Can Ayushman Card Cover Emergency Treatment Expenses at a Non-Empanelled Private Hospital After an Accident?

Hello,

Generally, you cannot claim reimbursement under the Ayushman Bharat PM-JAY scheme for treatment received at a non-empanelled private hospital. PM-JAY cashless treatment is normally available only at empanelled hospitals for approved treatment packages.

However, because the patient was admitted due to an accident and required emergency treatment, you should contact the hospital and the PM-JAY helpline to confirm whether any exception or other assistance applies to your case. Do not assume that the expenses will be reimbursed automatically.

What should you do now?

1. Keep all hospital bills, payment receipts, prescriptions, medical reports and the discharge summary.
2. Keep the accident-related documents, such as the medico-legal case (MLC) papers or police report, if available.
3. Contact the official PM-JAY helpline at 14555 and explain that the patient was admitted to a non-empanelled private hospital for emergency accident treatment.
4. Ask whether any reimbursement provision or other applicable assistance is available for your specific case.
5. If the patient still needs treatment, ask the hospital's treating doctor whether a transfer to an empanelled hospital is medically safe. Do not transfer the patient without medical advice.

What documents should you keep ready?

• Ayushman Card, if available.
• Aadhaar card or another accepted identity document.
• Hospital admission and discharge papers.
• Original bills and payment receipts.
• Doctor's prescriptions, investigation reports and treatment records.
• MLC papers or accident-related police documents, if applicable.

PM-JAY is primarily a cashless hospital-treatment scheme, not a general reimbursement policy for bills paid at any private hospital. The final decision depends on the applicable scheme rules and the details of your case. Keep all original records and obtain confirmation from the official helpline before expecting reimbursement.

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