Can Ayushman Bharat PM-JAY Cover a Shoulder MRI for Rotator Cuff Injury?

Hello,

Yes, an MRI is covered under PM-JAY when it is medically required as part of an approved inpatient treatment package ( IPD?) . However, a standalone MRI done only as an OPD diagnostic test is generally not covered in the same way as a packaged hospitalization.

Since your doctor has already advised an MRI for your rotator cuff problem, you should first check whether the hospital is empanelled or not

How to check a PM-JAY hospital

Go to the official PM-JAY Hospital Search page.

• Select your State.
• Select your District.
• Select Government/Private under Hospital Type, if required.
• Select Orthopaedics under Speciality.
• You can also enter the Hospital Name if you already know it.
• Select the appropriate Empanelment Type, if required.
• Enter the visible Captcha.
• Click Search.
• The list of empanelled hospitals matching your selection will appear.

Documents to carry

• Ayushman Bharat PM-JAY Card
• Aadhaar Card/valid ID proof
• Doctor's prescription advising the MRI
• Previous consultation papers
• Previous X-rays or other reports
• Current medicines/prescriptions
• Any previous discharge or treatment records\

Under standard Ayushman Bharat PM-JAY, the coverage limit is ₹5 lakh per family per year this does not mean every diagnostic test is automatically free. The specific MRI and treatment must meet the applicable PM-JAY package and eligibility requirements. (Note: some states run their own top-up schemes with higher limits for example, Punjab's Mukh Mantri Sehat Yojana offers ₹10 lakh per family per year for Punjab residents. If you're in Punjab, check with your hospital's Sehat/Ayushman desk which scheme and limit applies to you.)

If your shoulder pain has suddenly become severe, you have significant weakness, inability to lift the arm, swelling, numbness, or a recent injury, seek an orthopaedic evaluation promptly

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