Complete Guide for Disease Covered under Ayushman Bharat

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which was launched in September 2018, is one of the largest and most ambitious healthcare schemes in the world. The plan offers a health cover of up to ₹5 lakh per year per family. Care is targeted to the bottom 40% of India’s population and age group above 70 yrs, ensuring that the poorest and most vulnerable citizen gets quality healthcare without the fear of impoverishment due to medical costs. It is a fully funded program by the central and state governments, and beneficiaries are identified on the basis of Socio-Economic Caste Census (SECC) data. The basic motive of the Ayushman Bharat scheme is to lighten the load of healthcare treatment expenditures on the low-income groups by providing them with cashless treatment for various types of illnesses and disabilities.

In this article, we will provide you some information on how a registered user can get treated under Ayushman Bharat Yojana

Four Key steps to treatment under Ayushman Bharat 

Visit an empaneled hospital: The Ayushman Bharat scheme has coverage of many public and private empaneled hospitals in India. Any of these hospitals can be approached by beneficiaries for treatment. For the full list of hospitals covered under Ayushman Bharat, please refer to this link: 

Authentication and Pre-Authorization process: The beneficiary’s details and medical reports are authenticated at the hospital through Ayushman Bharat Implementation Support Agency (ISA) which processes the request for treatment and authorizes the same. 

Cashless Treatment: Post approval, the beneficiary can avail cashless treatment on approval of pre-authorization request. For the covered expenses up to 5 lakhs, the hospital directly gets reimburses from the Ayushman Bharat scheme. For expenses above 5 lakhs, the patient has to pay from his or her own pocket. 

Discharge and Follow-Up: The beneficiary leaves without having to pay anything out-of-pocket. The scheme also covers follow up care if needed.

What disease and procedures are covered under Ayushman Bharat?

Under the Ayushman Bharat Scheme, the list of medical conditions and procedures covered is vast and beneficiaries get access to a variety of healthcare services. The scheme includes around 1,393 medical packages, which include surgeries, treatments and diagnostics. These packages are included in 25 specialties, including cardiology, oncology, orthopedics and neurology. The following are major diseases and procedures covered under Ayushman Bharat Yojana:

• Cardiology:

1. Coronary artery bypass graft (CABG)
2. Angioplasty (with and without balloon gold placement)
3. Valve replacement surgeries

• Oncology:

1. Chemotherapy and radiothearpy in cancer treatment
2. Tumor removal surgery
3. Bone marrow transplantation

• Orthopedics:

1. Hip and Knee Joint Replacements
2. Fracture treatments
3. Spinal surgeries

• Neurology:

1. Brain tumor surgeries
2. Stroke and aneurysm treatment
3. Epilepsy surgery

• Pediatrics:

1. Pediatric cancer treatment
2. Premature Baby Neonatal Care

• General Surgery:

1. Appendectomy
2. Hernia repair
3. Gallbladder stone removal

• Obstetrics and Gynecology:

1. Cesarean sections
2. Hysterectomy
3. Management of ectopic pregnancies

• Urology:

1. Kidney stone removal
2. Prostate surgeries
3. For chronic kidney disease: dialysis

• Ophthalmology:

1. Cataract surgery
2. Treatment for glaucoma
3. Retinal detachment surgery

• ENT (Ear, Nose, and Throat):

1. Cochlear implants for hearing loss
2. Tonsillectomy
3. Sinus surgeries

• Dental and Maxillofacial Surgery:

1. Management of facial fractures
2. Cleft lip and palate repair

• Pulmonology:

1. Treatment for chronic obstructive pulmonary disease (COPD)
2. Lung cancer surgeries
3. Tuberculosis treatment

• Infectious Diseases:

1. Treatment for HIV/AIDS
2. Treatment of dengue and malaria
3. Hepatitis B and C treatment

Expenditures Not Covered Under Ayushman Bharat

Even though the Ayushman Bharat Scheme is based on a large covering, certain expenses and treatments are not covered under the scheme. Beneficiaries need to be aware of these exclusions so they do not face unexpected out-of-pocket charges. Some of the major exemptions include:

• Home Care Treatments: Outpatient consultations, medications and diagnostic tests not requiring hospitalization are not included in the scheme.

• Cosmetic and Plastic Surgeries: Cosmetic procedures like liposuction, facelifts, and hair transplants are not covered.

• Fertility Treatments: The scheme does not cover in-vitro fertilization (IVF), surrogacy, or any other fertility treatments.

• Non-Allopathic Treatments: Treatment lines under alternative medicine systems (Ayurveda, Homeopathy, and Unani), unless specified.

• Hospitalization-Free Diagnostic Tests: Diagnostic tests not covered as part of the hospitalization package.

• Dental and Vision Care: Regular dental care, glasses, and contact lenses are not covered.

• Disorders of Behavior and Lifestyle: Treatments for obesity, substance abuse and lifestyle-related illnesses are excluded.

• Experimental Treatments: Experimental or investigational procedures and treatments are not covered.

• Non-Medical Expenses: Patient or attendant travel, food, and lodging costs are not reimbursed.

Ayushman Bharat Scheme is a landmark initiative that is transforming healthcare access for millions of Indians. It ensures that beneficiaries are empowered to receive quality medical care without the fear of financial ruin by covering a broad spectrum of diseases encompassed by Ayushman Bharat. Ayushman Bharat Yojana has a long list of diseases you are treated for, from cardiology to emergency care, but beneficiaries must be aware of the coverage levels under Ayushman Bharat and exclusions to take an informed decision on their healthcare requirements. This plan is still evolving & is going to fill the gap that is faced in terms of healthcare accessibility and affordability & will take India closer to universal health coverage.