Does the Ayushman Bharat Card Cover ICU Admission Charges?

Hello,

Yes, ICU treatment can be covered under the Ayushman Bharat PM-JAY scheme when the patient is eligible, the hospital is PM-JAY empanelled, and the patient's condition falls under a covered treatment package that allows ICU care. The National Health Authority states that PM-JAY packages can include intensive-care services and ICU charges. 

However, simply being admitted to an ICU does not mean that every ICU expense is automatically covered. ICU admission must be medically required and linked to an eligible PM-JAY package. NHA also specifically states that ICU admission is allowed for specified packages.

What Should You Do?

1. Take the patient's Ayushman Bharat Card/e-Ayushman Card and Aadhaar or valid ID.

2. Go to the Ayushman desk/Ayushman Mitra at the empanelled hospital.

3. Ask them to verify the patient's PM-JAY eligibility.

4. Provide the doctor's prescription, medical reports and previous treatment records, if available.

5. Ask the hospital to confirm the applicable PM-JAY package and whether ICU care is included.

6. Confirm the cashless treatment process before admission, whenever the patient's condition allows.

If the patient is already seriously ill or has been advised immediate ICU admission, do not delay emergency treatment just to complete paperwork. PM-JAY has provisions for emergency cases, with beneficiary identification requirements to be completed as applicable.

How to Check Ayushman Coverage Before Going to the Hospital

Before visiting the hospital, follow these steps to confirm whether Ayushman Bharat PM-JAY benefits are available

1. Open the official PM-JAY hospital search portal

2. Select the state.

3. Select the district.

4. Enter and search for the exact hospital name.

5. Check whether the hospital's PM-JAY empanelment status is currently active.

6. Check whether the required speciality/package, is available under PM-JAY.

7. Contact the hospital's Ayushman/PM-JAY help desk before admission.

8. Confirm the required documents, eligibility, and whether the specific treatment or procedure is covered under your Ayushman card.

This verification can help avoid confusion regarding Ayushman coverage at the time of admission.

Documents to Carry

• Ayushman Bharat Card / e-Ayushman Card

• Aadhaar Card or valid ID proof

• Patient's medical reports

• Doctor's prescription

• Previous treatment records

• Previous discharge summary, if available

• Recent blood test reports, if available

The exact coverage depends on the patient's diagnosis, applicable package and the hospital's current PM-JAY empanelment.

We can help you identify suitable partner hospitals and assist with doctor consultation and treatment coordination.

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