Are Cataract Surgery Benefits Available Under the Ayushman Bharat Scheme?

Hello,

Yes, the Ayushman Bharat (PM-JAY) card help eligible patients get cashless cataract treatment at an empanelled hospital. This can reduce the financial burden of cataract surgery, provided the hospital offers the approved cataract treatment package and the patient meets the scheme's eligibility requirements.

What are the benefits of using an Ayushman Bharat Card for cataract surgery?

• Cashless treatment: If your treatment is approved under PM-JAY, you generally do not have to pay separately for the services included in the approved package.
• Coverage for cataract surgery: Cataract surgery may be covered when medically required and performed under an approved package at an eligible empanelled hospital.
• Eye examination and tests: Required examinations and investigations may be included in the approved package, depending on the package rules.
• Operation and hospital charges: Eligible costs such as the surgeon's fee, operation theatre and other included hospital services may be covered under the package.
• Intraocular lens (IOL): The lens used during cataract surgery is generally part of the approved treatment package, subject to its specifications. Premium lenses, such as multifocal, trifocal or toric lenses, may not be covered in the same way as standard lenses.
• Medicines and follow-up: Medicines, tests and follow-up services may be covered when they are included in the approved package. Confirm the exact inclusions with the hospital before treatment.
• Annual health cover: PM-JAY provides eligible families with health cover of up to ₹5 lakh per year for covered hospital treatment. This is the overall family cover, not a guaranteed amount for cataract surgery.

Which cataract surgery services are covered?

The exact services depend on the approved PM-JAY package and the hospital. The hospital's Ayushman help desk can confirm whether the following are included

• Pre-surgery eye examination and medically required tests.
• Cataract removal using an approved surgical technique.
• Standard intraocular lens implantation, as specified in the package.
• Eligible hospital, surgeon and operation theatre charges.
• Medicines and post-operative care included in the approved package.

Important: Do not assume that every type of lens, every diagnostic test or every additional service is covered. If you want a premium lens such as a multifocal, trifocal or Alcon PanOptix lens, ask the hospital whether it is covered under PM-JAY or would involve additional payment. Confirm the rules before agreeing to any extra charge.

How to Check Ayushman empanelled hospital?

1. Open the official Ayushman Bharat Empanelled Hospital Search Portal.
2. Select your state.
3. Select your district.
4. View the list of empanelled hospitals in your district.
5. Select the hospital type, such as Government or Private.
6. Choose the relevant specialty, such as Ophthalmology, if available.
7. Search for the exact hospital name.
8. Enter the captcha displayed on the screen.
9. Click on Search.
10. Check whether the hospital's empanelment is active. Contact its Ayushman help desk to confirm that cataract surgery is available under an approved package and ask whether prior approval is required.

Which documents should you carry?

• Ayushman Bharat Card, if available.
• Aadhaar Card or another valid photo ID.
• Doctor's prescription and eye examination reports.
• Previous eye treatment records, if available.
• Blood test or other investigation reports, if required.
• Referral letter, if applicable.

What should you do before getting cataract surgery?

1. Visit an eye specialist to confirm the cataract and discuss the suitable lens.
2. Check your eligibility for PM-JAY and visit an actively empanelled hospital.
3. Show your Ayushman Card and medical reports at the hospital's Ayushman help desk before surgery.
4. Ask for confirmation of the approved package, lens type, included services and any possible out-of-pocket expenses.
5. Proceed after the hospital confirms the coverage and completes any required approval.

Please share your state and district, and, if you have a particular hospital in mind, its name. We can help you understand how to check the hospital's empanelment and cataract treatment availability under Ayushman Bharat.

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