Ayushman Bharat – PM‑JAY provides up to ₹5 lakh per family per year for secondary and tertiary hospitalization care. But not everything is covered under this scheme. Knowing the exclusions helps you plan your healthcare and avoid unexpected costs.

1. Outpatient & Routine doctor Visits

Unlike full health insurance, Ayushman Yojana doesn’t cover OPD treatments — meaning:

Regular doctor consultations

Routine check‑ups

Diagnostic tests done outside of hospitalization

Medications taken without hospital admission

If your treatment doesn’t require hospital admission, it typically won’t be covered under the scheme.

2. General Diagnostic Investigations

Standalone scans and tests like MRI, CT scan, X‑rays, blood tests, etc., when done just for evaluation or check‑ups, are generally not covered unless they are part of an inpatient package.

3. Dental Treatments

Standard dental care — such as:

Root canal therapy

Cavity filling

Tooth extraction

Dental implants

Treatment of gum diseases

are not covered under Ayushman Bharat unless the procedure is required due to trauma, tumors, or conditions requiring hospitalization.

Note: Regular dental care remains an exclusion.

4. Infertility & Fertility Procedures

Treatments related to infertility — including IVF (In Vitro Fertilization) and other assisted reproductive technologies — are not covered under the standard benefit package unless they are specifically included.

5. Vaccinations Outside National Programmes

Routine or non‑essential vaccines and immunizations that are not part of the national immunization schedule are excluded — meaning you may need to pay out of pocket for these.

6. Cosmetic & Aesthetic Procedures

Ayushman Yojana primarily covers medically necessary treatments. Thus, cosmetic surgeries and beauty enhancements like:

Liposuction

Rhinoplasty

Neck lifts

Tattoo removal

Anti‑aging procedures

are not included under PM‑JAY coverage.

7. Circumcision (Infants under 2 for Non‑medical Reasons)

Circumcision performed for religious or personal reasons is not covered under the scheme. It may be covered only if it’s medically necessary due to illness or injury.

8. Persistent Vegetative State

Care for patients in a persistent vegetative state — maintained on life support without cognitive response — is excluded from Ayushman Bharat.

9. Non‑Allopathic & Alternative Treatments

Treatments under alternative systems such as Ayurveda, Homeopathy, Unani, Siddha, or yoga — unless specified as part of an inpatient care package — are usually not covered under the standard Ayushman Bharat benefit package.

10. Elective or Experimental Treatments

Marginal, experimental, or non‑standard therapies that are not recognized in the health benefits package are typically not reimbursed under Ayushman Yojana.

Important Takeaway

✅ The Ayushman Bharat – PM‑JAY scheme focuses on serious, hospitalization‑level care and catastrophic health expenses. Routine treatments, lifestyle procedures, and cosmetic or outpatient services are excluded to keep the program sustainable while prioritizing critical healthcare needs.

📌 Tip: If you’re planning a treatment and are unsure whether it’s covered, always check with your hospital or Ayushman Mitra before admission, and review the National health Benefit Package on the official Ayushman Bharat website.

 

Disclaimer:

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of any agency, organization, employer, or company. All information provided is for general informational purposes only. While every effort has been made to ensure accuracy, we make no representations or warranties of any kind, express or implied, about the completeness, reliability, or suitability of the information contained herein. Readers are advised to verify facts and seek professional advice where necessary. Any reliance placed on such information is strictly at the reader’s own risk.