Are dental treatments covered under PMJAY scheme?

Hello,

Yes, but only certain dental and oral-maxillofacial procedures can be covered under Ayushman Bharat PM-JAY. Routine dental treatment is generally not covered.

The official PM-JAY package list includes certain Oral & Maxillofacial Surgery procedures, such as some jaw tumour surgeries, treatment of oral submucous fibrosis, apicoectomy and correction of oro-antral communication. 

However, routine treatments such as dental fillings, root canal treatment and corrective/cosmetic dental procedures are generally excluded unless they arise from a disease or injury and require hospitalisation. 

What Dental Treatments Be Covered?

Coverage depends on the exact medical condition and package. For example, PM-JAY has listed certain procedures under Oral & Maxillofacial Surgery, including

• Certain jaw tumour/cancer surgeries

• Oral submucous fibrosis surgery

• Apicoectomy in eligible cases

• Correction of oro-antral communication

• Other specifically listed oral and maxillofacial procedures

So, you should not assume that every dental operation will be free with an Ayushman Card.

How to Check Whether Your Dental Surgery Is Covered

Follow these steps before planning the treatment

1. Check whether you are an eligible PM-JAY beneficiary.

2. Search for a currently empanelled PM-JAY hospital in your State and District.

3. Check whether the hospital provides Oral & Maxillofacial Surgery/Dental Procedures under PM-JAY.

4. Show your dental reports and doctor's prescription to the hospital's Ayushman Mitra.

5. Tell them the exact name of the dental surgery advised.

6. Ask whether that specific procedure has an applicable PM-JAY package.

7. Confirm whether pre-authorisation is required.

8. Confirm that the treatment will be cashless under the approved package before admission.

Documents to Carry

Take these documents to the Ayushman hospital

• Ayushman Bharat Card / e-Ayushman Card

• Aadhaar Card or valid government ID

• Dentist/Oral & Maxillofacial Surgeon prescription

• Dental X-ray/OPG/CT scan, if available

• Blood test reports, if available

• Previous treatment records

• Previous discharge summary, if available

• Any biopsy/pathology report, if applicable

• Current medication list

If the treatment is for a simple cavity, routine root canal, filling, cosmetic dental work or another outpatient dental procedure, it generally will not be covered under PM-JAY. 

If you tell us the exact dental problem and surgery advised, along with your city , We can guide you on what to check before admission.

We can help you connect with suitable doctors at partner hospitals and assist with consultation and treatment coordination.

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