How PMJAY Package Rates Work
PM-JAY does not reimburse hospitals based on actual treatment costs. Instead, it uses a fixed package rate system — every procedure has a pre-defined price that the hospital receives, regardless of the actual cost incurred. Understanding this system helps you know exactly what you are entitled to.
What Is a PM-JAY Package?
A package is a bundled rate for a specific medical or surgical procedure. For example, the “Total Knee Replacement — Unilateral” package has a fixed rate. This rate includes everything — surgeon fees, anaesthesia, OT charges, implant cost, ward charges, medicines, nursing, food, diagnostic tests, and post-operative care. The hospital receives this fixed amount and cannot charge you anything beyond it.
What Is Included in Every Package
- Pre-operative diagnostics (blood tests, X-rays, ECG, etc.)
- Surgery or procedure charges
- Surgeon, anaesthetist, and specialist fees
- OT and equipment charges
- Ward or ICU bed charges for the specified duration
- All medicines during hospitalisation
- Implants, devices, and prostheses (where applicable)
- Nursing and attendant care
- Food during hospital stay
- 3 days of pre-hospitalisation expenses
- 15 days of post-hospitalisation follow-up
- Transport allowance of ₹4,500
Rate Variations
PM-JAY package rates differ by hospital category. Government hospitals typically have lower package rates than private hospitals for the same procedure. Within private hospitals, NABH-accredited hospitals may have slightly higher approved rates. However, the patient pays nothing regardless — the rate difference affects only the hospital’s revenue.
Why This Matters to You
When a hospital performs joint replacement surgery under PM-JAY, the implant is included in the package. The hospital cannot say “the PM-JAY rate covers surgery but you need to buy the implant separately.” Similarly, for angioplasty under Ayushman Bharat, the stent cost is included. For cataract surgery, the IOL lens is included.
If any PMJAY empanelled hospital asks you to pay for medicines, implants, or any component that should be within the package, call 14555 immediately.
Disclaimer: PMJAYHospitals.com is an independent directory. For official information, visit pmjay.gov.in or call 14555.