What Benefits Are Available to Hemodialysis Patients Under the Ayushman Bharat Scheme in West Bengal?

Dear Sayan Bhattacharyya ji,

Under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), eligible hemodialysis patients in West Bengal receive cashless treatment at empanelled hospitals. The scheme provides financial support for eligible hospital treatments, subject to the applicable package rules and patient eligibility.

West Bengal has had its own state health scheme, Swasthya Sathi. Please check the patient's current eligibility and the applicable scheme with the hospital or official helpline before relying on coverage under AB PM-JAY.

Key Benefits for Hemodialysis Patients

• Annual financial coverage: Eligible families receive coverage of up to ₹5 lakh per family per year under PM-JAY, on a family-floater basis, for covered secondary and tertiary hospital care.
• Cashless dialysis: Hemodialysis is covered at an empanelled hospital when the patient is eligible and the treatment meets the applicable package rules. The hospital submits the approved claim under the scheme.
• Pre-existing conditions: Eligible pre-existing conditions are covered from day one under PM-JAY. The patient must still meet the scheme's eligibility requirements.
• Related treatment expenses: Covered package costs include applicable medicines, diagnostic tests and nursing care. Pre- and post-hospitalisation coverage is subject to scheme rules and the treatment package.
• Related procedures: Procedures such as AV fistula or AV shunt creation is covered when the applicable package and eligibility requirements are met.
• Portability across India: Eligible beneficiaries can generally use PM-JAY benefits at participating empanelled hospitals across India, subject to the applicable package and scheme rules.

Important Rules for Hemodialysis Sessions

The following operational rules have been reported for dialysis under PM-JAY. Patients should check the current requirements with the hospital's Ayushman help desk because implementation rules may change.

• Pre-authorisation: Dialysis approvals be issued in cycles, with renewal required when the approved cycle limit is reached. The provided information mentions six cycles per pre-authorisation block.
• Biometric attendance: Patients need to complete biometric authentication at the start and end of each session.
• Session duration: The provided information mentions a maximum four-hour period between entry and exit biometric authentication.

How to Check Eligibility and Find a Dialysis Hospital

• Check the patient's eligibility and Ayushman card status through the official PM-JAY beneficiary services.
• Find a hospital that is currently empanelled for the required dialysis package.
• Before starting treatment, check with the hospital's Ayushman help desk whether the patient's dialysis sessions are approved for cashless treatment.

How to Check Ayushman empanelled hospital?

Follow these steps to find a hospital that offers dialysis under Ayushman Bharat

1. Open the official hospital search website: Ayushman Empanelled Hospital Search.
2. Select West Bengal as your state.
3. Select your district.
4. View the list of empanelled hospitals in your district.
5. Select Government or Private under hospital type.
6. Choose Nephrology, Dialysis or the relevant specialty, if available.
7. Select the hospital name, if the option is available.
8. Enter the captcha code shown on the screen.
9. Click Search to see the matching hospitals.
10. Check with the hospital's Ayushman help desk that its empanelment is active, hemodialysis is available under the scheme, and the patient's eligibility and treatment approval are in place.

Documents required for hemodialysis

• Ayushman Bharat card, if already issued.
• Aadhaar card or another valid identity document.
• Kidney function test reports, such as creatinine and eGFR, if available.
• Doctor's prescription and advice for hemodialysis.
• Previous dialysis records and treatment history.
• Hospital admission papers, discharge summary or other medical reports, if applicable.
• Any additional documents required by the hospital to verify eligibility and obtain approval.

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