Can Heart Treatment for a 13-Year-Old Girl Be Covered Under the Ayushman Card?

Hello,

Yes, heart treatment is covered under Ayushman Bharat PM-JAY.

A 13-year-old child with a reported “swelling in the heart” should be evaluated by a pediatric cardiologist as soon as possible. The exact problem needs to be confirmed because “heart swelling” can refer to different heart conditions, and treatment depends on the diagnosis.

If the family is financially weak, they should check Ayushman Bharat PM-JAY eligibility. PM-JAY provides cashless treatment for eligible beneficiaries at empanelled hospitals, with coverage of up to ₹5 lakh per family per year. The scheme has no age restriction for eligible family members.

What the family should do now

1. Take the child to a hospital with a pediatric cardiology/cardiology department.

2. Carry all previous reports, especially ECG, echocardiography (2D Echo), X-ray, CT/MRI, blood tests and prescriptions.

3. Tell the hospital's Ayushman Mitra/Ayushman desk that the child needs evaluation and treatment for a heart condition.

4. Ask them to check the child's Ayushman eligibility and whether the required treatment is covered under an applicable PM-JAY package.

5. Do not delay the child's medical evaluation while waiting for the card if the child is unwell.

PM-JAY empanelled hospitals can provide specialised services such as cardiology and cardiothoracic care, subject to the hospital's approved speciality and applicable package.

Steps to check an Ayushman hospital

1. Open the official PM-JAY hospital search.

2. Select the child's state.

3. Select the district/city.

4. Choose Government or Private hospital.

5. Select the relevant speciality, such as Cardiology or Paediatric care.

6. Enter the exact hospital name, if known.

7. Complete the captcha, if shown.

8. Click “Search”.

9. Check that the hospital's PM-JAY empanelment is active and that the required speciality is listed.

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

Documents to carry

• Ayushman Card/e-card, if already available

• Aadhaar Card or other valid government ID

• Ration card/family ID, if available

• Child's birth certificate or other child ID

• Parent/guardian's ID

• Doctor's prescription/referral

• 2D Echo and ECG reports

• Blood test reports

• X-ray/CT/MRI reports, if done

• Previous hospital records and discharge papers

• Current medicines and prescriptions

Important

If the child has severe breathing difficulty, bluish lips or fingers, fainting, severe chest pain, extreme weakness, or suddenly becomes unresponsive, take her to the nearest emergency department immediately. PM-JAY has an emergency process for eligible beneficiaries, so treatment should not be unnecessarily delayed while arranging documents. 

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