF/ESI status does not block access which are as follows:

For the universal 70-plus senior citizen category, existing coverage under ESI or private health insurance does not disqualify a senior from also availing PM-JAY.

The National Health Authority and the Employees' State Insurance Corporation (ESIC) have entered into an arrangement, under which ESI beneficiaries can access treatment at PM-JAY-empanelled hospitals and vice versa.

How to Check The Eligibility?

Those wanting to check their own status can do so via the "Am I Eligible" tool on the official PM-JAY beneficiary portal or app, using their mobile number, name, state, ration card, or household number, or by visiting a nearby Common Service Centre with identity documents.