Ayushman Bharat PM-JAY — What Is Covered
The Ayushman Bharat PM-JAY scheme provides health coverage of up to ₹5 lakh per family per year for secondary and tertiary care hospitalisation. The scheme covers 1,949 medical packages across 27 specialties, including surgeries, medical treatments, diagnostic procedures, and day-care treatments.
This guide explains what is covered, what is excluded, and how the ₹5 lakh coverage works.
Key Benefits at a Glance
- ₹5 lakh per family per year on a floater basis (shared among all family members)
- Cashless and paperless treatment at empanelled hospitals across India
- No cap on family size — all members in the SECC database are covered
- No age limit — newborns to senior citizens are covered
- Pre-existing diseases covered from day one with no waiting period
- 3 days of pre-hospitalisation expenses covered (tests, consultations)
- 15 days of post-hospitalisation expenses covered (follow-up, medicines)
- Transport allowance of ₹4,500 per hospitalisation included
Specialties Covered Under PM-JAY
The scheme covers treatments across 27 medical and surgical specialties. The most commonly used specialties include:
Medical specialties: General Medicine, Paediatrics, Neonatal Care, Oncology (Medical), Mental Health, Emergency Room care, Infectious Diseases.
Surgical specialties: General Surgery, Cardiology and Cardiac Surgery, Orthopaedics, Joint Replacement, Ophthalmology (Eye), ENT, Urology, Neurosurgery, Obstetrics and Gynaecology, Plastic and Reconstructive Surgery, Burns Management, Oral and Maxillofacial Surgery.
Oncology: Medical Oncology (chemotherapy), Surgical Oncology (tumour removal), Radiation Oncology (radiation therapy), and Paediatric Cancer.
Advanced procedures: Organ Transplant (kidney, liver, heart), Interventional Neuroradiology, Cardio-thoracic and Vascular Surgery.
Common Treatments and Surgeries Covered
Some of the most commonly availed treatments under PM-JAY include: cataract surgery, knee replacement, hip replacement, coronary bypass surgery (CABG), angioplasty, dialysis, cancer chemotherapy, caesarean section delivery, appendectomy, hernia repair, gallbladder removal, kidney stone treatment (lithotripsy), brain tumour surgery, and spinal surgery.
What Is NOT Covered
While PMJAY covers a wide range of treatments, certain things are excluded:
- OPD (Out-Patient Department): Regular doctor consultations, prescription medicines, and diagnostic tests without hospitalisation are not covered
- Cosmetic surgery: Procedures done for beautification rather than medical necessity
- Fertility treatment: IVF and other assisted reproduction treatments
- Organ purchase: Cost of purchasing organs for transplant (the surgery itself is covered)
- Drug rehabilitation: Unless medically necessary and requiring hospitalisation
For the complete list of covered packages and exclusions, visit the official PMJAY website or call 14555.
How the ₹5 Lakh Coverage Works
The ₹5 lakh is a family floater — this means the total coverage of ₹5 lakh is shared among all family members for the entire year. For example, if one family member uses ₹3 lakh for a surgery, the remaining ₹2 lakh is available for other family members for the rest of that year.
The coverage resets every year. Unused amounts do not carry forward to the next year.
Find hospitals for your treatment: Search PMJAY empanelled hospitals at PMJAYHospitals.com by state, district, and specialty.
Disclaimer: PMJAYHospitals.com is an independent directory and is not affiliated with the National Health Authority or any government body. For official information, visit pmjay.gov.in or call 14555.