Does Ayushman Bharat Cover OPD Cancer Treatment?

Dear Sakshi Rana ji,

Ayushman Bharat (PM-JAY) mainly covers hospitalisation (IPD) and approved day-care treatments. Routine OPD (Outpatient Department) consultations are generally not covered. However, many cancer treatments, such as chemotherapy and radiation therapy, are provided as day-care procedures, which means you may not need an overnight hospital stay, but the treatment can still be covered under PM-JAY if it is part of an approved package.

What Cancer Treatments Are Covered?

Eligible patients can receive cashless treatment for approved cancer packages, including

• Chemotherapy (Day-care or IPD)

• Radiation therapy

• Cancer surgery

• Hospital admission and ICU care, if required

• Medicines and consumables during hospitalisation

• Diagnostic tests included in the approved treatment package

• Pre-hospitalisation and post-hospitalisation expenses as per PM-JAY guidelines

What Is Usually Not Covered Under OPD?

The following services are generally not covered when taken as routine OPD services without hospital admission or an approved day-care package\

• Regular doctor consultation fees

• General follow-up OPD visits

• Standalone blood tests, CT scans, MRI, PET scans, or biopsies

• Medicines purchased from outside the hospital for home use

• Oral chemotherapy medicines taken at home (unless included under a specific approved package)

How to Avail Cancer Treatment Under PM-JAY

• Visit a PM-JAY empanelled hospital.

• Meet the Ayushman Mitra at the help desk.

• Submit your Ayushman Card and Aadhaar Card.

• The oncologist will evaluate your condition.

• The hospital will obtain the required pre-authorisation.

• Once approved, eligible chemotherapy, radiation therapy, or surgery can be provided cashlessly.

How to Check Whether the Hospital Accepts Ayushman Bharat (PM-JAY)?

Before starting treatment, verify whether the hospital is empanelled under PM-JAY.

Online Verification

• Visit the PM-JAY Hospital Finder.

• Select:

  • State

  • District

  • Hospital Name (or Oncology specialty)

• Click Search.

• Confirm that the hospital is PM-JAY empanelled.

How HexaHealth Can Assist You

• Ayushman Bharat Guidance: We help you understand PM-JAY eligibility and cancer treatment coverage.

• Cancer Specialist Consultation: We help connect you with experienced oncologists.

• Hospital Selection: We help you find PM-JAY empanelled and HexaHealth partner cancer hospitals.

• Treatment Guidance: We explain chemotherapy, radiation therapy, surgery, and available treatment options.

• Documentation Support: We guide you with the documents required for PM-JAY verification and pre-authorisation.

• Appointment Assistance: We help coordinate specialist consultations and hospital appointments.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth