List of Diseases Covered Under Ayushman Bharat (PM-JAY)

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is one of India's major government health assurance schemes for eligible beneficiaries. It provides cashless hospitalization benefits for a wide range of approved medical and surgical treatments at empanelled hospitals.

One important point to understand is that Ayushman Bharat does not work as a simple list of diseases where every case automatically becomes free. The National Health Authority (NHA) defines treatment packages and procedures under different medical specialties. Whether a particular treatment is covered depends on the applicable package, beneficiary eligibility, hospital empanelment, and scheme rules.

For patients searching for the diseases covered under Ayushman Bharat, this guide explains the major treatment categories, common procedures, exclusions, pre-existing conditions, and how to verify coverage before hospitalization. If you'd like expert guidance on your eligibility, you can book free appointment in Delhi before planning your treatment.

Table of Contents

1. How the Ayushman Bharat Disease List Works

2. Major Diseases and Treatments Covered Under PM-JAY

3. Cardiology and Heart Treatment

4. Cancer Treatment

5. Neurology and Neurosurgery

6. Orthopaedic Treatment

7. Kidney and Urology Treatment

8. Gastroenterology and General Surgery

9. Eye and ENT Treatment

10. Gynaecology and Maternal Care

11. Child and Newborn Treatment

12. Burns and Reconstructive Surgery

13. Mental Healthcare

14. Infectious Diseases

15. Are Pre-Existing Diseases Covered?

16. What Is Not Covered?

17. How to Check Whether Your Treatment Is Covered

18. Frequently Asked Questions

19. Conclusion

How the Ayushman Bharat Disease List Works

The Ayushman Card does not contain a complete list of every disease or procedure covered by the scheme.

Instead, PM-JAY uses defined health benefit packages that include specific medical and surgical procedures across different specialties.

When an eligible patient requires hospitalization for a covered treatment, the empanelled hospital identifies the applicable package and follows the required authorization and claim process.

This means you generally do not need to know the package code yourself. The hospital's Ayushman Bharat help desk can check whether your particular diagnosis or procedure falls under an applicable package.

Because treatment packages and implementation rules can change, patients should verify the current status of a specific procedure before planned admission.

Major Diseases and Treatments Covered Under PM-JAY

PM-JAY provides coverage across a broad range of specialties and treatment categories.

Common areas include:

• Cardiology
• Oncology
• Neurology and neurosurgery
• Orthopaedics
• Urology and kidney care
• General surgery
• Gastroenterology
• Ophthalmology
• ENT
• Gynaecology
• Maternal and child healthcare
• Burns and reconstructive surgery
• Infectious diseases
• Mental healthcare
• Other approved medical and surgical specialties

The exact procedures available can depend on the applicable PM-JAY package and state-level implementation.

Cardiology and Heart Treatment

Heart-related hospitalization can be expensive, which makes PM-JAY coverage particularly important for eligible patients.

Depending on applicable packages, cardiac treatment may include procedures such as:

• Coronary angioplasty
• Cardiac procedures
• Coronary artery bypass surgery
• Valve-related procedures
• Treatment for certain serious cardiovascular conditions

Patients experiencing symptoms such as severe chest pain, breathlessness, sweating, or sudden weakness should seek emergency medical attention rather than waiting for scheme verification.

Cancer Treatment Under Ayushman Bharat

Cancer care is an important part of PM-JAY's secondary and tertiary healthcare coverage.

Depending on the approved package, coverage may include:

• Cancer surgery
• Chemotherapy
• Radiotherapy
• Oncology-related hospitalization
• Supportive treatment associated with covered packages

Coverage depends on the specific cancer treatment and applicable package.

Patients should confirm the exact treatment package with the hospital's Ayushman desk before beginning planned treatment.

Neurology and Neurosurgery

PM-JAY includes approved treatments for several neurological and neurosurgical conditions requiring hospitalization.

Depending on applicable packages, this area may include treatment related to:

• Stroke
• Certain brain conditions
• Brain tumours
• Selected neurosurgical procedures
• Certain neurological emergencies
• Other approved neurological conditions

Not every neurological consultation or investigation is automatically covered. The treatment must fall under an applicable package.

Orthopaedic Treatment

Orthopaedic care is another major treatment category under Ayushman Bharat.

Depending on the applicable package, treatment may include:

• Fracture management
• Trauma treatment
• Selected joint replacement procedures
• Knee replacement
• Hip replacement
• Orthopaedic surgeries
• Treatment of certain ligament and joint conditions

For planned surgery, patients should confirm whether the specific procedure and hospital are currently covered under the applicable scheme package.

Kidney and Urology Treatment

Kidney and urinary system conditions can require expensive procedures and hospitalization.

Depending on the applicable package, PM-JAY may cover treatments such as:

• Kidney stone procedures
• Dialysis-related care
• Urological surgeries
• Treatment of certain kidney conditions
• Selected renal procedures

The exact coverage depends on the approved package and clinical requirements.

Gastroenterology and General Surgery

Several commonly treated surgical conditions fall within general surgery and gastrointestinal care.

Depending on applicable packages, this may include:

Gallbladder Stones

Selected surgical treatment for gallstones may be covered when the procedure meets the applicable package requirements.

Hernia

Certain hernia repair procedures may be covered under approved surgical packages.

Appendicitis

Hospitalization and surgical treatment for eligible appendicitis cases may be covered.

Piles

Certain surgical procedures for piles may be covered under applicable packages.

Other Digestive Conditions

Selected gastrointestinal and digestive conditions requiring hospitalization may also have applicable treatment packages.

Always confirm the exact procedure before admission because coverage is package-specific.

Eye and ENT Treatment

PM-JAY also includes approved treatments in ophthalmology and ENT.

Depending on applicable packages, treatment may include:

• Cataract surgery
• Selected glaucoma procedures
• Certain retinal procedures
• ENT surgeries
• Treatment for selected ear, nose, and throat conditions

Routine eye or ENT consultations should not automatically be assumed to be covered simply because the hospital is empanelled.

Gynaecology and Maternal Care

Maternal healthcare and selected gynaecological treatments are included within the broader PM-JAY treatment framework.

Depending on applicable packages, this may include:

• Delivery-related hospitalization
• Caesarean section
• Selected gynaecological procedures
• Treatment of certain pregnancy-related complications
• Newborn care for eligible conditions

The exact coverage depends on the applicable package and beneficiary circumstances.

Child and Newborn Treatment

PM-JAY also provides treatment packages for eligible children and newborns requiring hospitalization.

Depending on applicable packages, this can include treatment for certain:

• Birth-related complications
• Surgical conditions
• Serious illnesses
• Neonatal conditions
• Paediatric medical conditions

Parents should confirm the applicable package with the hospital before planned treatment.

Burns and Reconstructive Surgery

Serious burns can require prolonged hospitalization, surgery, wound management, and rehabilitation.

Approved PM-JAY packages may cover certain treatments related to:

• Severe burns
• Burn-related hospitalization
• Surgical management
• Selected reconstructive procedures
• Post-burn contracture correction

Coverage depends on the specific condition and applicable package.

Mental Healthcare Under Ayushman Bharat

Mental healthcare has become an increasingly important part of India's healthcare system.

Certain mental health services and hospitalization-related treatments may be covered under applicable government health benefit packages.

However, patients should verify the specific mental health service or treatment with the empanelled hospital because coverage is not necessarily the same for every consultation or outpatient service.

Infectious Diseases

Certain infectious diseases requiring hospitalization can fall under approved treatment packages.

Depending on the applicable package, this may include treatment related to serious infections and selected infectious diseases.

Examples may include conditions such as:

• Tuberculosis
• Malaria
• Serious bacterial infections
• Other approved infectious conditions

The specific diagnosis and treatment package determine eligibility for coverage.

Are Pre-Existing Diseases Covered Under PM-JAY?

Yes. One of the important features of PM-JAY is that pre-existing conditions are covered from the beginning of coverage, subject to the applicable scheme and treatment package rules.

This can be particularly relevant for people living with chronic conditions such as:

• Diabetes
• Hypertension
• Heart disease
• Kidney disease
• Other long-term medical conditions

However, having a pre-existing disease does not mean that every consultation, test, or treatment related to that disease is automatically free. The specific hospitalization or procedure must fall within an applicable PM-JAY package.

What Is Not Covered Under Ayushman Bharat?

Understanding exclusions is just as important as knowing what is covered.

PM-JAY is primarily focused on eligible secondary and tertiary hospitalization, rather than unlimited healthcare expenses.

Depending on the applicable rules, services that may not be covered include:

• Routine OPD consultations
• Medicines purchased outside covered hospitalization
• Cosmetic or purely aesthetic procedures
• Treatments outside approved packages
• Certain fertility treatments
• Services that do not meet the package requirements

The exact exclusions can depend on the applicable scheme rules and package.

Therefore, do not assume that an Ayushman Card makes every hospital service free.

Does Ayushman Bharat Cover Every Surgery?

No.

A hospital being empanelled does not mean that every surgery performed there is automatically covered.

For a planned procedure, three important things should be checked:

• Beneficiary eligibility
• Whether the procedure has an applicable PM-JAY package
• Whether the hospital is authorized to provide that package

The hospital's Ayushman help desk can help verify these details before admission.

How to Check Whether Your Disease or Treatment Is Covered

If you are unsure whether your condition is covered, don't rely only on a general online disease list.

You can:

Check Your PM-JAY Eligibility

Use the official PM-JAY beneficiary services or Ayushman-related government platforms to verify your beneficiary status.

Ask an Empanelled Hospital

Visit the hospital's Ayushman Bharat help desk and provide your relevant identification and medical documents.

Confirm the Specific Procedure

Ask whether your exact surgery, procedure, or hospitalization is available under an applicable PM-JAY package.

Carry Your Medical Reports

Previous prescriptions, diagnostic reports, scans, and doctor's recommendations can help the hospital understand your treatment requirement.

What Should You Confirm Before Admission?

Before planned hospitalization, ask the Ayushman help desk:

• Is my Ayushman eligibility active?
• Is this hospital currently empanelled?
• Is my specific treatment covered?
• Which PM-JAY package applies?
• Is prior authorization required?
• What documents should I bring?
• Are there any expenses that are not included in the package?

Getting these details in advance can reduce confusion during admission.

Final Takeaway

The diseases covered under Ayushman Bharat span a wide range of medical and surgical specialties, including heart disease, cancer, neurological conditions, orthopaedic problems, kidney and urological conditions, gastrointestinal disorders, eye and ENT conditions, maternal and child healthcare, burns, and other approved treatments.

However, the most important thing to remember is that having an Ayushman Card does not automatically make every disease, test, consultation, or surgery free. PM-JAY works through defined treatment packages, beneficiary eligibility requirements, empanelled hospitals, and applicable government rules.

If you are planning treatment, verify your Ayushman eligibility and the exact treatment package before admission. This is the safest way to understand whether your particular disease or surgery can be treated cashlessly under PM-JAY. You can also book free appointment in Delhi to get expert help with your eligibility and treatment planning.