Which Diseases are not Covered under the Ayushman Card?

Anyone opting for the Ayushman card under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme must know about its inclusions and exclusions for treatment. Although most people read the terms and conditions before applying, many overlook the exclusions.

To avoid such mishaps, it is crucial to correctly know about the exclusion factors, along with the inclusions. Keep reading to check out the major exclusions under this scheme.

What Diseases or Conditions are Excluded from the Ayushman Card?

Even though the PMJAY scheme offers comprehensive health insurance coverage of ₹5 lakh per family per year, it does not include all types of health conditions and procedures.

Some of the exclusions include:

● Outpatient Treatments (OPD)

Conditions that do not require hospitalisation, such as routine doctor visits, check-ups, diagnostic tests, or medications for chronic conditions, are typically not covered. Only hospitalisation for secondary and tertiary care is included.

● Hospitalisation for Evaluation or Observation Only

Costs related to hospitalisation, mainly for health evaluations, diagnoses, and observations, are excluded from the scheme. Furthermore, vitamins, tonics, or supplements are not included unless they are a part of a recognised treatment for an injury or disease.

● Infertility and Assisted Reproductive Technologies

Technologies such as IVF (In Vitro Fertilisation) or other infertility treatments are not included unless specifically mentioned in the National Health Benefit Package.

● Dental Treatments

Routine dental procedures, such as root canal treatments, cavity fillings, dental implants, periodontal therapies, or cosmetic dental surgeries, are not covered under the Ayushman Bharat scheme.

However, dental treatments due to tumours, trauma, cysts, or injuries requiring hospitalisation are included.

● Vaccinations and Immunisations

Vaccines and immunisation procedures that are not included in the national immunisation programme are excluded from coverage.

● Cosmetic and Aesthetic Surgeries

Surgical procedures performed solely for cosmetic or aesthetic reasons, including anti-ageing surgery of the face and body, tattoo removal, augmentation, fat grafting, neck lifts, and aesthetic rhinoplasty, are not covered under this scheme.

● Persistent Vegetative State

Patients suffering from persistent vegetative state (PVS), who are unresponsive to physical or psychological stimuli are not eligible for the Ayushman Bharat coverage.

● Circumcision for Infants Under Two Years

Circumcision is only permitted if it is medically required for a disease that is not excluded or if it results from an accident.

The Ayushman Bharat programme is an initiative that provides financial security and cashless hospital care to countless economically vulnerable families. However, it does not provide coverage for certain conditions that you must check beforehand.

Knowing these exclusions will help beneficiaries budget for additional health-related costs, make informed health decisions, and ensure financial strain does not affect essential healthcare needs.