Does Ayushman Bharat Cover Diabetes Treatment?

Dear Vijay Gupta ji,

Yes, diabetes is covered under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY). Diabetes is considered a pre-existing disease, so eligible beneficiaries can receive treatment from day one without any waiting period.

However, PM-JAY mainly covers hospitalisation (IPD) and approved day-care treatments. Routine OPD consultations and regular diabetes medicines taken at home are generally not covered.

What Diabetes Treatment Is Covered?

If diabetes leads to serious health complications requiring hospital admission, PM-JAY cover

• Hospitalisation for uncontrolled diabetes.

• Diabetic ketoacidosis (DKA) or severe low blood sugar (Hypoglycaemia).

• Treatment for diabetic foot ulcers or infections.

• Surgery related to diabetic complications, if medically required.

• Kidney complications caused by diabetes, including dialysis (where applicable).

• Heart-related procedures such as angioplasty or bypass surgery due to diabetes-related heart disease.

• ICU care, medicines, diagnostic tests, doctor fees, and nursing charges during hospitalisation.

• Pre-hospitalisation and post-hospitalisation expenses as per PM-JAY guidelines.

What Is Generally Not Covered?

The following are usually not covered under PM-JAY when taken as routine outpatient (OPD) services

• Regular diabetes check-ups.

• OPD consultation fees.

• Daily insulin or oral diabetes medicines for home use.

• Routine blood sugar monitoring tests done without hospital admission.

How to Avail Diabetes Treatment Under PM-JAY

• Visit a PM-JAY empanelled hospital.

• Meet the Ayushman Mitra at the help desk.

• Submit your Ayushman Card and Aadhaar Card.

• The doctor will examine your condition.

• If hospitalisation is required, the hospital will obtain pre-authorisation.

• Once approved, eligible treatment will be provided cashlessly.

Documents You Need

Keep the following documents ready:

• Ayushman Card.

• Aadhaar Card.

• Doctor's prescription.

• Previous medical records.

• Blood sugar reports and other investigation reports, if available.

• Hospital referral (if applicable).

How to Check Whether the Hospital Accepts Ayushman Bharat (PM-JAY)?

Before taking treatment, verify that the hospital is empanelled under PM-JAY.

Online Verification

• Visit the PM-JAY Hospital Finder.

• Select:

  • State

  • District

  • Hospital Name (or Specialty)

• Click Search.

• Confirm that the hospital is PM-JAY empanelled.

How HexaHealth Can Assist You

• Ayushman Bharat Guidance: We help you understand PM-JAY eligibility and diabetes treatment coverage.

• Doctor Consultation: We help connect you with experienced diabetologists, endocrinologists, and physicians.

• Hospital Selection: We help you find PM-JAY empanelled and HexaHealth partner hospitals near your location.

• Treatment Guidance: We explain available treatment options, possible complications, and when hospitalisation may be required.

• Documentation Support: We guide you with the documents required for PM-JAY verification and pre-authorisation.

• Appointment Assistance: We help coordinate specialist consultations and hospital appointments.

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