Quick answer: PM-JAY covers a fixed list of hospitalisation treatments, called health benefit packages, across many specialties. To check your treatment, ask the Arogya Mitra desk at an empanelled hospital or call the PM-JAY helpline on 14555, with your doctor’s diagnosis and advised procedure. Coverage depends on the treatment being in the package list and the hospital being empanelled for that specialty.
What PM-JAY covers
According to the government, PM-JAY covers 1,949 procedures across 27 specialties, such as general medicine, surgery, oncology and cardiology. Hospital services within a package, including drugs for 15 days after discharge, diagnostics up to three days before admission, food and lodging for the patient, are provided without cost to the beneficiary. Cover is up to 5 lakh rupees per family per year.
| Usually covered | Usually not covered |
|---|---|
| Listed hospitalisation procedures | Routine outpatient visits |
| Pre-existing conditions from day one | Treatments not in the package list |
| Medicines and diagnostics within the package | Treatment at hospitals not empanelled for that specialty |
| Patient food and lodging during admission | Travel, and family stay and food |
How to check, step by step
- Get the diagnosis and advised procedure in writing from your doctor.
- Check your eligibility and card status on the official beneficiary portal.
- Ask an empanelled hospital’s Arogya Mitra to match the procedure with a PM-JAY package.
- Call 14555 if you have questions about coverage or eligibility.
- Confirm before travelling that the chosen hospital is empanelled for that specialty.
Senior citizens aged 70 and above
In 2024, PM-JAY was extended to all senior citizens aged 70 and above, regardless of income. Families with elderly parents should check eligibility and get the card made before it is needed.
More on the official PM-JAY website. See also using your Ayushman card in another state and how to find hospitals that accept Ayushman Bharat.
If your treatment is not covered
If the Arogya Mitra says your treatment is not covered, ask three things: is it not in the package list at all, is this hospital simply not empanelled for that specialty, or is there a documentation problem? The answer changes what you do next. If it is a hospital issue, another empanelled hospital may be able to help. If it is not in the package list, check your state’s own health scheme or any private insurance you have. If you believe you are being wrongly refused, call 14555 to raise a grievance.
Our guide to hospital charges insurance usually won’t cover also helps families plan for costs outside any scheme.
Questions to ask the Arogya Mitra
- Is this procedure covered under PM-JAY at this hospital?
- Which package applies, and does it cover the full planned treatment?
- Are any items outside the package, such as extra days or specific medicines?
- What documents do you need today?
- How long does pre-authorisation usually take here?
Write down the answers and the name of the person you spoke to, especially if you are travelling from another state.
Scheme coverage and the family’s other costs
Even when treatment is fully covered, families still pay for travel, accommodation and food, and sometimes for items outside the package. Plan for these early, especially if treatment is in another city. See budgeting for stay and food near the hospital and our complete guide to hospital costs.
If your doctor changes the treatment plan, ask the Arogya Mitra desk to check coverage again, because a different procedure may fall under a different package.
How NEIMHAANS helps
NEIMHAANS is a non-clinical healthcare concierge that has helped families travelling for treatment since 2007. We help families prepare the diagnosis and documents, check which empanelled hospitals handle the advised treatment, and speak to the hospital’s PM-JAY desk before travel. We cannot approve or guarantee PM-JAY coverage; that decision rests with the scheme and the hospital. See our services.
Frequently asked questions
How do I know if my treatment is covered under PM-JAY?
Ask the Arogya Mitra desk at an empanelled hospital to check the treatment against the scheme’s health benefit packages, or call the PM-JAY helpline on 14555. Your doctor’s diagnosis and planned procedure decide which package applies.
Does PM-JAY cover outpatient visits?
PM-JAY is mainly for hospitalisation. It covers listed secondary and tertiary care packages, including diagnostics shortly before admission and medicines for a period after discharge, rather than routine outpatient visits.
Are pre-existing conditions covered?
Yes. PM-JAY covers pre-existing conditions from day one for eligible beneficiaries.
Are senior citizens covered?
In 2024, the government extended PM-JAY to all senior citizens aged 70 and above regardless of income. Check eligibility and card status on the official beneficiary portal.
This article is part of our complete guide to hospital costs in India.
This article is general information, not medical, legal, insurance or financial advice. Rules, schemes and hospital policies change, so always confirm details with your hospital, insurer or the relevant authority.