Ayushman Bharat Treatment & Package List: What’s Covered Under PM-JAY
Quick answer: PM-JAY covers over 1,900 treatment procedures across roughly two dozen medical specialities — including cardiology, oncology, orthopedics, general surgery, and more — bundled into fixed-price “packages” under the Health Benefit Package (HBP) list. Coverage goes up to ₹5 lakh per family per year, and the exact package list is periodically revised by the National Health Authority.
Key Takeaways
- Treatments are grouped into standardized “packages,” each with a fixed price the hospital is paid regardless of exact costs incurred.
- The Health Benefit Package (HBP) list has been revised more than once since PM-JAY launched in 2018, most notably as HBP 2.0 and HBP 2.2, adding, removing, and repricing packages.
- Not every hospital offers every package — coverage depends on what a specific hospital is empanelled for.
- Pre-existing conditions are covered from day one, with no exclusions based on age, gender, or family size.
How the Package System Works
Rather than reimbursing whatever a hospital happens to charge, PM-JAY pays a fixed, pre-negotiated rate for each defined treatment package — this keeps costs predictable for the scheme and prevents overbilling. A package typically bundles the surgery or procedure itself, associated medicines and consumables, a defined period of pre- and post-hospitalization care, and standard diagnostics tied to that treatment.
Broad Categories of Covered Treatment
| Category | Examples |
|---|---|
| Cardiology & cardiac surgery | Angioplasty, bypass surgery, valve procedures |
| Oncology | Cancer surgery, chemotherapy, radiation therapy |
| Orthopedics | Joint replacement, fracture surgery, spine procedures |
| General surgery | Hernia repair, gallbladder removal, appendectomy |
| Nephrology & urology | Dialysis, kidney stone removal, urological surgery |
| Neurology & neurosurgery | Brain and spinal surgery, stroke management |
| Obstetrics & gynecology | Complicated deliveries, gynecological surgery |
| Critical care | ICU care, ventilator support |
This list is illustrative, not exhaustive — the full, current package list with exact codes and prices is maintained by the National Health Authority and updated periodically.
How to Check If a Specific Treatment Is Covered
- Ask your treating hospital’s PM-JAY desk directly — they work with the package list daily and can confirm quickly.
- Check the official Health Benefit Package documentation published by the National Health Authority for the specific procedure code.
- If you’re unsure which category your condition falls under, the PM-JAY helpline (14555) can help point you in the right direction.
What’s Generally Not Covered
| Typically excluded | Why |
|---|---|
| Purely cosmetic procedures | Not classified as medically necessary secondary/tertiary care |
| Outpatient consultations without hospitalization | PM-JAY is designed around hospitalization-based packages, not routine OPD visits |
| Treatment at non-empanelled hospitals | Cashless coverage only applies at hospitals empanelled for that specific package |
Common Mistakes
| Mistake | What to do instead |
|---|---|
| Assuming a treatment isn’t covered just because one hospital doesn’t offer it | Check the official hospital list for another empanelled hospital that offers that specific package |
| Relying on an outdated package list found online | Confirm current package details directly with the hospital’s PM-JAY desk or NHA’s official documentation |
| Assuming pre-existing conditions are excluded | PM-JAY explicitly covers pre-existing conditions from day one, unlike many private insurance policies |
Conclusion
PM-JAY’s package-based system covers a genuinely broad range of hospitalization needs, but exact coverage for any specific procedure depends on the current package list and the hospital you visit. When in doubt, the hospital’s own PM-JAY desk is usually the fastest way to get a definitive answer for your situation.
Frequently Asked Questions
How many treatments does PM-JAY cover?
Over 1,900 procedures across roughly two dozen medical specialities, organized into fixed-price treatment packages that are periodically revised.
Are pre-existing conditions covered?
Yes, PM-JAY covers pre-existing conditions from day one, with no waiting period or exclusion based on age, gender, or family size.
Does every empanelled hospital offer every treatment package?
No, coverage depends on which packages a specific hospital is empanelled for — check with the hospital or the official hospital list.
How do I confirm if my specific treatment is covered?
Ask the hospital’s PM-JAY desk directly, check NHA’s official Health Benefit Package documentation, or call the helpline at 14555.
Related: How to Use Your Ayushman Card at a Hospital, PM-JAY Hospital List guide, and Ayushman Card Eligibility Criteria.
