The main eligibility path — SECC-2011 deprivation category
Ayushman Bharat PM-JAY's core eligibility criterion is whether a household was identified as belonging to a deprivation category in the Socio-Economic Caste Census (SECC) 2011 — not a direct income test. This means eligibility for most beneficiaries was effectively determined back in 2011 based on specific deprivation indicators (housing type, land ownership, occupation, and similar factors), rather than a household's current income level.
The 2024 expansion — universal coverage at age 70+
A 2024 expansion added a second, entirely separate eligibility path: every citizen aged 70 or older is covered regardless of income or SECC status, closing a gap where an elderly person from a non-deprived household previously had no path to coverage under the scheme at all. This age-based path and the SECC-based path are independent — meeting either one alone is sufficient for eligibility.
Worked examples across three scenarios
A 75-year-old, regardless of SECC status: eligible via the age-70+ expansion, with the full ₹5,00,000/family/year cover. A 45-year-old identified as SECC-2011 deprived-category: eligible via the SECC path, same ₹5,00,000/family/year cover. A 45-year-old NOT identified as SECC deprived-category: not eligible under either of these two core criteria — though state-specific extensions (many states have broadened PM-JAY coverage beyond the central scheme's base criteria) may still apply and aren't captured by these two central rules alone.
The annual cover amount is per family, not per person
The ₹5,00,000 annual cover applies per family per year, not per individual family member — multiple family members can draw on the same shared ₹5,00,000 pool across the year for their combined hospitalization expenses, rather than each person having their own separate ₹5,00,000 allocation.
Why checking eligibility matters before assuming coverage either way
Because eligibility hinges on a 2011 census classification most people don't actively track day-to-day, many potentially eligible households don't realize they qualify, while others may incorrectly assume income alone determines eligibility and rule themselves out without checking their actual SECC status or the age-based path. Checking eligibility through official government channels (rather than assuming based on income) is the only reliable way to confirm coverage, especially given that state-specific extensions can broaden eligibility beyond these central criteria.