Ayushman Bharat Card: Eligibility, Benefits, How to Apply & Use

Ayushman Bharat is one of the most popular flagship schemes of the Government of India. Designed especially to enhance the healthcare system at the primary, secondary, and tertiary levels. This scheme aims to help over 12 crore poor and vulnerable families, covering around 55 crore people.

Key Features of the Ayushman Bharat Card

• Cashless Healthcare- Under this scheme, one can use cashless healthcare services for up to Rs 5 Lakh per family yearly. One can avail of these services in impaneled hospitals.
• Works as a family floater plan- Ayushman Card benefits are available for more than one family member.
• Pre-Existing Disease Coverage- Covers all the pre-existing conditions from day one.
• Women’s health- Provides special packages for women’s health issues, such as breast cancer, cervical cancer, and maternity care.
• Senior citizens - Provides health insurance coverage of up to ₹5 lakh per year for senior citizens above the age of 70 years.
• Medicine and Medical Consumables- Includes coverage for essential medicines and consumables required during treatment.
• Non-Intensive and Intensive Care Services- Ensures access to standard and critical care services, depending on the patient’s medical needs.
• Post-Hospitalization Follow-Up Care (Up to 15 Days)- Includes follow-up consultations, medications, and therapies to support recovery and prevent readmission after discharge.

Documents required to apply for Ayushman Bharat Card

• Aadhaar card for identity and biometric verification.
• Income certificate.
• Family documents like CM letter/PM letter/ration card.
• Caste certificate.
• Bank account-related documents.
• Bank account-related documents.

Eligibility criteria to apply for the Ayushman Bharat Card

Eligibility is determined based on the Socio-Economic and Caste Census (SECC) 2011 data. The scheme targets economically weaker sections, such as:

• Families living in rural areas with no shelter, or manual laborers, or SC/ST households.
• Urban households with occupations like domestic work, rickshaw pulling, or street vending.

Eligibility Criteria for Rural Households

• Residing in a single room with kucha walls and roof.
• No adult member aged 16 to 59 years
• Having a disabled member or no able-bodied adult member.
• Belonging to Scheduled Castes (SC) or Scheduled Tribes (ST).
• Landless households primarily depend on manual casual labor for income.

Eligibility Criteria for Urban Households

• Beggar
• Ragpicker
• Domestic worker
• Street vendor/hawker/cobbler/other service provider working on streets
• Construction worker/ labour/ plumber/ security guard/ painter/ mason/ welder/ coolie and other head-load worker/Sweeper/ mali/ sanitation worker
• Home-based worker/ handicrafts worker/ artisan/ tailor
• Transport worker/ conductor/ driver/ helper to conductors and drivers/ rickshaw puller/ cart puller
• Shop worker/ peon in small establishment/ assistant/ helper/delivery assistant/attendant/ waiter
• Electrician/ assembler/ mechanic/ repair worker
• Chowkidar/ washer-man

How to Check If You Are Eligible for an Ayushman Bharat Card?

The eligibility of an individual to receive the Ayushman Bharat card is confirmed through the PM-JAY website. The facility enables a beneficiary to verify his/her information by entering the required information on the portal, including verifying Aadhaar and mobile number.

If your name appears on the list of beneficiaries, you can go ahead and apply for or create your Ayushman Bharat card. Your Ayushman card eligibility income and next steps will be based on the information recorded in the government database.

Reasons why there is no record of a beneficiary include inaccurate personal information, discrepancy between the Aadhaar/mobile number, non-compliance with the eligibility criteria, and missing information from the database.

If your name does not come in the beneficiary list, verify the information filled in and follow the necessary steps provided on the official PM-JAY or beneficiary portal.

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How Does the Ayushman Bharat Card Work?

• Visit an impaneled hospital and show your Ayushman Bharat Card.
• The hospital staff verifies your eligibility using the card details.
• Once verified, you receive cashless treatment for the covered medical services.

How to Use an Ayushman Bharat Card at a Hospital?

