Are ICU Charges Covered Under the Ayushman Bharat PM-JAY Scheme?

Hello,

Yes, ICU charges can be covered under Ayushman Bharat PM-JAY, provided the patient is eligible for the scheme, the hospital is actively empanelled and the ICU stay is medically required under an approved treatment package.

Under PM-JAY, eligible beneficiaries can receive cashless treatment of up to ₹5 lakh per family per year, subject to scheme rules. ICU charges are generally included in the approved treatment package rather than paid as a separate daily ICU allowance.

What ICU Expenses Can Be Covered?

Depending on the approved treatment package and medical requirement, coverage include

• ICU bed and nursing charges.
• Ventilator and oxygen support, if medically required.
• Monitoring of heart rate, blood pressure and other vital signs.
• Doctor and specialist fees.
• Required medicines, injections and medical consumables.
• Necessary blood tests, X-rays and other investigations.

Important Conditions for ICU Coverage

• Eligible patient: The patient must be eligible under the Ayushman Bharat scheme.
• Empanelled hospital: Treatment must be provided at a hospital with active PM-JAY empanelment.
• Approved treatment package: The patient's medical condition must come under an approved PM-JAY package that includes the required ICU care.
• Medical approval: The hospital's Ayushman Mitra desk must complete the required approval process, including pre-authorisation wherever applicable.

Simply getting admitted to an ICU does not guarantee cashless coverage. Not every ICU admission or hospital charge is automatically covered. The exact coverage depends on the approved package and scheme rules.

How to Check Ayushman Empanelled Hospital?

Follow these simple steps to find a hospital that accepts Ayushman Bharat

1. Visit the official government portal: Ayushman Empanelled Hospital Search.
2. Select your state.
3. Select your district.
4. Choose Government or Private hospital, if the option is available.
5. Select the speciality related to the patient's medical condition, if available.
6. Enter the hospital name, or view the hospitals listed in your district.
7. Enter the captcha and click on Search.
8. Check whether the hospital's PM-JAY empanelment is currently active.
9. Contact the hospital's Ayushman Mitra desk and check whether the required treatment package includes ICU care and whether cashless approval is possible.

You can also check overall empanelled list of hospitals in your district.

Documents Required for Ayushman ICU Treatment

• Valid Ayushman card of the patient.
• Aadhaar card or another valid government photo ID.
• Ration card or family eligibility documents, if required.
• Doctor's prescription and admission advice.
• Previous medical reports and investigation results.
• ECG, scan reports or other relevant test reports, depending on the condition.
• Previous hospital discharge summary, if available.
• Current medicines and treatment details.

How to Get Cashless ICU Treatment?

1. Visit an empanelled hospital and approach the Ayushman Mitra help desk.
2. Show the patient's Ayushman card and medical reports.
3. The hospital will check the patient's eligibility and required treatment package.
4. The hospital will submit the necessary documents for approval, wherever required.
5. Once the treatment is approved under the scheme, eligible expenses can be covered on a cashless basis as per PM-JAY rules.

Please share your city, state and the medical condition for which the patient needs ICU admission. We can help you find a suitable partner hospital and guide you on checking the required Ayushman treatment facility.

If the patient is having a medical emergency, please go to the nearest emergency department immediately. Do not delay urgent treatment while checking hospital empanelment.

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