Is Jaw Reconstruction Surgery Covered Under PM-JAY for Cancer Patients?

Hello,

Yes, jaw reconstruction as part of medically necessary cancer treatment is covered under Ayushman Bharat PM-JAy.

For a patient with oral or jaw cancer, treatment involve removal of the tumour and reconstruction of the jaw using methods such as a bone graft, flap or other reconstructive technique. The exact procedure and package need to be confirmed by the treating hospital and its Ayushman desk.

Routine dental treatment or purely cosmetic procedures should not be assumed to be covered. The important point is whether the jaw reconstruction is medically necessary and part of the covered cancer treatment.

PM-JAY provides cashless benefits of up to ₹5 lakh per eligible family per year for covered hospitalisation, subject to scheme rules and applicable packages.

How to Check Hospital Under Ayushman Card 

1. Open the official PM-JAY hospital search portal.

2. Select the patient's State.

3. Select the District where treatment is required.

4. Select Government or Private Hospital.

5. Select the relevant speciality, such as Surgical Oncology, Head & Neck Surgery or Oral and Maxillofacial Surgery, depending on the available options.

6. Enter the hospital name if you have a particular hospital in mind.

7. Complete the Captcha, if shown.

8. Click on Search.

9. Check that the hospital is currently PM-JAY empanelled and has the required speciality.

10. You can also check the overall empanelled list of hospital of your district

Pre-Authorisation

For major cancer-related procedures, the hospital may need to submit the patient's medical records and treatment details for pre-authorisation before the covered treatment is provided. The hospital's Ayushman desk can guide you through this process.

Documents to Keep Ready

• Ayushman Card

• Aadhaar Card or valid ID

• Cancer diagnosis/biopsy report

• Doctor's prescription and treatment plan

• CT/MRI/PET scan reports, if available

• Previous medical records

• Previous surgery/treatment records, if applicable

• Discharge summary, if applicable

• Blood and other investigation reports

• Current medicines/prescriptions

• Any referral letter, if applicable

• Other documents requested by the hospital's Ayushman desk

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