Which Government Schemes Cover Laser Eye Treatment in India?

Hello,

Yes, some laser eye treatments is covered under government health schemes in India when they are medically necessary and included in the scheme's approved treatment packages.

For example, the official Ayushman Bharat PM-JAY package list includes treatments such as glaucoma surgery and retinal laser photocoagulation. It also includes procedures such as retinal cryopexy and vitreoretinal surgery.

However, coverage depends on the exact eye condition and treatment. A person should not assume that every type of laser eye procedure is free under a government health scheme.

Is LASIK for removing glasses covered?

Routine LASIK done only to reduce dependence on glasses is generally not covered under PM-JAY because cosmetic or lifestyle treatments are excluded.

Which eye laser treatments be covered?

Depending on the scheme and applicable package, medically necessary procedures can include :

• Laser treatment for certain retinal conditions

• Retinal laser photocoagulation

• Certain glaucoma procedures

• Treatment for diabetic eye complications when an approved package applies

• Other approved retinal or eye procedures

The exact procedure and package must be confirmed with the hospital's scheme desk.

What about CGHS and ECHS?

CGHS and ECHS have their own rules, approved rates, empanelled hospitals, and eligibility conditions. ECHS provides cashless medical care through its network of government and empanelled private hospitals, but the exact procedure and coverage should be checked under the applicable ECHS rules.

ECHS also continues to publish updated hospital empanelment and treatment-related circulars, so current eligibility should be checked before treatment.

What should you do to check the coverage?

First, identify exactly why the doctor has advised laser treatment. For example, there is a major difference between laser treatment for weak eyesight and laser treatment for diabetic retinopathy or a retinal tear.

If you have an Ayushman card :

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

2. Select your state.

3. Select your district.

4. Select a government or private hospital.

5. Select ophthalmology.

6. You can check the list of empanelled hospitals in your district.

7. Search for the hospital you want to visit.

8. Check that its PM-JAY empanelment is active.

9. Visit the hospital's Ayushman Mitra or PM-JAY desk.

10. Give them the eye doctor's prescription and diagnosis and ask whether your exact laser procedure is covered and whether pre-authorisation is required.

PM-JAY benefits are provided through defined health benefit packages, so the exact procedure matters.

Which documents should you keep ready?

• Ayushman card or other government health-scheme card

• Aadhaar card, if required for verification

• Eye doctor's prescription

• Eye examination reports

• OCT or retinal scan, if available

• Previous treatment records

• Diabetes reports, if the laser treatment is related to diabetic eye disease

• Previous hospital records, if available

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