Who Is Eligible for Ayushman Bharat PM-JAY?
The Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world’s largest government-funded health insurance scheme, covering over 55 crore Indians across approximately 12 crore families. But not everyone qualifies automatically — eligibility is determined by specific criteria based on the Socio-Economic Caste Census (SECC) 2011 data.
This guide explains exactly who is covered, how to check your eligibility, and what to do if you believe you should qualify but are not found in the system.
Eligibility Criteria for Rural Families
In rural areas, the PMJAY scheme uses deprivation criteria from the SECC 2011 to identify eligible families. Your family is automatically eligible if it falls under any of these categories:
D1 — Only one room with kucha walls and kucha roof: Families living in houses with mud/temporary walls and roof.
D2 — No adult member aged 16-59: Families where no member falls in the working-age group.
D3 — Female-headed household with no adult male member aged 16-59: Households headed by women without a working-age male member.
D4 — Disabled member and no able-bodied adult: Families with a disabled member and no other able-bodied adult to earn.
D5 — SC/ST households: Families belonging to Scheduled Castes or Scheduled Tribes.
D6 — No literate adult above 25 years: Families where no adult member above 25 years of age can read or write.
D7 — Landless households deriving income from manual casual labour: Families without any land who survive on daily wage labour.
Additionally, the following categories are automatically included regardless of other criteria: families without shelter, destitute living on alms, manual scavenger families, primitive tribal groups, and legally released bonded labourers.
Eligibility Criteria for Urban Families
In urban areas, the following occupational categories from the SECC 2011 are eligible for PM-JAY:
- Rag pickers
- Beggars
- Domestic workers
- Street vendors, hawkers, and cobblers
- Construction workers, plumbers, masons, painters, and welders
- Sanitation workers, sweepers, and gardeners
- Home-based workers, artisans, and handicraft workers
- Transport workers — rickshaw pullers, cart pullers, and auto/taxi drivers
- Shop workers, assistants, peons, helpers, and delivery workers
- Electricians, mechanics, assemblers, and repair workers
- Washermen and chowkidars
Who Is NOT Eligible
The PM-JAY scheme does not cover families that:
- Own motorised two-wheelers, three-wheelers, four-wheelers, or fishing boats
- Own mechanised agricultural equipment like tractors
- Hold a Kisan Credit Card with a limit above ₹50,000
- Have any household member who is a government employee
- Have any member earning more than ₹10,000 per month from non-agricultural enterprises
- Pay income tax
- Own a refrigerator or a landline phone
- Own more than 2.5 acres of irrigated land or 7.5 acres of non-irrigated land
- Live in houses with three or more rooms and pucca walls and roof
How to Check Your PMJAY Eligibility
There are multiple ways to check whether your family is in the PMJAY beneficiary list:
Method 1 — Online: Visit pmjay.gov.in and click on “Am I Eligible.” Enter your mobile number and state, verify with OTP, then search using your name, ration card number, or SECC HHID number.
Method 2 — Helpline: Call the PMJAY toll-free helpline 14555 (available 24/7). Provide your Aadhaar number or family details, and the operator will check your eligibility status.
Method 3 — CSC: Visit your nearest Common Service Centre with your Aadhaar card. The CSC operator can instantly check your eligibility in the PMJAY database.
Method 4 — Hospital: Visit any PMJAY empanelled hospital and ask the Ayushman Mitra at the help desk. They can check your eligibility and help you generate your card on the spot.
What If You Are Eligible But Not in the System?
Some families that meet the eligibility criteria may not appear in the PMJAY database due to errors in the SECC 2011 data, name mismatches, or incomplete records. If you believe your family should be eligible:
Step 1: Visit your nearest CSC or district health office with your family documents (Aadhaar, ration card, income certificate).
Step 2: Request the operator to check your SECC status and flag any discrepancies.
Step 3: If your name is missing from the SECC database, the operator can help you file a request for inclusion through the state health agency.
Step 4: Some states have expanded eligibility beyond SECC criteria. Check with your state’s health department for state-specific additions.
State-Specific Expansions
Several states have expanded PM-JAY coverage beyond the central SECC criteria. For example, some states cover all families with an annual income below ₹5 lakh or ₹8 lakh. These expansions vary by state and are funded jointly by the central and state governments. Check with your state’s Ayushman Bharat implementation agency for the latest eligibility rules in your state.
PMJAY Eligibility — Key Facts
- No cap on family size — all members listed in SECC are covered
- No age limit — new-born babies to senior citizens are all covered
- Pre-existing diseases are covered from day one — no waiting period
- Coverage is portable — use your card at any empanelled hospital across India
- The ₹5 lakh cover is per family per year, on a floater basis
Ready to find a hospital? Use PMJAYHospitals.com to search for PMJAY empanelled hospitals by state, district, and specialty.
Disclaimer: PMJAYHospitals.com is an independent directory and is not affiliated with the National Health Authority or any government body. Eligibility information is based on publicly available scheme guidelines and may be updated by the government at any time. For official eligibility verification, visit pmjay.gov.in or call 14555.