How Much Coverage Is Available Under the Ayushman Card for Liver Disease Treatment?

Hello,

Yes, liver disease treatment is covered under Ayushman Bharat PM-JAY.

How much coverage is available?

Eligible families can receive up to ₹5 lakh per family per year for covered secondary and tertiary hospitalisation at empanelled hospitals. The amount is not given to the patient as cash; the approved treatment is paid to the empanelled hospital according to PM-JAY rules. 

Liver-related treatment is covered when the required procedure is included in the applicable PM-JAY package. Depending on the condition, treatment can involve medicines, investigations, hospitalisation, procedures or surgery.

The scheme also provides, for covered hospitalisation, up to 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses such as diagnostics and medicines. 

What can be covered?

Depending on the approved package and medical requirement, the coverage can include :

• Doctor consultation related to the hospitalisation

• Diagnostic tests

• Medicines and medical consumables

• Hospital bed and nursing charges

• Operation theatre charges

• ICU care where applicable

• Implants, where required under the package

• Treatment of complications during the covered hospitalisation

• Post-hospitalisation follow-up covered under the scheme

What about liver transplant?

A liver transplant is a highly specialised treatment, and you should not assume that the complete transplant cost will automatically be covered up to ₹5 lakh. Coverage depends on the applicable PM-JAY package and the rules of the relevant state and hospital. The hospital's Ayushman desk should confirm the exact package and approval before treatment.

What is generally not covered?

Standalone OPD consultation and treatment are generally not covered under PM-JAY. Covered benefits are primarily for listed hospitalisation packages.

Steps to check an Ayushman hospital

1. Open the official Ayushman Bharat PM-JAY hospital search.

2. Select your State.

3. Select your District.

4. Choose Government Hospital or Private Hospital.

5. Select the relevant specialty, such as Gastroenterology or the specialty related to your treatment.

6. Select or enter the hospital name, if you have a particular hospital in mind.

7. Complete the captcha, if shown.

8. Click Search.

9. Check that the hospital is currently empanelled under PM-JAY.

10. You can also check overall empanelled list of hospital of your district.

11. Before admission, ask the hospital's Ayushman Mitra to confirm whether your exact liver treatment or procedure is covered and whether the required approval has been obtained.

Documents to carry

• Ayushman Bharat PM-JAY card

• Aadhaar card or accepted identity proof

• Mobile number

• Doctor's prescription

• Liver function test reports

• Ultrasound, CT or MRI reports, if available

• Previous medical reports and prescriptions

• Biopsy or other specialist reports, if applicable

• Previous discharge summary, if any

• Details of current medicines

For a planned procedure, the hospital also require medical documents for pre-authorisation before treatment.

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