Is Cancer Treatment Covered Under the PMJAY Scheme?

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The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) offers comprehensive health insurance coverage for a range of serious diseases, including cancer, without requiring beneficiaries to pay high medical costs, as long as they belong to eligible families.


Read on to learn more.


Does PMJAY Cover the Treatment of Cancer?


Yes, but the treatment and its duration depend on the kind of cancer diagnosis. Cancer management under PMJAY is a process of treatment approval, following which the most suitable treatment is decided for each individual patient, much like in the ‘tumour board’ approach.


The combination of surgery, chemotherapy, radiation therapy, and supportive treatment in cancer care makes it imperative that there is a clinical treatment approval process to evaluate and approve the most appropriate approach.


Pre-Authorization Process for Cancer Treatment


A cancer treatment package under PMJAY is required to be pre-authorised.


It involves two steps:



  • The complete course of treatment must be pre-authorised, specifying the various stages of treatment. The detailed Oncology Treatment Plan Approval Form (Annexure 1) should be completed, signed, and uploaded at this point.

  • An extra pre-authorisation has to be performed at each pre-defined treatment level when choosing the corresponding treatment package.


What Type of Cancers Are Covered Under PMJAY?


PMJAY covers various treatment procedures and cancer-related diseases, including:



  • Chemotherapy and radiation therapy

  • Breast cancer

  • Cervical cancer

  • Oral cancer

  • Gastrointestinal cancers

  • Lung cancer


Eligibility Criteria for PM-JAY


PM-JAY extends the health cover to eligible families (rural and urban) depending on their socio-economic parameters identified through Government data.


Rural Beneficiaries


The families in rural areas qualify for PM-JAY as long as they fulfil any one of the following deprivation criteria:



  • A family residing in a single room house with couture roof and wall.

  • Households that do not have an adult who is between 16 and 59 years of age.

  • Families in which there was no adult male member (ages 16-59).

  • Households that have a disabled member and no able-bodied adult to support the family.

  • Scheduled Castes (SC) or Scheduled Tribes (ST) families

  • Landless households that primarily depend on manual casual labour for their livelihood.


Also, the following categories will be included automatically under scheme:



  • Homeless households

  • Poor families or families that live on alms

  • Manual scavenging was done by families

  • Primitive Tribal Groups (PTGs)

  • Freed bonded labourers


Urban Beneficiaries


In urban areas, PM-JAY eligibility is determined based on occupation. The scheme is for people who work in these categories:



  • Ragpickers

  • Beggars

  • Domestic workers

  • Sellers or peddlers selling on streets, cobblers, hawkers and other service providers working on streets.

  • Construction workers, plumbers, masons, labourers, painters, welders, security guards, coolies etc who have heads on their loads.

  • Street sweepers, sanitation workers and gardeners (malis)

  • Workers in their homes, craftsmen, artisans and tailors

  • Transport workers, drivers, conductors, helpers, cart pullers and rickshaw pullers

  • Apprentices, shop workers, assistants and peons in small shops, helpers, delivery assistants, attendants, waiters

  • Electrical workers, mechanics, assemblers and repairers

  • Washermen and chowkidars


All these eligibility criteria ensure that economically weak and deprived populations will have access to quality healthcare benefits under PM-JAY.


Benefits of Ayushman Bharat Health Insurance Plans


Healthcare has been made more accessible and affordable for eligible families with several benefits under Ayushman Bharat Health Insurance.


1. Cashless Hospitalisation


PMJAY offers cashless treatment at empanelled hospitals, both public and private. This helps to substantially lower out-of-pocket medical costs because the beneficiaries do not have to pay upfront costs. The eligible hospital bills are settled directly under the scheme, allowing access to healthcare services in a timely manner without any financial burden.


2. Extensive Disease Coverage


It includes over 1,500 medical treatments and medical conditions, including serious illnesses like cancer, heart disease, and kidney disease. This plan includes a comprehensive range of cover for major surgeries, diagnostic testing, hospitalisation, and post hospitalisation care to give families a complete health protection plan.


3. Nationwide Accessibility


Treatment could be provided to beneficiaries at any hospital that is PMJAY empanelled in India, regardless of their residence. This portability is especially advantageous for migrant workers and families who often move to other parts of the country, giving them access to quality health care services throughout the country.


4. No Age or Family Size Restrictions


PMJAY applies to all family members irrespective of age or gender, or the number of dependents in the family. This all-inclusive strategy offers financial security to the whole family and helps to alleviate the burden of health-care expenses.


5. Insurance for Pre-existing Conditions


PMJAY does not have any waiting periods for pre-existing diseases, unlike many health insurance plans. People with chronic health conditions like diabetes, high blood pressure, or cancer can get treatment as soon as they need it.


PMJAY helps to enhance healthcare access and lessen the burden of healthcare costs for eligible families in India when they suffer from cancer treatment or other important diseases.