Does Ayushman Bharat (PM-JAY) cover medical insurance for children?

Dear A B ji

Yes, children can receive treatment under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), if they are included in an eligible family and have a valid Ayushman Card. There is no separate minimum age requirement for children under the regular PM-JAY scheme.

The scheme provides cashless treatment of up to ₹5 lakh per eligible family per year at hospitals empanelled for the required treatment package. However, not every hospital or every treatment is covered.

What Treatments Are Covered for Children?

Children receive coverage for eligible hospital treatments, depending on the medical condition and approved package.

Examples include :

• ENT problems, such as tonsils or certain ear conditions.
• Paediatric treatment for eligible illnesses requiring hospital admission.
• Some heart-related treatments and procedures.
• Eligible treatment for fractures and other injuries.
• Some urology and kidney-related treatments.
• Eligible general medical and surgical treatments.

Routine OPD consultations, medicines or tests without an eligible hospitalisation package are generally not covered under standard PM-JAY. The hospital must be actively empanelled for the required speciality and treatment package.

How to Check an Ayushman Empanelled Hospital?

Follow these steps to find a suitable hospital for your child's treatment

1. Visit the official Ayushman Bharat hospital search portal.
2. Select your state.
3. Select your district.
4. Choose Government or Private hospital, depending on your preference.
5. Select the required speciality, such as Paediatrics, ENT, Cardiology or another relevant department.
6. Enter the hospital name, if the option is available, complete the captcha and click Search.
7. Check whether the hospital has active PM-JAY empanelment.
8. Contact the hospital's Ayushman help desk to check whether your child's specific treatment is covered under an approved package.
9. Before admission, check whether any referral or pre-authorisation is required.

You can also check overall empanelled list of hospital of our district.

Documents Required for a Child's Ayushman Treatment

Please keep these documents ready

• Child's valid Ayushman Card, if already issued.
• Parent's or guardian's Aadhaar card or accepted identity proof.
• Child's birth certificate or other age proof, if required.
• Family identity or eligibility documents, if required for verification.
• Doctor's prescription and medical reports.
• Previous treatment records, discharge summaries and investigation reports, if available.
• Referral or pre-authorisation documents, if required.

What If the Child Does Not Have an Ayushman Card?

First, check whether the family is eligible under PM-JAY and whether the child is included in the eligible family record. You can check through the official Ayushman beneficiary portal.

How Can We Help You Find a Hospital?

Please share the following details:

• City and state: Where do you want the child's treatment?
• Child's age: How old is the child?
• Medical problem: What health problem is the child experiencing?
• Treatment required: Has a doctor recommended any specific treatment or procedure?
• Ayushman Card: Does the child already have an Ayushman Card, or do you need help checking eligibility?

Once you share the city, state and child's medical problem, we can help you find suitable hospitals and doctors from our partner network and guide you about checking Ayushman treatment availability.

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