The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), popularly known as the Ayushman Bharat scheme, is one of India’s most comprehensive health insurance schemes. The initiative aims to provide financial protection for economically vulnerable families against the high costs of medical treatment. To ensure the scheme benefits those who need it most, the government has periodically updated the eligibility criteria for the Ayushman Card. These changes have broadened the scope of coverage and made healthcare more accessible to a larger population.
In a significant move, the Union Cabinet approved a major expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) on September 11, 2024. Under this decision, all senior citizens aged 70 and above will receive health coverage, regardless of their income.
This expansion is set to benefit around 4.5 crore families, including 6 crore senior citizens, by providing them with free health insurance coverage of up to Rs 5 lakh per family. With this approval, every senior citizen in this age group will have access to the scheme’s benefits, regardless of their socio-economic status.
Key New Developments
- New Distinct Card: Eligible senior citizens aged 70 and above will receive a new, distinct card under the AB PM-JAY scheme
- Top-Up Coverage: Senior citizens within families already covered by AB PM-JAY will receive an additional top-up cover of up to Rs 5 lakh per year. This top-up will be for them, and they will not have to share it with other family members under the age of 70.
- Family Coverage: Senior citizens who are not part of an existing AB PM-JAY family coverage will be provided with a cover of up to Rs 5 lakh per year on a family basis
- Choice of Schemes: Senior citizens who are already benefiting from other public health insurance schemes like the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), or Ayushman Central Armed Police Force (CAPF) have the option to either continue with their current scheme or opt for AB PM-JAY
- Eligibility with Private Insurance: Senior citizens who are covered by private health insurance policies or the Employees’ State Insurance scheme are also eligible to benefit from AB PM-JAY
In this article, we will explore the latest changes in the eligibility for the Ayushman Card and discuss who stands to benefit from these updates.
What is the Ayushman Card?
The Ayushman Card is an identification card issued under the Ayushman Bharat scheme, enabling eligible individuals to access free healthcare services at empanelled hospitals. With this card, beneficiaries can receive up to Rs. 5 lakh in health insurance coverage per family per year. The coverage extends to secondary and tertiary healthcare services, ensuring protection against large medical expenses.
The Ayushman Card is part of the government’s efforts to provide universal healthcare access to India’s economically disadvantaged population, with a focus on improving the country’s overall health outcomes.
Who was initially eligible for the Ayushman Card?
Initially, the Ayushman Card was offered to beneficiaries identified through the Socio-Economic Caste Census (SECC) of 2011. Households were selected based on predefined criteria, focusing on those who were most vulnerable, such as rural families with no adult male members, households with disabled members, and families living in makeshift dwellings or working as manual labourers.
In urban areas, eligibility was determined based on the occupation of household members, with the scheme focusing on low-income workers such as street vendors, domestic workers, construction labourers, and rickshaw pullers. However, over time, the government has updated these criteria to include more groups that require financial assistance for healthcare.
Latest changes in eligibility for the Ayushman Card Recognising the need for wider coverage, the government has introduced several changes to the eligibility criteria for the Ayushman Card. These changes aim to make the scheme more inclusive and ensure all vulnerable groups access essential healthcare services.
Who stands to benefit from the latest changes?
The expanded eligibility criteria for the Ayushman Card open up the scheme to a broader section of society. Here’s a closer look at the groups that stand to benefit from these changes:
1. Migrant Workers: Migrant workers often find themselves in precarious situations, moving from one place to another in search of employment. The inclusion of migrant workers in the scheme ensures that they can access healthcare services in any part of the country without worrying about location-based restrictions. This change will provide them with peace of mind, knowing that they have access to free healthcare services regardless of their employment or residence status.
2. Urban Informal Workers: The expansion of eligibility for urban informal workers, such as domestic workers, daily wage earners, and street vendors, ensures that a larger portion of the urban population is covered. These workers often do not have employer-sponsored health insurance and struggle to pay for medical treatments. With the Ayushman Card, they will be able to access quality healthcare without incurring heavy expenses.
3. Rural Vulnerable Groups: The inclusion of rural artisans, landless labourers, and other low-income groups in the updated eligibility criteria ensures that even more rural families can benefit from the scheme. Many of these individuals live in remote areas with limited access to healthcare facilities, and the Ayushman Card will enable them to seek timely medical attention without the financial stress.
4. Women and Children: Households led by women, such as widows or single mothers, often face financial challenges when it comes to healthcare. The updated eligibility criteria prioritise these families, ensuring that women and children have access to medical care when they need it. This change helps to address the healthcare inequalities faced by women and children, particularly in rural areas.
5. Elderly and Disabled Individuals: The elderly and disabled often require more medical attention due to chronic illnesses or disabilities. The latest updates to the scheme provide greater access to healthcare for these individuals, ensuring that they are not financially burdened by their medical needs. The Ayushman Card will cover their hospitalisation costs, allowing them to receive the care they need without worrying about expenses.