Beneficiaries can use the Ayushman Bharat Card at an empanelled hospital to access eligible healthcare services under the scheme. The general process includes:

• Visit an empanelled hospital: Choose a hospital participating in the Ayushman Bharat scheme and inform the hospital staff that you are an eligible beneficiary.
• Identity verification: Provide your Ayushman Bharat Card and required identification documents. Hospital staff verify your beneficiary details.
• Hospital admission: If the required treatment is covered and admission is approved, the hospital completes the applicable verification and documentation process.
• Cashless treatment: Eligible hospitalisation expenses are covered under the scheme as per the applicable package and rules. Beneficiaries generally do not have to pay the covered amount upfront.
• Discharge and settlement: After treatment, the hospital completes the required documentation and claim-related process with the scheme authorities. Covered expenses are settled according to the applicable PM-JAY procedures.

This process is similar in principle to cashless health insurance, where eligible treatment expenses can be settled without the beneficiary paying the covered hospitalisation expenses upfront. However, Ayushman Bharat works under its own government scheme rules and eligibility criteria.

How to Apply for an Ayushman Bharat Card

• Step 1: Visit the official website of Pradhan Mantri Jan Arogya Yojana and click on the ‘Am I Eligible’ tab on the menu bar.
• Step 2: You will be redirected to the Beneficiary NHA portal, where you need to select the 'Beneficiary’ option and log in by entering your mobile number, captcha code, and the OTP received on your phone.
• Step 3: Select the scheme as ‘PMJAY’ and choose other required details, including state and district.
• Step 4: Choose 'Aadhaar Number’ under the Search By column and enter your Aadhaar number.
• Step 5: All the family members will be listed along with their Ayushman card status.
• Step 6: If the status of your Ayushman Bharat card is ‘Not-Generated’, then you can click on ‘Apply Now’ under the ‘Action’ column.
• Step 7: Authenticate yourself using your Aadhar number by entering the OTP received on your registered mobile number.
• Step 8: Enter the requested details of the family members, including their mobile numbers, and submit the details to complete the Ayushman card online application process. Once approved, you will be able to download your Ayushman Bharat card.

Ayushman Bharat Card vs Private Health Insurance

Ayushman Bharat and private health insurance both provide access to healthcare coverage, but they differ in eligibility, cost, coverage structure, hospital network, and claim process.

For people who qualify for PM-JAY, the scheme can provide significant healthcare support. However, private health insurance can offer different coverage features depending on the policy. Understanding the different types of health insurance can help individuals understand the types of private coverage available.

People looking for healthcare options for economically weaker sections can also explore best health insurance plans for people below poverty line. Depending on their needs and eligibility - some individuals may consider private health insurance in addition to government-sponsored healthcare benefits.

Common Reasons Why an Ayushman Bharat Card Application May Be Rejected

An Ayushman Bharat Card application or generation request may face issues for several reasons. Some common reasons include:

Incorrect Aadhaar or Personal Details

A mismatch between Aadhaar number, Name, Date of Birth, Mobile Number, etc. can cause issues in successful verification. There is also an Ayushman Card income limit, so it is recommended that applicants carefully check whether they have filled out correct information.

Eligibility Mismatch

If the applicant is not eligible as per the eligibility criteria of the scheme or does not find his/her information in the beneficiary database, then the application cannot go further.

Incomplete Documentation

Issues may arise from missing or incomplete documents while verifying. The application must include the necessary identification and documentation that was asked for.

Duplicate Beneficiary Records

Duplicates and existing files may hinder a new application process. The applicant will have to verify through the proper correction process instead of creating duplicate applications.

What to Do If Your Application Is Rejected

If the application gets rejected or the details of the beneficiary cannot be verified, one must initially look at the stated reason from the portal. It is also essential to rectify any mistake that may exist in the provided information.

If the issue continues, applicants can contact the relevant government support channel or visit an authorised centre for assistance with their beneficiary details and application status.

Bottom Line

The Ayushman Bharat Card is more than a document-it is a step toward a healthier, more equitable India. Bridging the gap between quality healthcare and affordability ensures that no one is left behind in the journey toward universal health coverage.