Ayushman Card Rules And Coverage Explained

Many Ayushman Card holders believe every medical bill becomes free, but the scheme has clear limits. Ayushman Bharat PM-JAY mainly helps eligible families with serious hospital treatment, not routine healthcare expenses.

What The Scheme Covers

Under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, eligible families can get cashless treatment of up to Rs 5 lakh every year at empanelled hospitals. The cover is mainly for hospitalisation, surgeries, secondary care, tertiary care, and serious illnesses. In approved cases, pre-hospitalisation and post-hospitalisation costs may also be included.

What Is Not Free

OPD visits are the biggest point of confusion. Doctor consultation fees, private clinic visits, regular checkups, fever, cough, headache treatment, and routine tests are usually not covered if admission is not needed. Patients may also have to pay for daily medicines, vitamins, and supplements.

Warning For Patients

Cosmetic surgery, IVF, routine dental cleaning, and non-essential treatments are generally outside the coverage list. Before treatment, families should confirm whether the hospital is empanelled and whether the procedure is approved under PM-JAY.