PMJAY Covered Diseases: Comprehensive List

Posted on: Dec 24, 2024 | 3 mins | Written by: HDFC ERGO Team

PMJAY Covered Diseases: Comprehensive List

Let’s say someone has limited financial resources and relies heavily on the government scheme like Pradhan Mantri Jan Arogya Yojana (PMJAY) to afford the mounting bills during a medical emergency. Now, when he/she goes to the hospital, the person is informed that the disease is not covered as part of PMJAY. It can come as a huge shock to the patient and his/her family. That’s why it is key to know the inclusions and exclusions of all insurance policies. So, let’s take a closer look at the list of diseases covered under the insurance policy and what may not be covered.

Critical Diseases or Illnesses Covered Under Ayushman Bharat Yojana Scheme

The Ayushman Bharat Yojana Scheme, also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY), is a health insurance scheme covering the economically weaker sections of society. The scheme offers medical coverage of up to Rs 5 lakhs per family annually, giving them access to quality healthcare.

Some of the critical PMJAY-covered diseases include –

• Coronary artery bypass grafting

• Prostate cancer

• Double valve replacement

• Pulmonary valve replacement

• Carotid angioplasty with stent

• Laryngopharyngectomy with gastric pull-up

• Skull base surgery

• Anterior spine fixation

• Tissue expander for disfigurement following burns

Other Medical Conditions Covered under PMJAY

Apart from critical illnesses, the Ayushman Bharat scheme covers other medical conditions like –

• Cardiac issues

• Maternal and Paediatric Care

• General surgeries such as gall bladder surgeries, appendectomy, hernia surgery, etc.

• Orthopaedic surgeries like joint replacement surgeries, fractures, and dislocations

• Congenital disordersm

• Kidney transplant

• Corneal transplant

• Bone marrow transplant

• Neurosurgery

• Chemotherapy and radiotherapy

• ENT procedures

• Burns

What is Not Covered under PMJAY

The PMJAY health insurance policy does not cover the following –

• OPD (out-patient department) consultations

• Cosmetic surgeries

• Fertility treatments like IVF

• Treatments related to self-inflicted injuries or substance abuse

• Drug rehabilitation

How to Know if a Disease in Covered under PMJAY?

To know the PMJAY covered diseases list, you can visit the PMJAY website (https://pmjay.gov.in/) which will have a comprehensive list of the covered diseases. You can also check with the insurers associated with the PMJAY scheme and from empanelled hospitals or Ayushman Bharat centres.

Conclusion

The Pradhan Mantri Jan Arogya Yojana (PMJAY) covers a wide range of medical conditions, including critical diseases or illnesses as mentioned above. You can find the entire list of diseases covered under PMJAY in the policy document or on the official website of PMJAY. If you fulfil the eligibility criteria to be a PMJAY beneficiary, you will get the Ayushman Bharat Card, which will help you avail of cashless hospitalisation at network hospitals. If you don’t fall in the eligibility category, you must buy an individual or family health insurance policy to protect yourself and your family financially against a wide range of health conditions. If you or your parents are at risk of developing critical ailments, it’s good to add critical illness insurance to your basic healthcare plan because such policies are particularly meant to cover the high treatment costs of critical illnesses.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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