Does PMJAY cover cancer treatment and checkups?

Dear M Seetharamaswamy Ji,

Yes, empanelled hospitals can accept PM-JAY cards (Ayushman Cards) for cancer treatment, but routine outpatient health checkups are generally not covered.

What Cancer Treatment Is Covered?

Depending on the applicable PM-JAY package, eligible beneficiaries may receive cashless treatment for

• Cancer-related surgeries

• Chemotherapy

• Radiation therapy

• Inpatient/day-care cancer treatment

• Necessary investigations and supportive treatment associated with a covered package

• Treatment of pre-existing conditions, subject to PM-JAY rules

However, a standalone OPD consultation, routine cancer screening or a diagnostic test done independently not be covered under the hospitalization package.

What About Cancer Checkup?

If by “checkup” you mean a routine OPD consultation or preventive cancer screening, do not assume it will be cashless under PM-JAY.

If the patient has already been diagnosed with cancer and the doctor recommends investigations as part of a covered treatment or hospitalization, the applicable package should be checked with the hospital's Ayushman Mitra.

How to Find a PM-JAY Cancer Hospital?

Not every Ayushman-empanelled hospital provides oncology treatment. A hospital be empanelled for some specialities.

You can check it this way

1. Open the official PM-JAY Hospital Search portal.

2. Select your State.

3. Select your District.

4. Select the relevant speciality, such as Oncology/Medical Oncology/Surgical Oncology/Radiation Oncology, where available.

5. Search the hospital name.

6. Check that the hospital's PM-JAY empanelment is currently active.

7. Contact the hospital's Ayushman Mitra desk and confirm that oncology treatment is currently available under PM-JAY.

8. Ask whether the exact treatment required chemotherapy, radiation, cancer surgery or another procedure is covered under an applicable package.

Is Prior Approval Required?

For certain planned cancer treatments, the hospital need to obtain pre-authorisation from the concerned authority before treatment. The hospital's Ayushman Mitra/PM-JAY team generally handles the required approval process.

Documents to Carry

When visiting a PM-JAY hospital for cancer treatment, keep these documents with you

• Ayushman Bharat Card / e-Ayushman Card

• Aadhaar Card or valid government ID

• Cancer specialist's prescription

• Biopsy/pathology report, if available

• CT/MRI/PET-CT reports, if available

• Blood test reports

• Previous treatment records

• Previous discharge summary, if available

• Current medicines list

If the patient has already been diagnosed with cancer, do not delay consultation while trying to complete the Ayushman verification. Take the available medical reports to an empanelled hospital and ask the Ayushman Mitra to verify eligibility and the applicable oncology package.

If you share the patient's city and state and tell us whether the requirement is cancer surgery, chemotherapy, radiation, biopsy, PET-CT or just a consultation/checkup, we can guide you on how to identify a suitable PM-JAY hospital near you.

We can help patients connect with experienced cancer specialists at partner hospitals and assist with consultation, appointments and treatment coordination.

HexaHealth can help connect you with the right specialists and streamline the process. Please let us know how we can further assist you.

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