Which Treatments Are Free Under the Ayushman Scheme—and Which Are Not? Know Before Getting Your Card

Ayushman Bharat PMJAY: Amidst the rising costs of medical treatment and hospital expenses, the government has launched the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana to provide significant relief to poor and needy families.

Under this scheme, eligible families receive free medical treatment worth up to ₹5 lakh annually. While this offers substantial financial relief to those in need, this free coverage—up to the ₹5 lakh limit—does not apply to every ailment or every type of medical procedure. Furthermore, the benefits of this scheme cannot be availed at just any hospital; specific rules and limitations have been established under the program. Let’s explore these details in depth.

When Can You Avail the Benefits of This Card?

Regarding the benefits of this card, the coverage is primarily applicable only when a patient requires hospitalization. Expenses for treating common ailments such as fever, cough, headaches, or minor illnesses are not included in this scheme. In other words, you must personally bear the costs for expenses such as doctor’s fees, OPD (Outpatient Department) visits, routine check-ups, blood tests, or X-rays.

Diseases Covered Under the Scheme

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana covers the treatment of various critical illnesses and major surgical procedures. Let’s take a look at the specific diseases and conditions included in this coverage:

Heart Diseases: Treatment for conditions such as heart attacks, angioplasty, bypass surgery, and high blood pressure is covered.
Cancer Treatment: This includes chemotherapy, radiation therapy, and the treatment of cancers affecting the breast, lungs, stomach, and mouth.
Neurological Disorders: Treatment for conditions such as strokes, brain tumors, Parkinson’s disease, and epilepsy is covered.
Kidney and Liver Diseases: This includes treatment for dialysis, chronic kidney disease, cirrhosis, and Hepatitis B and C.
Bone and Joint Issues: Treatment for conditions such as fractures, hip and knee replacement surgeries, and arthritis is covered.
Women’s and Children’s Health: This includes coverage for normal deliveries, C-sections, NICU (Neonatal Intensive Care Unit) care, and the treatment of critical illnesses in children.

What Treatments Are Not Covered?

Certain treatments are not covered under this scheme:

• OPD (Outpatient Department) consultations
• Cosmetic and plastic surgery
• IVF and test-tube baby procedures
• Routine dental treatments
• Vitamins and supplements
• Treatment related to substance abuse or self-harm

The benefits of this scheme are available only at hospitals that are empanelled with the government. Therefore, before getting admitted, ensure that you verify whether the hospital accepts the Ayushman Card.

Who Is Not Eligible for Benefits?

Individuals holding government jobs, those who pay income tax, those with PF (Provident Fund) deductions, or those availing of ESIC (Employees’ State Insurance Corporation) facilities are generally not eligible to receive benefits under this scheme. It is designed exclusively for the economically weaker sections of society.

Important Points to Keep in Mind Before Commencing Treatment

• Always seek information at the Ayushman Desk located within the hospital first.
• Ensure you verify exactly which facilities and services are provided free of cost.
• Note that there may be separate charges for private rooms or additional diagnostic tests.