Ayushman Bharat – PM‑JAY provides up to ₹5 lakh per family per year for secondary and tertiary hospitalization care. But not everything is covered under this scheme. Knowing the exclusions helps you plan your healthcare and avoid unexpected costs.
1. Outpatient & Routine doctor Visits
Unlike full health insurance, Ayushman Yojana doesn’t cover OPD treatments — meaning:
Regular doctor consultations
Routine check‑ups
Diagnostic tests done outside of hospitalization
Medications taken without hospital admission
If your treatment doesn’t require hospital admission, it typically won’t be covered under the scheme.
2. General Diagnostic Investigations
Standalone scans and tests like MRI, CT scan, X‑rays, blood tests, etc., when done just for evaluation or check‑ups, are generally not covered unless they are part of an inpatient package.
3. Dental Treatments
Standard dental care — such as:
Root canal therapy
Cavity filling
Tooth extraction
Dental implants
Treatment of gum diseases
are not covered under Ayushman Bharat unless the procedure is required due to trauma, tumors, or conditions requiring hospitalization.
Note: Regular dental care remains an exclusion.
4. Infertility & Fertility Procedures
Treatments related to infertility — including IVF (In Vitro Fertilization) and other assisted reproductive technologies — are not covered under the standard benefit package unless they are specifically included.
5. Vaccinations Outside National Programmes
Routine or non‑essential vaccines and immunizations that are not part of the national immunization schedule are excluded — meaning you may need to pay out of pocket for these.
6. Cosmetic & Aesthetic Procedures
Ayushman Yojana primarily covers medically necessary treatments. Thus, cosmetic surgeries and beauty enhancements like:
Liposuction
Rhinoplasty
Neck lifts
Tattoo removal
Anti‑aging procedures
are not included under PM‑JAY coverage.
7. Circumcision (Infants under 2 for Non‑medical Reasons)
Circumcision performed for religious or personal reasons is not covered under the scheme. It may be covered only if it’s medically necessary due to illness or injury.
8. Persistent Vegetative State
Care for patients in a persistent vegetative state — maintained on life support without cognitive response — is excluded from Ayushman Bharat.
9. Non‑Allopathic & Alternative Treatments
Treatments under alternative systems such as Ayurveda, Homeopathy, Unani, Siddha, or yoga — unless specified as part of an inpatient care package — are usually not covered under the standard Ayushman Bharat benefit package.
10. Elective or Experimental Treatments
Marginal, experimental, or non‑standard therapies that are not recognized in the health benefits package are typically not reimbursed under Ayushman Yojana.
Important Takeaway
✅ The Ayushman Bharat – PM‑JAY scheme focuses on serious, hospitalization‑level care and catastrophic health expenses. Routine treatments, lifestyle procedures, and cosmetic or outpatient services are excluded to keep the program sustainable while prioritizing critical healthcare needs.
📌 Tip: If you’re planning a treatment and are unsure whether it’s covered, always check with your hospital or Ayushman Mitra before admission, and review the National health Benefit Package on the official Ayushman Bharat website.
Disclaimer:
The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of any agency, organization, employer, or company. All information provided is for general informational purposes only. While every effort has been made to ensure accuracy, we make no representations or warranties of any kind, express or implied, about the completeness, reliability, or suitability of the information contained herein. Readers are advised to verify facts and seek professional advice where necessary. Any reliance placed on such information is strictly at the reader’s own risk.
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